Margaret Thatcher: harm reduction heroine

Cross-posted with….

I’ve been following my left-liberal friends’ reaction to Margaret Thatcher’s death. I take it they’re not huge fans of her historical legacy. I’m not such a big fan myself. But one aspect of her legacy deserves some notice. The Thatcher government responded rather effectively and humanely to the HIV/AIDS crisis. Embracing harm reduction measures such as syringe exchange and methadone maintenance, it saved thousands of lives. Indeed the words “harm reduction,” anathema to American drug control policy until the Obama administration, were official watchwords of British drug policy. As Alex Wodak and Leah McLeod summarize this history:

By 1986 the Scottish Home and Health Department concluded that ‘the gravity of the problem is such that on balance the containment of the spread of the virus is a higher priority in management than the prevention of drug misuse.’ and recommended accordingly that ‘on balance, the prevention of spread should take priority over any perceived risk of increased drug use.’ This approach was strengthened by the influential UK Advisory Committee on the Misuse of Drugs asserting in 1988 that ‘the spread of HIV is a greater danger to individual and public health than drug misuse…accordingly, services that aim to minimize HIV risk behaviour by all available means should take precedence in development plans.’

Thatcher-era British policies provided a damning contrast to the Reagan and George H. W. Bush administrations, which so disfigured their legacies by allowing HIV policy to become yet another front in the culture wars. More than 600,000 Americans have died after being diagnosed with AIDS. An unknowable number of these deaths would not have occurred had our government moved with greater speed, resources, and humanity to contain a deadly epidemic.

The HIV epidemic struck at the weakest points of American society and our political life. The centrality of homosexuality and drug use guaranteed that HIV prevention would spark bitter ideological and moral fights. Within the British system, these fights occurred in a context in which experts at the National Health Service and related public health bodies commanded real legitimacy and respect within the political process.

Things played out rather differently here. In September 1985, President Reagan prepared to make his first, very-late public comments on AIDS. Responding to unfounded fears, health authorities proposed to include the following words in his speech: “As far as our best scientists have been able to determine, AIDS virus is not spread through casual or routine contact.”

These words were never spoken. A young White House aide redacted them. This story is telling, not because that young aide—now Chief Justice of the United States—got the science wrong. It’s telling because the medical and public health consensus was casually over-ruled by a young lawyer who knew little about AIDS. Public policy is not only about making the right decision. It is also about creating the right organizational capacities and the right norms of decision-making so that judicious analysis is performed and is then given a proper hearing. That didn’t happen.

The Reagan presidency ended twenty-five years ago. That was a different time. Public attitudes have changed—not least because of what we all witnessed in the HIV epidemic itself. Maybe it’s unfair to judge American public policy of the 1980s by our values three decades later.

Still, it’s still worth remembering that one of the English-speaking world’s greatest conservative politicians faced the same crisis, at the same moment, just across the Pond. And the Iron Lady did much better.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

8 thoughts on “Margaret Thatcher: harm reduction heroine”

  1. “These words were never spoken. A young White House aide redacted them. This story is telling, not because that young aide—now Chief Justice of the United States—got the science wrong. It’s telling because the medical and public health consensus was casually over-ruled by a young lawyer who knew little about AIDS.”

    Of course exactly the same thing happened with the McGovern commission, and the total lives ruined is probably larger (fewer immediate deaths, but many many more people involved). And yet this remains an obscure factoid and the people who raise it and the health issues around it are considered cranks…

  2. Well, I’m sorry when anyone dies. But I’ll be darned if I’m going to invest the time to figure out if Thatcher was as bad as she seemed. Fortunately, I’m not God and my opinion doesn’t really matter.

    But … that blog you linked to is kind of spanky, and I’d never heard of it, so thanks. There’s a nice piece on the whole Keystone issue. Darned if I didn’t learn something new today and it’s only noon.

    1. “Robot economists…” see, now *there’s* a horror movie.

      Or, are most of them more like zombies?

      Well. This is not very nice of me.

  3. One of the reason for Thatcher’s ‘non moral’ tone on Aids, particulary her Health Secretary’s Norman Fowler wide-spread successful campaign> to alert the british public to the danger of Aids, was that some memebers of her cabinet were gay and many of her principled supporters. One such was former undersecretary Lord Avon, who held a seat in the House of Lords,(his father was the late prime minister Anthony Eden)and he was forced to resign as a junior environment minister in March 1985, because of ill health. He was a good friend of Prime Minister Thatcher and hedied of Aids a few months later, in August 1985,> when there had only been a couple of hundred reported HIV deaths until that time in the UK. Thatcher was also a former chemist and not as impervious or hostile to science as most of the GOP leaders have been. Margaret Thatcher, 1989: “We are seeing a vast increase in the amount of carbon dioxide reaching the atmosphere. The result is that change in future is likely to be more fundamental and more widespread than anything we have known hitherto”.

  4. A note on Mrs Thatcher – this Saturday some rugby games will be preceded with a minute’s silence in her honour.

    There will no minute’s silence at any Premier League soccer game (soccer is the game followed by the vast majority). For many, expecially in the North of England, in the collieries and cities (Liverpool, Manchester, Sheffield), her memory is too raw.

    In Belfast, a small crowd danced on the street – I was amazed, and a little appalled, to see the same in places like Liverpool and Glasgow. One middle-aged woman interviewed on TV said “She made my youth a misery”.

    1. If you knew anything about how Thatcher behaved towards Liverpool and its people, you would hardly be surprised at their rejoicing. I can’t say I blame the Glaswegians either.

      Thatcher’s legacy of division and destruction was – and is – felt far more acutely in the North and Scotland than anywhere else.

  5. Harold, I didn’t really need another reason to dislike John Roberts. This proves the man is a political hack from way back. Apparently that is a plus if you want to be Chief Justice.

  6. Thanks for this note. I did know that Britain actually had done a bit better on harm reduction than the U.S. but hadn’t noted the connection to the Thatcher government. I will say that my main thatcher story was that I, at the time a US Air Force officer stationed in England, had gone over to London to watch the annual oxford/cambridge crew races and then decided to go downtown to Tower Records. Almost immediately after getting into Tower, they started boarding up windows and asked us to leave. It turns out, I had taken the tube right into the center of the poll tax riots and that a building was on fire about 3 blocks away. We stopped to help some poor kid who’d gotten bashed in the head. I think it might have helped the ambulance that some Americans and a random canadian doctor were keeping an eye on him – everyone including the sketchiest people were immensely polite to us. After I got home my housemate marveled at how clueless I was. I should’ve watched more TV. Everyone in Britain, except me and about 3 friends, knew that millions of people were pouring into London and there was going to be a riot. Anyway, not a fan of Ms. Thatcher’s but it’s time for the U.S. to get over its harm reduction aversion.

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