2025-06-11 –, BS G.33 - 120 cap.
Background Harm reduction is an important public health concept, but it has proven problematic in the context of health-harming industries, including tobacco, alcohol and gambling, all of which have strategically co-opted the concept to serve their corporate interests. While it is well established that such industries share political lobbying and influencing strategies, less is known about how they leverage “harm” and "responsibility” in their efforts to undermine development and implementation of evidence-based health policy.
Objectives This paper aims to explore industry narratives around “harm” and “responsibility”, and critically assess suitability of these concepts in the development of innovative harm reduction solutions.
Methods We conducted a scoping review of literature on corporate use of ‘harm reduction”, focussing on tobacco, alcohol and gambling. Web of Science and Scopus were searched using the terms “harm” and “responsib*” combined with “tobacco”, “alcohol” and “gambling”. Two reviewers independently screened eligible studies for inclusion. Using critical discourse analysis, we identified and assessed key similarities and differences in the strategies by which health-harming industries can impede development of harm reduction policies that serve public health.
Results Our findings show similarities between industries in the framing of “harm” and “responsibility”, including: emphasis on complexities around product consumption; focus on the individual; deflection from population-level solutions; medicalisation; and blaming public health for failing to address the problem.
Implications This study highlights a critical need to reconsider the utility of concepts like “harm” and “responsibility”, known to have been co-opted by health-harming industries, in the development of novel policy solutions.
Rachel Barry, University of Bath, Centre for 21st Century Public Health, Local Health and Global Profits Research Consortium
Iona Fitzpatrick, University of Bath, Centre for 21st Century Public Health, Tobacco Control Research Group
Sophie Braznell, University of Bath, Centre for 21st Century Public Health, Tobacco Control Research Group
Nancy Karreman, University of Cambridge, MRC Epidemiology Unit, Local Health and Global Profits Research Consortium
Sarah Trolley, University of Bath, Department for Health, Centre for 21st Century Public Health
Rachel works within the Centre for 21st Century Public Health as a researcher for the Local Health and Global Profits Research Consortium, a multi-university, multisectoral project focused on how to improve health and equity at local level in the UK. I am also Vice President of the International Confederation on Alcohol, Tobacco and other Drug Research Societies (ICARA).
I am internationally recognised for my research on cannabis regulation and its implications for health (and broader agendas such as crime and finance) and on cannabis and related industries. With expertise in questions around policy coherence and coordination, my work focuses on three main areas:
Exploring the barriers and facilitators for developing coherent approaches to regulating the supply of unhealthy commodities and the conduct of companies that manufacture these products, notably cannabis, tobacco, alcohol and e-cigarettes.
Understanding how complex systems of overlapping global, regional and national policies shape and constrain implementation of national health policy innovation.
Developing evidence to inform innovation in cannabis governance by drawing on historical and contemporary lessons from regulating the global tobacco and alcohol industries.