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?