Harm Reduction: A Core Concern
for Medical Anthropology
One of the most important and least appreciated topics in medical anthropology is harm reduction. It is not only a practical logic that characterizes our age of risk, but a fundamental way people have approached preventive health within local health cultures. Using research I have conducted during the past 25 years in both international and national contexts, I first consider vulnerability and harm reduction in general to set the stage for a more detailed discussion of harm-reduction strategies. After reviewing longstanding and emergent harm-reduction strategies in South and Southeast Asia, I draw upon theories of reflexive modernity and risk society (Giddens 1991; Beck 1992, 1996) to discuss harm reduction as a way of life in the United States and end by highlighting a few areas of harm reduction that beg further inquiry to move the field forward.
The topic of harm reduction can be positioned within a larger thematic area in anthropology: the anthropology of vulnerability, risk, and responsibility. This thematic area encompasses the study of 1) layperson perceptions of vulnerability, 2) the production and representation of knowledge about risk, 3) the politics of responsibility associated with a knowledge of risk, 4) lay response to and trust of expert knowledge about risk, and 5) harm reduction as both an expression of agency and a form of manipulation.1 As an expression of agency, harm-reduction practices are undertaken to reduce a sense of vulnerability and enhance a sense of self-control. As a form of manipulation, harmreduction practices are fostered at the site of the individual body by parties who wish to deflect attention away from risk factors affecting a population's