Early days of Harm Reduction in Liverpool

In the mid 1980s, the Mersey Health Region, which consisted of the counties of Merseyside and Cheshire in the UK, became the focus of attention because of its radical and pioneering approach to dealing with the problems connected with drug use. Most of this focused on Liverpool, the biggest city in the region. Liverpool has a proud history of public health and was the first city in the world to appoint a Medical Officer of Health in 1847.

At that time it was identified as the unhealthiest town in Britain. In the early to middle 1980s, John Ashton of the University of Liverpool, Department of Public Health, and later Mersey Regional Director of Public Health and Howard Seymour, Head of the Health Promotion of the Mersey Regional Health Authority (MRHA), had been developing the ideas of the New Model for Public Health. This brought together the old ideas of environmental change, prevention and therapeutic interventions. But they went further and recognized the importance of those social aspects of health problems, which are caused by lifestyles. In this way it seeks to avoid the trap of victim blaming.

They were interested in applying it to a then emerging public health problem, drugs and AIDS. Liverpool, actively promoting a shift towards the promotion of healthier lifestyles through its prominent involvement in the World Health Organization’s ‘Healthy Cities’ project, was one of the first two British cities to participate in the project launched in 1996. Under he leadership of John Ashton, a number of effective community-based projects aimed at creating healthier lifestyles were created.

In the mid-1980s, an influx of cheap brown heroin gave Liverpool another bad reputation as “smack city”. Other parts of the Mersey Region, including the areas of the Wirral and Bootle had similar high levels of heroin use. It was estimated that there were about 5000 heroin users in the Wirral out of a total population of about 300,000, and that there were about 20,000 drug users in the region in a population of about two and a quarter million people. Services were much as they were in the rest of the UK, with detoxification being the prevalent treatment. According to one drug worker at one Drug Dependency Unit, one person was detoxified 14 times in 12 months.

In 1985, Ashton and Seymour attended the World Health Education Conference in Dublin and met Glen Margo from San Francisco who was working on AIDS prevention. He made such an impression on them that they invited him to Liverpool to give a series of lectures to sensitize decision makers and potential activists across the community to the issue of AIDS and to present a model for organizing prevention programmes.

Extensive media coverage raised awareness in the general public of an issue that had not been taken seriously in the UK. A subsequent visit to the USA revealed a difference in approach between New York and San Francisco, the latter being a classic public health approach involving political organization, market research of groups at risk, creative use of mass media, activism, the involvement of the risk groups in programmes and community support. At the same time other key individuals—including the late Sir Donald Wilson, Chairman of the Mersey Regional Health Authority, John Marks, a psychiatrist in the region and Allan Parry, a health promotion worker found themselves in the right place at the right time. Parry was responsible for the implementation of the strategy and played a crucial role in its development. All of these factors facilitated the implementation of a harm reduction approach to drug use in the region, especially the threat of HIV through the sharing of infected injecting equipment.

This was based on public health principles that influenced the later historic recommendations of the UK’s Advisory Council on the Misuse of Drugs (ACMD) 1988 report. Services were created from 1985 involving the consumer, which gave drug users the information and the means to protect themselves, especially those drug injectors most at risk. The Mersey Harm Reduction Model was taking shape.

Pat O'Hare

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