Attention
I’m reading Flourish by Daniel Coyle this week. The subtitle is The Art of Building Meaning, Joy, and Fulfillment. I wasn’t sure what to expect, honestly, because I’m sometimes put off by things that are just a bit too earnest, but it’s not, and I’m really enjoying it. 

A sentence that stood out to me, quoting British philosopher Iain McGilchrist: “The type of attention we bring to the world changes the world we find.”

The type of attention we bring to the world changes the world we find. 

Advocacy is a long game
I shared a little cartoon a couple of years ago on Facebook: 

Two people are standing in a garden. One says to the other, “Aren’t you worried what next year will bring? Everything is so crazy these days.” The other replies, “I think it will bring flowers.” “Oh, really? Why?” “Because I’m planting flowers.”

In 2023, we were told by the government that the main reason that Manitobans had the highest rates of hepatitis C in the country was, I kid you not, “patient noncompliance.” 

We knew that was BS, so we flew into Winnipeg, drove 8 hours north, and attended a harm reduction peer gathering in the parking lot of an arena in The Pas. That’s where a young, gay, Indigenous man who uses drugs told me that he has known he has hepatitis C for a few years, but the government will only pay for him to be treated one time, so he’s going to wait until he’s done using drugs, and then he will cure his Hep C. 

Up in The Pas, this man was making a strategic life decision with the information he had. But when he skipped the telehealth appointment with the “hepatitis investigation unit” in Winnipeg since he was going to “save” his treatment for later, it was understood as patient noncompliance. A classic unintended outcome of a policy that rations hepatitis C medication for people who “deserve” it. (I can tell you the racism is next-level in Manitoba, but it’s really something you have to see for yourself to believe.) 

We gathered stories like this all week and went back down to Winnipeg to share our findings with the government on World Hepatitis Day. It was…impactful. And it was the beginning of working with some good people (and working around some jerks) to make important changes. 

We have been working on policy barriers in Manitoba for two and a half years now, chipping away, one small win at a time. 

Then. Last week, the Manitoba Harm Reduction Network held a 3-day test-and-treat event in Swan River. Swan River has been in a hepatitis C outbreak for years, and despite our best efforts, barrier after barrier meant that eager and willing people could not get treated. But enough policies had changed by this spring that point-of-care tests could be used and their results accepted, meaning diagnoses could happen same-day instead of waiting for lab results, and prescriptions could be given. Also, a family doctor could write the prescriptions, instead of one of three hepatologists in the province. Much lower barrier. This event could not have even happened three years ago.

So, 44 people were tested, and 37 were HCV-positive with active infection. (That’s bananas, by the way.) Almost all of them were able to start treatment within 2 days. They’ll take a daily pill for 8 weeks (supports are in place to help that happen), and they’ll be cured. 

Obviously, I can take only partial credit, but at the risk of sounding corny (and maybe a bit too earnest), we planted some stubborn little advocacy flowers in 2023, and as the snow melts in 2026, they are finally blooming. 

So today I’m paying attention to this. 

I’m carefully reconnecting and thanking the middle managers, bureaucrats, and community workers who played a part in getting us here. 

I’m helping to document this win so we can share it widely with other communities. 

And I’m thinking about all the other stubborn little advocacy flowers I have planted all OVER the country that I thought hadn’t taken root, but might bloom when I least expect them. 

I’m also paying attention to the positive energy buzzing off everyone who was involved in this test-and-treat event. They are so excited and engaged and ready for the next one. They set out to organize an event, but it would appear they also found meaning, joy, and fulfillment in being part of it. 

So yeah. We never know what wonderful things may come out of our efforts. But we can be mindful of where we put our attention, and it will shape the world we find. 

​

For some of you, Risk, Set, Setting will not be new. It is a widely recognized theory in harm reduction, but its applications go far beyond substance use. 

As Hassan describes it, Norman Zinberg, through his 1984 book Drug, Set, and Setting, “gave academic support to things that activists have been saying for decades.” 

In his theory, the term drug means any substance someone uses for mood- or mind-altering experiences. Mindset, or set, describes the mood or state of the person prior to using the substance. Setting refers to the social and physical environment in which use occurs. Hassan writes, “For example, a gay person sitting on a gay beach with friends during a butterfly migration using LSD will have a radically different drug experience compared to an isolated teenager in a dark bedroom using LSD alone.”

This three-part approach seems simple and even intuitive, but it has the potential to be deeply disruptive. 

Accountability, Reframed
The current dominant narrative collapses all of this into one word: choice. 

We are told that if someone is using drugs, it’s a personal failure. 
Or if someone is living in an encampment, it’s service refusal. 

Risk, Set, Setting (RSS) interrupts that reduction and widens the frame. It shifts the focus from isolated behaviour to shared conditions.

Traditional treatment and services centre the drug itself as the problem, and therefore commonly require abstinence or sobriety in order to access care. RSS challenges this practice by showing that harm is shaped by multiple components, many of which are structural. 

Hassan concludes, “When we understand RSS, we can begin to play with this triangle and address common outcomes. … We can rethink this model and apply it to intimate partner violence, police violence, self-injury, medication management, disability, chronic illness, houselessness, and more.” 

We can ask better questions: 

• What would make someone safer today?
• What would reduce harm in this setting?
• What stability might change the trajectory?

That doesn’t eliminate personal responsibility or agency. Rather, it locates it within reality.

And it does help us move from managing “high-risk behaviours” to reshaping high-risk environments.

From Individual Blame to Shared Environment
When we label behaviour as “high-risk” without examining the setting, we quietly absolve ourselves of responsibility for the conditions that produced it.

Importantly for our work, we can help (re)create those settings. 

Policies are part of setting. 
Shelter rules are part of setting. 
Even the stories we tell and the narratives we build are part of setting. 

And those settings shape outcomes. 
When we see through the RSS lens, the conversation shifts from individualism toward interconnectedness.
Because none of us operates outside of set and setting. We are all shaped by our histories. We are all navigating risk. We are all living within systems that either support or destabilize us.
The difference is that some people are navigating far harsher environments — often ones we collectively design or at least tolerate. And harsher environments predict harsher outcomes.

Disrupting Othering With ContextOne of the most powerful aspects of this framework is that it opens space for history and context, which is the kind of reframing the Frameworks Institute encourages communicators to use.

It allows us to say:

• The overdose crisis is not simply about individual irresponsibility; it is shaped by decades of policy decisions, criminalization, and an increasingly toxic supply.
• Encampments are not evidence of moral decline; they are evidence of structural scarcity.
• Relapse is not proof of bad character; it is often a predictable response to instability, trauma, and isolation.
  

When we zoom out, individual blame is harder to sustain. 

A Framework For Good
Risk, Set, and Setting is disruptive because it refuses simplistic explanations. It complicates the story in ways that demand we look at ourselves: at our policies, our budgets, and our narratives.

It reminds us that harm is not just a matter of willpower. It is shaped by environment.

If we want different outcomes, we cannot focus only on individual behaviour. We must reshape the settings we collectively create, including our narratives and shared understanding of homelessness and drug use.

We can continue policing “high-risk behaviours.”
Or we can redesign the conditions that make them high-risk in the first place.

The choice — collectively — is ours.

Looking ahead: 2026
2026 is going to be a year with a lot of changes for me personally: I’ve chosen to end a 12-year contract I’ve had leading the Network of Rare Blood Disorder Organizations this coming April, and the girls will graduate high school in June, and we expect that at least one, if not both of them, will live somewhere else in September. 

While there are some unknowns, I’m excited to see what shows up to fill the space I’m purposely creating in my schedule and in my brain. 

In the meantime, I have decided to sort of “pilot” a more structured approach to how I create my to-do lists this winter. 

I regularly face choices in where to put my time and attention (you probably are too):

• Urgent vs meaningful
• Loud vs strategic
• Individual fixes vs structural change
• Motion vs leverage

When I look across the 2026 work plans for the organizations I’m part of, a clear throughline emerges: messaging and narrative work focused on changing how people understand marginalized groups and social issues — because humane policy depends on it.

• Overcoming othering 
• Reframing problems as system failures
• Shifting narratives
• Building shared understanding that enables collective action

More than ever, the skillset I need and the work I do across my various roles is integrating, and I need to protect significant creative space in my schedule for narrative work and learning more about movement building, not just on the side for fun, but as a core part of my paid work. This is exciting!

I want to be really intentional about ensuring the space created by wrapping up at the NRBDO doesn’t get sucked into other people’s to-do lists. 

I want to make sure that, to the extent possible, the items on my daily to-do lists flow from the strategic priorities I have set and the select few flagship projects I have chosen, not from requests in my inbox. This does not come naturally to the people-pleasing, Enneagram 3s among us! But it feels really important for me to at least try in this season.

 So, while I don’t really have a word, I am trying out a bit of a new filter for 2026: 

I protect my time to focus on what matters. 

In 2026, outside the work I’m wrapping up with the NRBDO, I am focusing on narrative change and movement-building to counter othering and support humane housing and health policy, particularly for people who use drugs and people experiencing homelessness.

If something doesn’t clearly advance this, it’s likely a no.

I’m a pretty productive person. I plan my days around tasks, and I complete a LOT of tasks, but I’m not necessarily super conscious of whether those tasks align with my stated priorities. In January, I’m going to be testing out some structures and rhythms that let me design my days with this in mind (not just activity and checking things off, even though I DO find checking things off very satisfying). 

But as I do this, I will keep a little counterbalance to hold alongside this filter about protecting my time for things that matter — something I heard on a podcast this week that really grabbed my attention and may resonate with you, too: it’s possible to optimize yourself right out of a beautiful life. 

As in, time management systems are great when they serve us and the life we want to build. But we should be the boss of those systems, not a slave to them. Efficiency isn’t the goal. A beautiful, meaningful life that leaves room for curiosity and creativity and relationships and a bit of wandering is. And that's a gentle reminder I want to carry in my pocket with me into 2026. 

​Lately, I’ve been wondering whether the shifts I write about might help with this particular flavour of anger. Maybe I’m angriest when I’m being certain instead of curious. Or when I’m wishing people would appreciate my efforts instead of grounding myself in solidarity.

So I tried practicing those shifts this week. And you know what? It has helped.

When I make the effort to stay curious — not my default setting these days — the anger loosens its grip a bit. It doesn’t soften the righteous anger that fuels justice work. That stays. But it does soften the ego-driven anger: the anger of over-identification, of wanting credit, of feeling like everything is on my shoulders.

But there’s more to it. Some of this anger comes from carrying responsibilities that should be collective and working inside systems that don’t meet the scale of the need. From feeling unseen, under-resourced, and undervalued. Sound familiar?

For years the advice was “self-care.” And sure — it’s better than nothing. But I’m noticing a shift toward recognizing that community care is even better. All this pressure breeds anger; connection relieves some of it.

Connection interrupts the isolation that tells us it’s all on us. It restores a sense of collective effort. It reminds us: I have an important part to play, but I don’t have to do everything.

Maybe that’s part of why unions are cool again. Maybe we’re remembering that collective power isn’t just effective — it’s energizing. I once heard Dean Spade say that we often think, “I’m too tired to go to tonight’s organizing meeting,” but when we actually go, it gives us more energy than a nap ever would. I think about that a lot.

To be clear, the anger at structural injustice, chronic scarcity, and political hostility is legitimate.

But if we find our people, stay curious, and sit in solidarity, maybe we can change how we experience this context internally. So this important work doesn’t eat us alive.