Ingrid van Beek: Navigating the urban policy jungle—some dos and don’ts

ingrid_van_beekThe past 20 years has seen an increasing commitment to evidence based medicine. This approach has also started to inform public policy making. This more objective way of determining the best method forward is especially important in the potentially controversial field of illicit drugs, which has both public health and public order implications.

There is now ample evidence that harm reduction initiatives such as needle syringe programmes and opioid substitution therapy are effective. However, in order to translate such evidence into public health gains, communities need to be willing to accommodate such programmes in their midst.

To enable an informed community debate about such matters we also need evidence regarding the local impacts of such programmes, and how they are best ameliorated, to ensure that such programmes can be established and maintained in appropriate locations.

I have been the director of the Kirketon Road Centre (KRC) in Sydney’s Kings Cross area for the past 25 years.

KRC is a government funded public health facility of the local health district, which has statutory responsibility for the prevention, treatment, and care of HIV and other transmissible infections among vulnerable populations in its geographical area.

Kings Cross has long been the epicentre of Australia’s sex and drugs industries, arguably since the arrival of the First Fleet. Hence the decision to establish a targeted primary healthcare service in the Kings Cross community in 1987.

For eight of those 25 years (until 2008) I was also the founding medical director of what remains Australia’s still only medically supervised injecting centre (MSIC), which is also located in Kings Cross.

In both of these roles I have been in the firing line of several high profile public campaigns focused primarily on their specific locations. These date back to 1996, when every telegraph pole in the area was plastered with “Say No to Needle Exchange” posters opposing the location of what became known as K2 on the main street of Kings Cross.

This proved to be something of a dress rehearsal for the big show stopper, which took the form of protracted legal action in the NSW Supreme Court to stop the MSIC opening in 2001, by the then Kings Cross Chamber of Commerce and Tourism.

The Kirketon Road Centre also faced opposition to its placement of a needle syringe automatic vending machine in a nearby suburb in 2009, and more recently when we relocated K2 to what is now known as Clinic 180 in Kings Cross.

So here is my “guide” to navigating for the long term survival of often controversial drug related harm reduction initiatives, engaging all of the tiers that count: people who inject drugs, the rest of the local community, and government.

1. Garner political support and provide relevant evidence.
2. Mobilise other “expert” voices and communicate information effectively.
3.  Develop a relationship with media.
4. Join every local community committee; establish your own community committee and focus on local impacts; consider community forums, but beware of the pitfalls.
5. Try to find the common ground, but do not agree to something that will set up your programme for failure.
6. Offer to pilot initiatives, but limit review period (preferably no longer than 12 months).
7. Develop a plan of management to assess, monitor, and review any impacts.
8. Be approachable and available at all times, and be proactive in responding to complaints.
9. Be willing to be flexible and modify operations if needed.
10. Continue community dialogue in the good times as well as the bad times.

Finally to conclude: By any international yardstick the Kirketon Road Centre and the Sydney MSIC are “best practice” models, which I am extremely proud to have been associated with. I am prouder still that they have contributed to preventing an HIV epidemic among Australian drug users, as well as improving overall health among vulnerable populations in the local area. But perhaps even more importantly, together they continue to keep people alive by preventing and managing opioid overdoses, which remain the most immediate threat to life in this population in Sydney’s Kings Cross.

AND this has only been possible because we have the now strong support of the local and wider communities in which they exist.

Competing interests: I  declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.”