The Canadian Public Health Association framework for a public health approach to substance use
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This policy statement by the Canadian Public Health Association (CPHA) provides a framework for a public health approach to substance use that centres the voices of people with lived and living experience of substance use. It defines the perspective that CPHA, in collaboration with community and partners, has established as foundational to future substance use work.
Clearly defining a public health approach to substance use facilitates greater coordination of evidence-informed programs and services to address substance use and respond to the ongoing toxic drug supply. The public health approach to substance use described in the framework encompasses 10 key principles informed by a wide range of evidence and knowledge sources, including published literature, surveys, focus groups and community engagement.
These key principles (p. 7) are summarized below. A public health approach to substance use:
- respects the autonomy and right to self-determination of people who use substances
- acknowledges the spectrum of substance use and focuses on reducing potential harms and maximizing potential benefits
- uses a human rights (not a criminal justice) framework while acknowledging the historic and current harms of drug policy
- centres people with lived and living experience of substance use as experts and provides fair compensation
- supports the underlying determinants of health and addresses health inequities
- works to protect the freedom, health, wellness and safety of people who use substances
- ensures a collaborative and comprehensive range of programs and services to meet people where they are at
- is trauma and violence informed, gender transformative, anti-racist, anti-oppressive and culturally safe
- works to end stigma and discrimination
- is pragmatic and evidence informed
Although this framework does not cover all the levers that impact policies and public health response (e.g., legislative and regulatory levers are not included), it does provide a foundation for discussion and can be used to inform the development of substance use policies, programs and services.
The framework aligns with public health roles to improve health equity. Modifying and orienting interventions and services with an understanding of the unique needs of people who use substances helps address inequities and disrupt substance use-related stigma and discrimination.
Use this resource to
- Understand the foundational principles of a public health approach to substance use across the substance use spectrum
- Facilitate conversation about how a public health approach to substance use is essential to upholding health equity and social justice
- Inform the development and modification of substance use policies, programs and services
- Advocate for public health approaches to substance use that prioritize the perspectives of people with lived and living experiences of substance use
Alignment with NCCDH work:
Modifying and orienting interventions is one of the four public health roles for advancing health equity. Incorporating lived and living experience of substance use is critical to pursuing equity and justice for people who use substances.
The following two resources use a storytelling approach to guide public health practice in this area:
Story 4: Community expertise, building community power and making change happen: Peer-2-Peer Program
Mobilizing Opioid Agonist Therapy to bridge gaps during COVID-19. Equity in Action
The following webinar explores the BC Centre for Disease Control document Peer engagement principles and best practices: A guide for BC health authorities and other providers as a practical tool to inform health system decisions and priorities to reduce substance use-related harms:
Peer engagement to inform public health action on substance use and health equity
See other resources on substance use health.
Reference
Canadian Public Health Association. (2024). The Canadian Public Health Association framework for a public health approach to substance use. https://www.cpha.ca/sites/default/files/uploads/policy/positionstatements/2024-PHASU-PolicyStatement-e.pdf
Tags: Stigma, discrimination, Substance use, Public Health Organization, Document, Policy Brief