Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction

As the articles in the recent special issue on harm reduction illustrate, the last decade has seen an impressive expansion of harm reduction in public health. Policies and programs using it have dramatically improved the formerly ignored health problems of marginalized populations. This article looks at the history of harm reduction, and the growing role that the medicalization of social and political problems plays in the governance of the margins in the neo-liberal state. It describes how the acceptance of harm reduction approaches coincided with a political need to address social disorder and reduce expense in health and legal services, and criticizes the current assumption that more harm reduction services will automatically result in a more humane society. While this paper supports those authors who urge a greater political engagement from harm reduction advocates in public health, it also urges a direct political critique of the social and legal systems that create harm, and the harm reduction research that critically examines how harm reduction, while aiming to prevent harm in the short term, may sustain systems of harm in a larger sense.