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Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

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  • Harris, Magdalena

Abstract

In the United Kingdom, increases in premature mortality among the intersecting populations of people made homeless and people who inject drugs map onto the implementation and solidification of fiscal austerity policies over the past decade, rather than drug market fluctuations and trends as in North America. In this context, it is crucial to explore how poverty, multi-morbidity and care delay interplay in exacerbating vulnerability to mortality among an aging population of people who use illicit drugs. The mixed methods Care & Prevent study generated survey data with 455 PWID and in-depth qualitative interviews with a subsample (n = 36). Participants were recruited though drug treatment services and homeless hostels in London from October 2017–June 2019. This paper focuses on qualitative findings, analysed thematically and contextualised in relation to the broader survey sample. Survey participants report an extensive history of rough sleeping (78%); injecting-related bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts emphasise engagement with the medical system as a ‘last resort’, with admission to hospital in a critical or a “near death” condition common. For many severe physical pain and debility were normalised, incorporated into the day to day. In a context of everyday violence and marginalisation, avoidance of medical care can have a protective impetus. Translation of cultural safety principles to care for people who inject drugs in hospital settings offers transformative potential to reduce serious health harms among this population.

Suggested Citation

  • Harris, Magdalena, 2020. "Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care," Social Science & Medicine, Elsevier, vol. 260(C).
    • Handle: RePEc:eee:socmed:v:260:y:2020:i:c:s0277953620304020
    DOI: 10.1016/j.socscimed.2020.113183
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    References listed on IDEAS

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    1. DeVerteuil, Geoffrey, 2015. "Conceptualizing violence for health and medical geography," Social Science & Medicine, Elsevier, vol. 133(C), pages 216-222.
    2. Harris, Magdalena & Rhodes, Tim & Martin, Anthea, 2013. "Taming systems to create enabling environments for HCV treatment: Negotiating trust in the drug and alcohol setting," Social Science & Medicine, Elsevier, vol. 83(C), pages 19-26.
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    Cited by:

    1. Zhang, Chaoxiong, 2022. "Building care amid navigating liability risks: The possibility of policy-driven care in China's drug-control arena," Social Science & Medicine, Elsevier, vol. 314(C).

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