Safer Solutions: When We Miscalculate Health Risks, We Get Health Policy Wrong

Welcome to “Safer Solutions,” a biweekly newsletter devoted to exploring policy’s role in reducing health risks. We believe people should have access to evidence-based information and tools that can improve individual and community health and even save lives (all while saving taxpayer dollars). We’ll use this space for a series of easy-to-understand posts breaking down concepts about risks and how to minimize them through harm reduction. Harm reduction is the idea that when people engage in behaviors that carry health risk, such as drug use or smoking, there are tools and strategies they can use to minimize those risks on their journey to better health. Every other week, we’ll break down a complex phenomenon, explain an evidence-based approach, investigate a harm reduction debate or disagreement, or touch on the news of the day to make these concepts real and present. 

When We Miscalculate Health Risks, We Get Health Policy Wrong

The decisions we have to make about our health are not always simple. We are constantly navigating relative risk: Eat more of this or less of that, drink alcohol more or less (or not at all), take or don’t take medicine that offers benefits and side effects. But as we make these choices, we don’t always accurately assess the risks. Sometimes we focus too much on potential negative outcomes that are, in actuality, quite rare, causing us to misjudge the lower-risk choice as the riskier one. This is often the case with vaccine hesitancy, for example.

Sometimes we make this mistake because of misinformation from lawmakers, health practitioners, and the media. Sometimes we know that a behavior is risky in a general sense, but we underestimate our individual risk (something commonly seen with sexual health). And sometimes our decision-making about relative risks involves a messy mix of all of these phenomena.

Many proven tools and strategies can help us make better choices for our health. Our focus for this series is on a category of strategies that we call “harm reduction”—approaches that allow people to make positive changes and reduce their health risks even if they do not fully abstain from a potentially risky behavior—like wearing a motorcycle helmet instead of selling your motorcycle. Harm reduction strategies can be highly effective for reducing health risks when three elements are present:

1. An individual engages in a behavior that carries risk;
2. The individual has access to accurate information about the relative risks of their behaviors and the tools that can reduce those risks; and
3. The individual has access to those tools that can reduce their risks.

Point one acknowledges that everyone has risk in their lives; acknowledging this can help people take steps that work for them to lower those risks. Point two is foundational for individual decision-making about whether to pursue a harm reduction strategy. Point three underscores the need for policymakers to ensure that government is facilitating, not hindering, that access; when bad information and misperceptions prevail, we often see laws and regulations that limit, block, or even criminalize access to these tools, which hurts us all.

When we misunderstand, miscalculate, or miscommunicate risk, we skew not just our individual decision-making, but policy conversations as well, and we miss opportunities to encourage and support people to make less risky choices in behaviors like tobacco use, drug use, and sex. If we misunderstand where the greatest risks lie, we might make individual and policy choices that exacerbate, rather than mitigate, harms to health.

This multipart series provides examples of how risk miscalculation, in various forms, can skew perceptions and policy agendas and hinder people’s access to information and tools they can use to better their health.

The first installment of this series will discuss how access to methadone, a medication for opioid use disorder, is stymied by excessive focus on relatively rare, negative consequences of that access. The second installment will discuss how pervasive misinformation about reduced-risk nicotine products negatively impacts decisions made by individuals, health care providers, and policymakers and creates roadblocks to tools that could help reduce the death and disease caused by combustible cigarettes. The third installment will focus on HIV and syphilis, exploring how people’s assumptions about which groups are at risk for these conditions can cause them to avoid harm reduction strategies in their own lives. The fourth and final installment of this series will explain how these various forms of risk misperception can converge, using opposition to syringe services programs as an example.

We’re Chelsea Boyd (cboyd@rstreet.org) and Jessica Shortall (jshortall@rstreet.org), the lead authors of this Safer Solutions newsletter. Please reach out to us if you have comments or suggestions for future topics we can cover.