Austerity P-PG (2013) 11. Adopted at the 73th meeting of Permanent Correspondent November 2013

Transcription

1 Austerity Athes Declaratio o protectig public health by esurig essetial services i drug policy uder austerity budgets ad explaatory memoradum P-PG (2013) 11 Adopted at the 73th meetig of Permaet Correspodet November 2013 Co-operatio Group to Combat Drug Abuse ad Illicit traffickig i Drugs

2 The Pompidou Group 1 3 The Pompidou Group s core missio is to cotribute to the developmet of multidiscipliary, iovative, effective ad evidece-based drug policies i its member states. It seeks to lik Policy, Practice ad Sciece ad focuses especially o the realities of local implemetatio of drug programmes. The shiftig, dyamic ature of the drug pheomeo has required the Group to adapt its role i order to deal with emergig problems ad chages i the drug situatio. Flexibility ad capacity for iovatio are two key attributes that have assisted the Group i meetig this challege. Agaist a iteratioal backgroud characterized by the presece of may Europea ad iteratioal bodies workig o drugs, the Pompidou Group provides a multidiscipliary forum of ope debate at the wider Europea level where it is possible for policy-makers, professioals ad researchers to discuss ad exchage iformatio ad ideas o the whole rage of drug misuse ad traffickig problems. I order to carry out this missio, it adopts a multidiscipliary, itegrated approach to all drug problems ad employs a variety of workig methods. I additio, the Pompidou Group udertakes a bridgig role both betwee EU ad o-eu Europea coutries ad towards eighbourig coutries i the Mediterraea regio. Because of its liks with the Coucil of Europe it also esures that policy recommedatios are cosistet with public policy as elaborated i other fields of Coucil work, such as public health, social cohesio ad peal policy, with particular emphasis o ethical issues ad respect of Huma Rights.

3 P-PG (2013) 11 rev 2 25 November The Athes Declaratio «Declaratio o protectig public health by esurig essetial services i drug policy uder austerity budgets (Athes Declaratio)» We the represetatives of States participatig i the 73rd meetig of Permaet Correspodets of the Pompidou Group, Notig that the global fiacial ad ecoomic crisis i Europe ad the related austerity measures have already brought about ad may immietly exacerbate challeges related to the health of the idividual ad of the populatio as a whole, as well as the cohesio of our societies; Notig with great cocer the chagig patters of drug use uder circum - staces of strict austerity measures, such as the possible risk of a earlier oset of drug use, the icreasig prevalece of ijectig use, relapses, risk takig, overdosig, particularly amog vulerable groups; the icreasig icidece of poly-drug use, ivolvig illicit ad licit substaces, the impact of such behaviours o public health as well as o crimiality; Cocered that the effects of ecoomic crisis possibly result i discrimiatory attitudes of society towards drug use ad people who use drugs that udermie risk ad harm reductio, drug treatmet, social re-itegratio ad the potetial for recovery; Recogisig the eed to better uderstad the effects of ecoomic crises o overall drug use ad drug policies, otably: The asymmetric impact of the crisis o certai populatio groups ad societies ;

4 6 7 The impact of the crisis o drug use, drug cosumptio patters ad related risks ad harms, icludig drug depedece, overdose, ifectious ad other blood bore diseases; The impact of austerity measures ad restructurig efforts o the overall health budgets ad o drug related public expediture; The cosequeces of resultig costraits o budgets of law eforcemet agecies ad overall drug supply reductio efforts, thus riskig a potetial icrease i the availability of drugs; The impact of reduced demad reductio resources, which may affect availability of risk ad harm reductio policies ad measures ad coverage for overall treatmet ad rehabilitatio ad reitegratio services; Recallig the obligatios of States uder the Coucil of Europe ad Uited Natios Covetios to protect fudametal rights ad freedoms, i particular the right to life ad huma digity, the right to protectio of health, the right to equitable access to quality health care services for all, the prohibitio of ay type of discrimiatio as well as the right of childre to be protected from arcotic drugs ad psychoactive substaces; Recallig the obligatios of States uder Art. 2 of the Iteratioal Coveat o Ecoomic, Social ad Cultural Rights, ad uder Art. 4 of the UN Covetio o the Rights of the Child, to progressively realise the right to the highest attaiable stadard of health to the maximum of available resources. Bearig i mid Resolutio 1884 (2012) o Austerity measures a dager for democracy ad social rights, ad Resolutio 1946 (2013) o Equal access to health care of the Parliametary Assembly of the Coucil of Europe; 1. Reaffirm our commitmet to the followig priciples eve i times of severe resource costraits: Drug policy implemetatio should be guided by fudametal equity ad quality stadards ad utmost respect for huma rights; A balaced approach i drug policy should also be reflected i budgets available for supply reductio ad demad reductio measures; Mutual assistace ad cooperatio at atioal ad iteratioal levels are essetial elemets of drug policy implemetatio; Immediate actio should be take or itesified i cooperatio with NGOs ad civil society to esure itegrated quality care (from prevetio through to recovery) is made available to vulerable populatios, thus protectig the idividual ad the society at large. 2. Where ecessary, appeal to all actors i drug policy to iitiate ad support immediate political actio to mitigate the impact of ecoomic crises, particularly o the most vulerable, ad to guaratee broad coverage, accessibility ad quality of essetial services, despite budgetary costraits. 3. Declare our resolve to cotiue providig such comprehesive, itegrated services as part of our atioal drug policies ad safeguard agaist ay type of discrimiatio. To achieve this: Where ecessary, urget actio must be take o the basis of idicators showig chages i the drug situatio ad its cosequeces. I some coutries there is already sufficiet evidece that justifies actio before a serious deterioratio of idividual ad public health idices as well as loss of huma lives occurs; Evidece based best practices o optimizig cost effectiveess i policy implemetatio should be used to address pressig budgetary costraits. Iovative solutios to providig essetial services at maageable costs should be ecouraged ad explored; Drug policies at the atioal level should be implemeted i cooperatio with NGOs ad the civil society, which ca foster greater service itegratio, optimise ecoomies of scale ad achieve improved cost effectiveess. 4. Commit the Pompidou Group to work o this issue ad to works towards its iclusio i the future work programme. 5. Call o other iteratioal orgaisatios ad o-member States to support the Pompidou Group s i its efforts to mitigate the cosequeces of ecoomic crises ad resultig austerity measures, i particular by joiig the Group s efforts to create safeguards agaist stigmatizatio ad discrimiatio of people who use drugs.

5 P-PG/DPEC (2013) 4 rev 25 November 2013 Explaatory memoradum o the Athes Declaratio 3 9 by the expert group o drug policy implemetatio i times of ecoomic crisis (DPEC) A worryig correlatio: ecoomic crisis, worryig public health treds ad the risks of discrimiatio 1. Sice the 1930s the study of ecoomic crises ad their cosequeces shows a relatio betwee mortality ad morbidity treds ad the capacity of health systems to respod to icreased demad for care, particularly by the most vulerable. 2. It has bee widely ackowledged that ecoomic crisis affects all determiats of health, such as utritio, housig, educatio ad employmet, further exacerbatig existig iequalities ad leadig to deterioratio of physical ad metal health as well as stuted growth i childre. Such effects have bee show to predomiatly impact vulerable groups, which are also faced with ecoomic ad social exclusio. More recet aalysis suggests that this impact of the ecoomic crisis o health determiats is also related to icreased bige alcohol ad problem drug use. 3. The curret fiacial crisis i Europe has led to a ever expadig ecoomic crisis ad the adoptio of austerity measures i several Europea coutries. Austerity affects all sectors of govermet spedig, icludig public health ad drug policies. Despite frequet atioal efforts

6 10 11 to rig-fece the public fiacig of health, austerity has adversely impacted o the levels of coverage i health ad social services, icludig drug treatmet provisio, i may coutries. Impact of the ecoomic crisis o drug use ad drug policies 4. The ecoomic crisis i Europe ad the resultig austerity measures applied to address it are already impactig both drug use ad drug policies. The followig areas of impact have bee idetified: 1. Drug Use developmets 1.1. Treds i drug use Icreased icidece of ew, cheaper ad more dagerous drugs; Icreased icidece of poly drug use, ivolvig both illicit ad licit substaces, such as alcohol ad prescriptio medicies; Earlier oset of drug use, particularly i coectio with icreased youth uemploymet; Icreased risk of former drug users relapsig Shift to riskier patters of takig drugs. There is evidece that ijectig drug use is spreadig i a growig umber of Europea coutries, posig grave public health risks Treds i health cosequeces 5. A joit risk assessmet by EMCDDA ad ECDC coducted with referece to recet HIV outbreaks amogst IDUs i both Greece ad Romaia has uderlied the eed for scalig up resposes i the face of the coutries ecoomic hardship. Data aalysis suggests that the outbreaks alog with the resultig mortality ad morbidity were liked to low or reduced levels of HIV prevetive services provisio, particularly harm reductio ad opioid substitutio treatmet availability. 6. Safeguardig public health ad public safety ecessitate rapid resposes to scale up HIV ad Hep C prevetive measures i both coutries, especially through wider availability of harm reductio ad substitutio treatmet programmes. High levels of patiet mobility across Europe make such resposes of urget ad vital importace to all Europea coutries, particularly as some Europea member states are reportig icreases i the prevalece of HIV amog IDUs. 7. Overall, recet treds show a icrease i the umber of HIV ifectios, alcohol-related deaths, suicides, metal health as well as other health related problems i coutries affected by the ecoomic crisis ad austerity measures. I additio, prelimiary aalysis suggests that depressio, icome reductio, growig healthcare costs ad cuts i service provisio prevet people from accessig care i time, thus aggravatig their idividual health ad impactig o geeral populatio health Treds i crime developmet 8. Due to risig uemploymet rates, particularly amog the youth, people are turig to small scale dealership as a meas to supplemet their (licit) icome, if ay. 9. Additioally, deliquecy related to drug use appears to be o the rise, through both small scale dealership ad acquisitive crime. Emergig evidece suggests violet property crime types such as robbery have icreased as a cosequece of recessio ad, furthermore, which i tur must be see as partly attributable to chages drug use patters, i the way that drug cosumptio ca be a eablig factor to overall crime levels Treds i social exclusio 10. There is a icreasig cocer amogst policy makers o the social represetatio ad stigmatizatio of drug depedece ad subsequet discrimiatio of people depedet o drugs. 11. Stigmatizatio of people depedet o drugs has bee icreasig i coutries implemetig austerity measures. I societies where

7 12 13 resources for legitimate causes, such as cacer ad autoimmue diseases, are scarce, drug depedece may be see as a moral failure ad resources dedicated to treatig depedet people as a first target for budget cuts. 12. As a result of such dimiishig social tolerace ad support, drug users are icreasigly faced with social exclusio, thus aggravatig their health ad udermiig their chaces of makig a full recovery. 13. I such a cotext policy makers are faced with icreasig difficulties whe advocatig for humae drug treatmet policies, which support patiet reitegratio ad recovery. 2. Drug policies 2.1. Impact o availability ad fudig of services 14. I some coutries there is evidece that the availability of treatmet ad harm reductio services, particularly Needle ad Syrige Exchage Programmes, has bee seriously affected by budgetary costraits. Amog other factors this has cotributed to icreased icidece of HIV/AIDS ad other commuicable diseases amogst IDUs (see above 1.2. Treds i health cosequeces). 15. Additioally, i a umber of Europea coutries severe ecoomic costraits have udermied efforts to sustaiably icrease the coverage of treatmet ad harm reductio services. 16. Global govermet fudig for HIV/AIDS prevetative ad treatmet programmes has also bee affected, thus impactig o overall HIV/AIDS icidece ad prevalece; most promiet case, the budget cuts i prevetive, treatmet ad cousellig services provided by the Global Fud to Fight Aids, Tuberculosis ad Malaria. 17. Budget cuts were also imposed o specialized treatmet programmes i prisos, implemeted by traied health professioals; as a result, depedet prisoers face udue restrictios whe accessig treatmet ad are discrimiated agaist by utraied staff Impact o accessibility of services 18. Eve whe services are available, they may ot be accessible by people i eed due to ecoomic ad geographic costraits or costraits impactig other areas of public spedig, such as social services. 19. For example, the abolitio of free trasportatio for drug users to some treatmet facilities may uduly burde or prohibit access to treatmet, harm reductio or rehabilitatio cetres. Itroductio of patiet charges i primary specialist care is a particular cause of cocer: patiets who caot afford the co-paymet for the geeral practitioer visit will ot be able to get a prescriptio for opioid substitutio therapy ad will thus udermie their effort to recover ad be well. 20. Overall, eve though availability of treatmet services, maily substitutio programmes, may have bee maitaied per se, some patiet groups may be uable to access such services. 21. A observed declie i umbers of patiets recorded i treatmet may ot be attributable to a actual reductio but rather caused by fear of stigmatisatio, reduced availability of services, difficulties i accessig services or closig dow of services Impact o quality 22. Durig such challegig ecoomic times it is crucial that States esure essetial services to be applied across the cotiuum of service provisio, while improvig cost effectiveess, fightig stigmatisatio ad allowig ad respectig at the same time patiet iformed choice ad offerig diversified, safe treatmet optios that cater for idividual treatmet eeds. Needed policy resposes 23. The ecoomic crisis is liked with a social ad political crisis. However the impact of the ecoomic crises is asymmetric, as it ofte does t affect the whole coutry or all populatio groups, but oly some regios, tows or sub-populatios, eve if the most vulerable. This allows for customized policy resposes targetig affected populatios or geographic

8 14 15 areas. I that maer, the scale of ivestmet required to rapidly respod to the moutig impact of ecoomic crisis ad austerity measures ca be both predictable ad more realistic ad, thus, more feasible to implemet. Whe faced to make choices betwee ivestmet i more priso places as a respose to a icrease i drug related crime or retaiig expediture for drug treatmet ad social support, it should be take ito accout the effectiveess of drug treatmet outweighs by far the alleged beefits of icarceratio. 24. I the light of the fact that availability, accessibility ad quality of services are elemets affected by ecoomic crisis, ad which create iequalities, thus aggravatig health idices, immediate political actio is called for to mitigate the impact of ecoomic crisis ad to provide essetial services for drug users uder strict budgetary costraits. Such immediate steps would iclude: (i) Review of atioal actio plas ad drug strategies to shift emphasis temporarily (for the duratio of austerity measures) to wide availability ad accessibility of essetial services i drug policy; (ii) Review of legislatio ad rules goverig pre-coditios ad fees to access such services with a view to a temporary (for the duratio of austerity measures) suspesio of such pre-coditios; (iii) Review of stadards ad procedures goverig service provisio to icrease diversity, flexibility ad adaptability, i respose to resource costraits, without udermiig coverage rates; (iv) Developmet of a framework to bestow atioal drug policy coordiatig bodies with executive ad decisio makig powers i times of acute crisis outbreaks i the drugs field (risk of loss of huma life or immediate public health ad safety threats) to allow for swift ad cocerted actio; (v) Developig ad usig idicators o harms that differet drugs provoke together with a decisio makig matrix; (vi) Defiitio of a miimum set of services, which should ad ca be available to ad accessible by all i eed. Such services should be provided with emphasis o quality ad with full respect to basic huma ad patiet rights; (vii) Efficiet maagemet ad programme implemetatio with a view to greater itegratio of services to the beefit of the idividual i eed: Needs-based prioritizatio of programmes ad activities to be able to rapidly respod to moutig challeges; Budget restructurig ad reallocatio of resources towards the most cost effective solutios, allowig ot oly for cost but overall budget impact of policies ad itervetios; Poolig of resources to address waste ad optimize ecoomies of scale; Itegratio of service provisio ad cooperatio across sectors, ivolvig multiple govermet agecies; Sharig of evidece-based best practices o optimizig cost effectiveess i policy implemetatio to address pressig budgetary costraits; Exploratio of possible ad feasible iovative solutios to optimize service provisio at maageable costs. 25. Overall, there should be a uderstadig about the eed to have coordiated policy resposes at our atioal levels emphasizig the followig priorities: 1. Esurig essetial services 26. Based o best practice, defie those services i drug policies that costitute the core of effective policy implemetatio, whose budget eeds to be safeguarded as a priority. Such process of prioritizig should bear i mid the followig aspects: Recogisig the importace of prevetive measures for HIV ad other commuicable diseases ad draw visibility to the eed to maitai sufficiet fudig for their o-goig implemetatio; Developig resposes to ew challeges, such as icreasig poly-drug use, misuse of prescribed medicies ad abuse of ew, more dagerous, drugs; Addressig earlier oset of drug use through programmes targeted to youg people, particularly those affected by youth uemploymet;

9 16 17 Assessig iovative solutios to optimize outcomes of service provisio whilst cotrollig for costs; Esurig fiacial impact is measured i terms of overall budget impact rather tha cost effectiveess of sigle itervetios; Itegrate service delivery to streamlie provisio of services ad optimize ecoomies of scale, whilst maitaiig wide accessibility ad availability; Maitai high quality of services through greater itegratio of service delivery poits i respose to defied eed. 2. Combatig stigma, discrimiatio ad social exclusio of drug users ad ivestig i buildig social support ad recovery etworks. 27. Serious cocers have bee expressed about recet discrimiatory behaviours towards drug users, emergig i the wake of global fiacial ad ecoomic crises, resultig to stigma ad social exclusio. The political ad societal acceptace of depedece as a health coditio, o differet from other chroic diseases, appears to be severely udermied by the social circumstaces followig austerity measures i coutries i fiacial crisis. 28. I this cotext it eeds to be recalled that member States have obligatios uder iteratioal ad atioal legal istrumets to safeguard fudametal stadards of huma rights ad the rule of law. These iclude: First of all the Coucil of Europe Covetio for the Protectio of Huma Rights ad Fudametal Freedoms which guaratees: The right to life The protectio of the digity ad idetity of all huma beigs The right to protectio of health The right to o-discrimiatio The prohibitio of ihuma or degradig treatmet Article 38.1 of the UN Sigle Covetio o Narcotic Drugs, which requires States to pay special attetio to ad take all measures for the prevetio of abuse of drugs ad for the early idetificatio, treatmet, educatio, after-care, rehabilitatio ad social reitegratio of persos depedet o drugs; Article 33 of the UN Covetio o the Rights of the Child (CRC), which calls for all ecessary measures to protect childre from exposure to arcotic drugs ad psychotropic substaces; Article 25 of the Uiversal Declaratio of Huma Rights (UDHR), which guaratees everyoe the right to a stadard of livig adequate for his health ad well-beig, icludig medical care ad ecessary social services, ad the right to security i the evet of uemploymet, sickess, disability, widowhood, old age or other lack of livelihood i circumstaces beyod his cotrol; ad Article 12 of the UN Iteratioal Coveat o Ecoomic, Social ad Cultural Rights (ICESCR), which recogizes the right of everyoe to the ejoymet of the highest attaiable stadard of physical ad metal health; ad i paragraph 2(c) ad (d) stipulates the resposibility of the States to take the ecessary steps to prevet, provide treatmet for ad cotrol epidemic, edemic, occupatioal ad other diseases ad create those coditios, which would assure medical service ad medical attetio is available equitably to all i eed. Article 11 of the Coucil of Europe Europea Social Charter (revised), which provides for the right to protectio of health ad stipulates that, with a view to esurig the effective exercise of the right to protectio of health, the Parties udertake, either directly or i cooperatio with public or private orgaisatios, to take appropriate measures desiged iter alia: to remove as far as possible the causes of ill-health; to provide advisory ad educatioal facilities for the promotio of health ad the ecouragemet of idividual resposibility i matters of health; to prevet as far as possible epidemic, edemic ad other diseases, as well as accidets. The WHO Europe Resolutio of 2002 to scale up the respose to HIV/AIDS i its Europea Regio, Committee for Europe resolutio.

10 States should as a matter of policy priority idetify ad provide equitable medical care ad social assistace to all i eed, particularly to vulerable idividuals ad groups facig exclusio. Appedix Stregtheig atioal ad iteratioal cooperatio ad assistace to address the impact of austerity measures i coutries faced with ecoomic crises 30. To effectively tackle the impact of ecoomic crisis ad effectively esure essetial services for drug users close cooperatio betwee the govermet sector, civil society ad NGOs is idispesable. Co-operatio ad joit actio will ot oly provide ew isights ad data from the field but will also help to optimise ivestmet ad the use of resources, as well as allow for makig good use of syergy effects. 31. I this cotext it may be importat rethik ad recofigure relatioships betwee the govermet sector ad civil society stakeholders. The aim of cooperatio ad joit actio i parterships should be to avoid duplicatio ad waste, create syergies, maitai service quality ad wide accessibility, as well as cost cotrol. Referece documets: Europea Observatory o Health Systems ad Policies et al. i The Lacet: Fiacial crisis, austerity, ad health i Europe, March 2013 ECDC AND EMCDDA GUIDANCE, Prevetio ad cotrol of ifectious diseases amog people who iject drugs, 2011 ECDC Techical Report o Risk Assessmet o HIV i Greece, 2012 WHO, EMCDDA, ECDC, Missio report: joit techical missio o HIV i Greece, 2012 UNODC World Drug Report 2012 UNODC, Moitorig the impact of ecoomic crisis o crime, 2012 Members of the expert group o drug policy implemetatio i times of ecoomic crisis: Mr José Q. BARBOSA Executive Director Civil Society Forum o Drugs (APDES) Av Jea Piaget VN Gaia, Portugal tel: jose.queiroz@apdes.pt Mr Mauel CARDOSO Deputy Geeral-Director Geeral-Directorate for Itervetio o Addictive Behaviours ad Depedecies Av. República, º 61-8º Lisboa, Portugal

11 20 21 Mr Valerij DOBROVOLSKIJ Chief Specialist of Drug, Tobacco ad Alcohol Cotrol Departmet Vilius, Lithuaia Tel: Mr Marius DUMITRESCU Expert withi the Aalysis, Strategies ad Public Policies Uit Natioal Ati-drug Agecy 37 Uirii, B-d, bl. A4, sector 3 BUCHAREST Tel: relatii.iteratioale@aa.gov.ro; saspp@aa.gov.ro Dr Joao GOULAO Geeral-Director Geeral-Directorate for Itervetio o Addictive Behaviours ad Depedecies Av. República, º 61-8º Lisboa, Portugal tel : joao.goulao@sicad.mi-saude.pt Ms Ada HOCEVAR GROM, MD Deputy Director Natioal Istitute of Public Health Trubarjeva 2, SI-1001 Ljubljaa, Sloveia Tel: ada.hocevar@ivz-rs.si Prof. Mierva Melpomei MALLIORI Presidet of OKANA Greek Orgaisatio Agaist Drugs 21 Averof Str. GR Athes, Greece Tel: +30 (210) presidet@okaa.gr or mmalliori@oteet.gr Mr Catali NEGOI-NITA Head of the Iteratioal Relatios ad Programmes Uit of Natioal Ati-drug Agecy 37 Uirii, B-d, bl. A4, sector 3 Bucharest, Romaia Tel: relatii.iteratioale@aa.gov.ro Mrs Aa Sofia SANTOS Substitute of the Permaet Correspodet Iteratioal Relatios Coordiator Geeral-Directorate for Itervetio o Addictive Behaviours ad Depedecies Av. República, º 61-8º Lisboa Portuga ltel: fax: sofia.satos@idt.mi-saude.pt Mrs. Elisabetta SIMEONI Presidecy of the Coucil of Miisters Departmet for Ati-drug Policies Head of Natioal Moitorig Cetre ad Iteratioal Relatios Via dei Laterai, Roma, Italy tel +39 (6) fax: +39 (6) e.simeoi@govero.it Ms Claudia STORTI Scietific Aalyst o Ecoomic Aalysis EMCDDA Lisbo, Portugal Claudi.Costa-Storti@emcdda.europa.eu

12 22 Ms Ioaa YIASEMI Head of Policy Departmet Cyprus Atidrug Coucil Cyfield Tower 130 Limassol Aveue City Home 81,4th Floor 2015 Strovolos, Nicosia, Cyprus Dr Sylvie WIEVIORKA Psychiatrist Coucillor of Paris Paris, Frace Pompidou Group Secretariat: Coucil of Europe F Strasbourg Cedex Frace Mr Thomas KATTAU Deputy Executive Secretary Tel : thomas.kattau@coe.it Ms Elea HEDOUX Admiistrative Assistat Tel : elea.hedoux@coe.it