A/79/177 I. Introduction 1. Preventing and redressing harm are aspirations that have long steered societies and their use of the law, including in the realm of health, 1 where “do no harm” has been a guiding principle for thousands of years. 2 Yet while the need for societies to steer away from harm has been straightforward, there has been less agreement on what constitutes and causes harm across time and space, as well as how to respond to it. Harm can present itself in numerous ways. Sometime s, it stems from certain behaviours or substances, other times, it stems not from the behaviours or substances themselves, but rather from how States address them (or not). In the cases of abortion, sex work, or same-sex relations, there is no actual or potential harm to start with; rather, harm is derived from State’s responses, which often take the form of criminalization. 3 However, this approach undermines public health efforts, imposing barriers to health services and worsening related health outcomes. 4 2. Colonialism has played a role in ingraining harmful norms and policies into legal systems across the world, including criminalization in circumstances such as the ones described above – one of the clearer manifestations of the looming power of States over individuals. The global dominance of corporations, largely headquartered in the global North while operating in the global South, resembles neocolonialism that contributes to spreading harm by manufacturing and commercializing harmful products, including tobacco, alcohol, unhealthy foods, and environmental harms. Against these interwoven complexities of power and resulting harms, a human rights based approach to harm reduction is crucial to show the way forward. 3. The Special Rapporteur follows the definition of harm reduction established as relating to policies, programmes and practices that aim to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws. 5 In the present report, she explores this model as applicable to drug use and to other issues that are central to sustainable peace and development, spotlighting populations that are often stigmatized, criminalized and discriminated against to the detriment of their enjoyment of human rights. In doing so, she explores what harm reduction looks like in the cases of drug use, HIV exposure, transmission, and non-disclosure, abortion, same-sex relations, and sex work, arguing that States should divest from a punitive approach, moving away from criminalization while also employing regulatory tools to improve health outcomes. For the cases of tobacco, alcohol, food and nutrition, and environmental harms, she argues that harm reduction means adequately and effectively regulating corporate actors. 4. The report builds on the well-established premise that health and human rights are mutually reinforcing frameworks, 6 meaning that a human rights approach can actively contribute to – and at the same time benefit from – public health tools such as harm reduction. 5. In harm reduction and all other realms, there is no path to sustainable peace and development without the meaningful participation of populations that face historic and ongoing forms of discrimination and marginalization, such as sex workers, women, LGBTIQA+ persons, Black people, Indigenous Peoples, migrant persons, __________________ 1 2 3 4 5 6 24-13226 Alice M. Miller and Mindy Jane Roseman, Beyond Virtue and Vice: Rethinking Human Rights and Criminal Law (University of Pennsylvania Press, 2019). World Health Organization (WHO), “Patient safety”, 11 September 2023. A/HRC/14/20, para. 5; and A/66/254, para. 21. Ibid. See https://hri.global/what-is-harm-reduction/. Jonathan Mann and others, “Health and human rights”, Health and Human Rights Journal, vol. 1, No. 1 (1994). 3/28