Analysis of Peer Work Contributions to the Sustainable Development Goals (SDGs)

This report synthesizes findings from an extensive body of literature to analyze the role of peer work in advancing the United Nations Sustainable Development Goals (SDGs). Peer work, where individuals with lived experience provide support and services, is identified as a critical strategy for health promotion, social inclusion, and economic empowerment, directly contributing to several key SDGs.

SDG 3: Good Health and Well-being

Peer work is a cornerstone for achieving SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. The literature demonstrates that peer workers are instrumental in reaching marginalized populations who are often disconnected from mainstream health services.

Target 3.3: End the Epidemics of AIDS, Hepatitis, and Other Communicable Diseases

Peer workers are on the front lines of combating blood-borne viruses. Their contributions are essential for global health sector strategies aiming for the elimination of HIV and viral hepatitis.

• HIV and Hepatitis C (HCV) Care: Peer workers facilitate testing, linkage to care, and treatment adherence for HIV and HCV, particularly among people who inject drugs. Studies from Australia, Vietnam, Indonesia, and Kenya highlight their effectiveness in navigating complex health systems.
• Harm Reduction: Peer-led initiatives, such as needle and syringe programs and overdose prevention, are fundamental to reducing the transmission of communicable diseases. They provide education and resources grounded in trust and shared experience.

Target 3.5: Strengthen the Prevention and Treatment of Substance Abuse

Peer support is a powerful tool in addiction services, offering a unique form of empathy and understanding that clinical approaches may lack.

1. Engagement and Support: Peer workers act as a bridge between individuals who use drugs and formal treatment services, improving engagement and retention in care, including in hospital settings.
2. Overdose Response: In the context of the overdose crisis, particularly in North America, peers are often first responders, saving lives through the administration of naloxone and providing immediate post-overdose support.
3. Mental Health and Homelessness: The intersection of substance use, mental health, and homelessness is a key area where peer support has proven effective, addressing complex needs holistically.

SDG 8: Decent Work and Economic Growth

While peer work provides significant societal benefits, the employment conditions for peer workers themselves are a critical area of concern, directly relating to SDG 8’s call for decent work for all.

Target 8.5: Full and Productive Employment and Decent Work

The formalization of the peer workforce presents both opportunities and challenges for achieving decent work standards.

• Employment Opportunities: Peer work offers a vital pathway to employment and economic stability for individuals who face significant barriers due to their history of substance use or other lived experiences.
• Precarious Work Conditions: Much of the literature, especially from Canada, highlights the precarious nature of peer work. This includes low pay (often stipends instead of wages), lack of benefits, job insecurity, and poorly defined roles.

Target 8.8: Protect Labour Rights and Promote Safe and Secure Working Environments

The well-being of the peer workforce is essential for the sustainability of these programs.

1. Emotional Labour and Burnout: Peer workers experience significant emotional labour, stress, and burnout from navigating traumatic situations, systemic stigma, and the dual identity of being both a worker and a member of the community they serve.
2. Workplace Safety and Support: There is a critical need for better organizational support, including robust training, clear supervision, fair compensation, and mental health resources to protect peer workers and ensure a safe working environment. This is particularly relevant in high-stress overdose response settings.

SDG 10: Reduced Inequalities

Peer work inherently addresses SDG 10 by empowering and promoting the social, economic, and political inclusion of marginalized populations.

Target 10.2: Empower and Promote Social, Economic, and Political Inclusion

Peer workers and their organizations are key agents of change in promoting equity.

• Challenging Stigma: By their very presence and expertise, peer workers challenge health-related stigma and discrimination within healthcare and social service systems.
• Community Empowerment: Peer-led organizations provide a platform for the voices of people who use drugs, ensuring their meaningful participation in the design and implementation of policies and programs that affect their lives.
• Policy Influence: Research highlights the growing influence of peer-based organizations in shaping drug policy at local, national, and even international (e.g., United Nations) levels.

Target 10.3: Ensure Equal Opportunity and Reduce Inequalities of Outcome

By improving access to services, peer work directly helps to reduce health inequalities.

• Bridging Gaps in Access: Peer workers connect the most vulnerable individuals to health, housing, and social services, mitigating the impacts of structural inequality.
• Advocacy for Rights: They advocate for the rights and dignity of their communities, fighting against discriminatory practices.

Cross-Cutting Themes and Synergies with Other SDGs

The impact of peer work extends beyond these core areas, showing synergy with other global goals.

SDG 1 (No Poverty) and SDG 16 (Peace, Justice and Strong Institutions)

• Economic Stability (SDG 1): Fair compensation for peer work can be a direct mechanism for poverty reduction among highly marginalized groups.
• Justice System Reform (SDG 16): The literature touches upon the tension between harm reduction and prohibitionist legal frameworks. Peer work operates within this tension, and its success is linked to broader drug policy reform, such as decriminalization and improved police-public health partnerships, which are essential for building just and effective institutions.

Conclusion and Recommendations for Policy Alignment with SDGs

The reviewed literature overwhelmingly supports the conclusion that peer work is a high-impact, multi-faceted strategy that advances numerous Sustainable Development Goals. It is fundamental to achieving good health and well-being (SDG 3), reducing inequalities (SDG 10), and has the potential to contribute to decent work (SDG 8). To fully realize this potential, policies must be developed to address the systemic challenges faced by the peer workforce.

1. Develop National Frameworks: Governments should support the development of national peer workforce guidelines, as seen in Australia and Ireland, to standardize roles, training, and compensation.
2. Ensure Fair Compensation and Decent Work: Organizations must move from volunteer stipends to fair wages and benefits, recognizing peer work as a professional discipline, in line with SDG 8.
3. Invest in Support and Training: Adequate funding is required for comprehensive training, ongoing supervision, and mental health support to prevent burnout and ensure the well-being of peer workers.
4. Promote Policy Reform: To create an enabling environment for peer work, continued efforts are needed to reform punitive drug laws and foster collaboration between public health and law enforcement, aligning with the principles of SDG 16.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

Based on the titles of the references provided, several Sustainable Development Goals (SDGs) are addressed. The core themes revolve around health, decent work, and reducing inequalities for marginalized populations, specifically people who use drugs.

1. SDG 3: Good Health and Well-being: This is the most prominent SDG. The references repeatedly focus on health issues such as HIV/AIDS (references 11, 14, 15, 41, 46, 100), Hepatitis C (references 18, 19, 21, 22, 45, 49), mental health (references 2, 4, 5, 6, 88, 91), substance abuse treatment (references 1, 9, 62), and harm reduction strategies like overdose prevention (references 54, 57, 71, 74). The role of peer workers is consistently examined as a method to improve health outcomes for these conditions.
2. SDG 8: Decent Work and Economic Growth: The article’s references explore the concept of “peer work” as a form of employment for people with lived experience of drug use. This connects to SDG 8 by examining work conditions (references 1, 69), compensation and equal pay (references 61, 65), workplace discrimination (references 26, 27), and the promotion of safe and secure working environments, including addressing issues like burnout and emotional labor (references 66, 70, 83, 87, 91).
3. SDG 10: Reduced Inequalities: The focus on “people who use drugs,” “homelessness,” and other “marginalized” or “vulnerable” populations directly addresses the goal of reducing inequalities. The references discuss tackling stigma and discrimination (references 25, 41, 119), empowering these groups through participation and employment (references 45, 48), and ensuring their social and economic inclusion (references 67, 78, 81).
4. SDG 16: Peace, Justice and Strong Institutions: Several references touch upon the institutional and legal frameworks surrounding drug use. This includes drug policy (references 56, 81), the role of law enforcement and the criminal justice system (references 106, 109, 111, 112), and the effects of decriminalization (references 113, 115, 116). These topics relate to promoting the rule of law, ensuring equal access to justice, and developing effective, accountable, and inclusive institutions.
5. SDG 17: Partnerships for the Goals: The concept of peer support and community-led initiatives inherently involves partnerships. The references describe collaborations between public health services, civil society organizations (e.g., peer-based drug user organizations), and individuals with lived experience to achieve health and social goals (references 63, 78, 79, 109, 118).

2. What specific targets under those SDGs can be identified based on the article’s content?

The article’s references point to several specific SDG targets:

• Target 3.3: End the epidemics of AIDS, combat hepatitis, and other communicable diseases. This is directly supported by numerous references on peer support for HIV and Hepatitis C prevention, testing, and treatment among people who inject drugs (e.g., 11, 14, 18, 20, 21, 46, 100).
• Target 3.4: Reduce premature mortality from non-communicable diseases and promote mental health and well-being. This is relevant to references discussing peer support for mental health services and for people with chronic conditions (e.g., 2, 5, 8, 88, 91).
• Target 3.5: Strengthen the prevention and treatment of substance abuse. This is a central theme, with nearly all references focusing on harm reduction, peer support for substance use disorders, and overdose prevention (e.g., 1, 9, 12, 54, 62, 71).
• Target 8.5: Achieve full and productive employment and decent work for all, and equal pay for work of equal value. This is addressed in references examining peer work as employment, the value it brings, and the need for fair compensation (e.g., 1, 48, 61, 65).
• Target 8.8: Protect labour rights and promote safe and secure working environments. This is highlighted by references that explore the precarious nature of peer work, burnout, emotional labor, and the need for organizational support and safety (e.g., 66, 69, 70, 82, 90, 91).
• Target 10.2: Empower and promote the social, economic and political inclusion of all. The entire model of employing peer workers is an act of inclusion. References on peer involvement in policy and research underscore this target (e.g., 45, 78, 81, 131).
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws and policies. This is reflected in studies on stigma, workplace discrimination, and the impact of drug decriminalization policies (e.g., 25, 26, 27, 113, 116, 119).
• Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels. This is supported by references advocating for and evaluating the meaningful participation of people who use drugs in developing policies, programs, and research (e.g., 76, 78, 81, 118).

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

While the article does not list official SDG indicators, the research topics cited in the references imply various ways to measure progress:

• Implied Indicators for SDG 3:
  • Rates of engagement in HIV and Hepatitis C testing and treatment services for people who use drugs (references 23, 46, 49).
  • Reduction in overdose incidents and mortality in areas with peer-led naloxone and overdose response programs (references 54, 71, 75, 127).
  • Number of individuals accessing harm reduction services (e.g., needle/syringe programs) through peer outreach (references 9, 80, 95).
  • Improved mental health outcomes (e.g., reduced symptoms, increased well-being) for clients of peer support services (references 2, 5).
• Implied Indicators for SDG 8:
  • Data on job satisfaction, burnout rates, and turnover intention among peer workers to assess work quality (reference 91).
  • Analysis of wages, stipends, and compensation models to evaluate fair pay for peer workers (references 61, 65, 67).
  • Existence and quality of organizational support structures, training, and supervision for peer workers (references 64, 92, 95, 96).
• Implied Indicators for SDG 10:
  • Measurement of perceived stigma and experiences of discrimination among people who use drugs in healthcare and workplace settings (references 25, 27, 45, 87).
  • Level of involvement and influence of peer-based organizations in policy-making processes (references 78, 79, 81).
  • Number and scope of peer-led services and programs, indicating economic and social inclusion (references 42, 57).
• Implied Indicators for SDG 16:
  • Rates of diversion of people who use drugs from the criminal justice system to health and support services (reference 115).
  • Analysis of government budgets and expenditure on harm reduction versus law enforcement (reference 103).
  • Number of policies and guidelines co-designed with people who have lived experience (reference 118).

4. Table of SDGs, Targets, and Indicators

Source: harmreductionjournal.biomedcentral.com