The View From The West

A WALK ON THE EAST SIDE

ON the corner of Main and Hastings in Vancouver's Eastside sits the
Carnegie Community Centre, housed in a wonderful old structure originally
erected as a library and similar to the Carnegie building on William Avenue
in Winnipeg.

A few nights ago, I was walking in the alleyway behind the centre and
watched in "shock and awe" as small clusters of drug-users engaged in
various acts of shooting up. Especially graphic was the sight of one young
woman leaning against the back of the building while plunging a needle into
her jugular vein, her neck deeply scarred from frequent past injections.

I was in the area, accompanied by staff members of VIDUS (the Vancouver
Injection Drug User's Study) to assess allegations by Human Rights Watch
investigators of police abuse during a recent crackdown on the Eastside
drug trade. As a Canadian board member for Human Rights Watch, I had been
called by Vancouver Mayor Larry Campbell to discuss this report, and
thought it wise to see for myself what was going on in what has been called
the drug capital of Canada.

It was an eye-opener in several ways, and raised for me a serious question
of Canadian public-health policy that has both domestic and international
implications.

Certainly, public-health issues have been very much in the news of late.
SARS, mad cow disease and West Nile virus have received blanket media
coverage, reminding us all of the vulnerabilities of living in an age when
diseases hatched in far-off parts of the globe become a direct menace to
our own population.

But what this preoccupation with exotic global health issues overlooks is
other, more widespread and lethal public-health threats, also global in
nature, which endanger far more Canadians and which suffer neglect and
general indifference from the public and policymakers alike. The research
staff at VIDUS have complied a series of studies that point to an explosive
increase in the incidence of HIV infection among the nearly 10,000
drug-users on the Eastside, particularly affecting women, young people and
aboriginals. But, as the study notes, "this health crisis is not unique to
Vancouver. Many North American cities are currently experiencing ongoing
HIV epidemics as a result of injection drug use."

Combine that with the deadly human toll taken by drug overdose and other
health problems among users and you have a potent killer of Canadians
occurring every day, with little outcry or attention paid. This public
indifference is all the more surprising at a time when there is serious
debate about the costs of health care. It is estimated that the lifetime
medical costs of an HIV-infected drug-user total $150,000. The combination
of health and enforcement-related costs from drug use is in excess of $5
billion annually.

One would think that those numbers alone would spur efforts at prevention
and treatment. Quite the opposite, and the situation is an indictment of
faulty, if not deadly, public policy that applies the wrong responses or no
response at all.

Dr. Martin Schechter, head of the Department of Health Care and
Epidemiology at the University of British Columbia, cites cancellation of
federal social-housing programs, community release of mental patients
without proper funding of care facilities, cutbacks in provincial treatment
programs, a freeze on funding for Canada's AIDS strategy and over-reliance
on law enforcement as major factors in the escalating pathology of drugs
and HIV in Canada.

The issue of over-reliance on police methods to control the problem is
particularly unsettling. A report from Canada's Auditor General says that
of the $454 million spent on our national drug strategy, $426 million (94
per cent) is spent on enforcement, with no discernible evidence that these
interventions generate any benefit. Police officers on the Eastside defend
the current community-enforcement effort -- part of Mayor Campbell's 'Four
Pillar' drug strategy supported by Ottawa and the B.C. government -- as
bringing a greater sense of security to the area. But they do admit it is
not a solution to the basic problem.

VIDUS fieldworkers on the Eastside say there are many successful prevention
strategies in Europe involving efforts to better educate potential users
and offer safer services to existing users, such as safe injection sites.
This contrasts with the North American emphasis on police power and the
courts. They felt Canada seems to identify more with the U.S. approach of
trying to limit supplies rather than controlling demand, and that we were
quite conservative in our overall strategy. But they say the underlying
culprit is a general shrinkage of services such as housing, community care
and poverty alleviation targeted to marginal groups in our population.

Previously on these pages, I have written that our cities represent the
frontier for determining Canada's global future. It's where we can develop
a smart agenda to cope with and master many problems of economic growth and
sustainable development. It appears that cities are also the battleground
for confronting a social crisis and demonstrating that we can still be a
caring society.

As we debate how to deal with terrorism, devote billions to erecting border
controls, sign on to missile-defense projects and anguish over the global
transfers of strange viruses -- all in the name of security -- let's
remember that real security begins at home. A walk on the Eastside of
Vancouver, and many other places like it throughout our country, should
remind us that we have a "human security" crisis in our midst.