This is a very timely question for me as I am doing some research on
harm reduction at the moment and thinking about how harm reduction fits
with what we do here.

It's great to see health promotion defined with the depth and breadth that
you give it. I do think that despite the chronic problem of people equating
prevention with health promotion, it is still a part of health promotion - a
small part but still a part.

I think harm reduction is in some respects treatment and in some respects
prevention. It overlaps both, depending on what form of harm reduction
we are talking about and the goal of the program/policy/intervention.

I don't think harm reduction contradicts health promotion at all.  To my
mind, there is a continuum of work needed in health - from health
promotion through to treatment and beyond (palliative care). Harm
reduction is a part of the continuum . I don't see it as an either/or thing -
either we do harm reduction or we do the kind of broad health promotion
work that you see that we need. For agencies that are involved in a
broad range of health-related activities I think it's possible to do both.

The issue for me in what you wrote is that staff at the agency think all
we need to do is harm reduction.  It may be people expressing their
frustration that most of the rest of the health world working on drugs/sex
issues is still focused on everything else BUT harm reduction. Clearly, as
you say, harm reduction doesn't deal with the cause of the initial
problems, but it can deal with the cause of some of the attendant
problems (i.e. the socially constructed part of those problems - no safe
place to do drugs, etc.)

The other way I think of harm reduction is in terms of good practice. Part
of health promotion is starting with where people are at, whether it's
behaviour change or community development or policy work. Harm
reduction involves meeting people where they are, rather than expecting
them to want what we want.

What do others think?