Extending public health framings of drug use to the health impacts of drug production: The case of coca growers in Northeastern Colombia

This article critically examines the absence of a public health approach to the well-being of coca leaf producers in Colombia, a group disproportionately affected by the War on Drugs. While harm reduction frameworks address drug <i>consumption</i> as a public health issue, no comparable strategy has been developed to tackle the health vulnerabilities afflicting those involved in drug <i>production</i>. Drawing on ethnographic research and interviews in Catatumbo - a coca-producing region in northeastern Colombia - this study highlights the multiple health risks faced by coca producers and leaf pickers, including toxic chemical exposure, vector-borne diseases, and the mental health consequences of pervasive violence, economic hardship, and sexual exploitation. These issues are exacerbated by stigmatization, infrastructural deficits, and militarized forms of state action. The article contests prevailing security and rural development models for tackling the public health challenges of populations engaged in criminalized agrarian activities, advocating instead for a reconceptualization of community health that incorporates harm reduction principles. It proposes an 'oblique' model of healthcare that values the mediation of community health workers and the autonomous organization of coca-growers. By bridging public health and peacebuilding discourses, it reframes the health challenges of coca leaf producers as matters of care and justice, rather than solely criminality or development.