Home > Inequality and illicit drug use.

Pike, Brigid (2011) Inequality and illicit drug use. Drugnet Ireland, Issue 38, Summer 2011, pp. 8-10.

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The more unequal a society, the higher the level of drug use. This finding is just one in a study by UK epidemiologists Richard Wilkinson and Kate Pickett into the social determinants of health, into ‘why health gets worse at every step down the social ladder’.1 Ireland was one of 22 ‘rich’ countries included in the study. The authors concluded that where there is inequality in a country, there is a corresponding loss of general health and well-being, as indicated by measures of community life and social relations, mental health, illicit drug use, physical health and life expectancy, obesity, educational performance, teenage births, violence, imprisonment and punishment, and social mobility. 

The nub of Wilkinson and Pickett’s argument is that the prevalence of poor health and social problems is related not to the average standard of living in a country but to the degree of inequality (as measured by the disparity between the incomes of the richest and the poorest inhabitants). The problem is not associated with the overall level of wealth in a country but with the size of the difference between those with the highest incomes and those with the lowest. With regard to illicit drug use, the authors found ‘a strong tendency for drug use to be more common in more unequal countries’, with Ireland lying just above the midpoint in terms of the relationship between drug use prevalence and income inequality.2
Widely read and debated, Wilkinson and Pickett’s work has been challenged on many grounds – the choice of countries studied, the selection of problems to be assessed, and failure to control for intervening variables such as national culture or welfare system. It has also been asserted that their findings were the result of ‘statistical flukes’, in other words, dependent on the presence of outliers.3  While it is not within the remit of Drugnet Ireland to assess the merits or otherwise of their approach and their arguments, Wilkinson and Pickett’s work provides a framework within which to interrogate the new government’s programme Government for national recovery 2011–2016 (PGNR),4 and in particular to explore whether and how they have made the link between illicit drug use and inequality.  Although Ireland’s policy makers have never made the link explicitly, they have made indirect links by associating illicit drug use with socio-economic disadvantage, marginalisation and exclusion.5
As long ago as 1996, the Ministerial Task Force on Measures to Reduce the Demand for Drugs, chaired by Pat Rabbitte TD, then Minister of State, recognised the link between drug misuse and socio-economic disadvantage. The task force recommended the establishment of drugs task forces in areas experiencing high levels of drug misuse, which also coincided with areas experiencing social and economic deprivation. Since 2001 Ireland’s national drugs strategies have set the drugs issue within the wider policy context of social inclusion, to which a number of other national strategies in Ireland, such as health, anti-poverty and education, are also linked.6  
In the PGNR, the government brings two new terms to the fore inrelation to social policy – fairness and equality. In their introductory Statement of Common Purpose, the coalition partners state: ‘We are both committed to forging a new Ireland that is built on fairness and equal Citizenship. ... By the end of our term in Government Ireland will be recognised as a modern, fair, socially inclusive and equal society supported by a productive and prosperous economy.’ Along with chapters on the Economy, Reform and Progress, the PGNR contains a chapter on Fairness.
Although the authors of the PGNR do not define fairness, the measures in the chapter on Fairness are placed within the context of principles which, it may be assumed, the government believes will lead to a fair society ­– social solidarity, social inclusion, and reduction of stigma. With regard to equality, the chapter on Fairness does provide some explanation: under the heading Equality and Social Protection, the authors describe equality as being at the heart of what it means to be a citizen in Ireland’s democracy: ‘The government believes that everyone has the right to be free from discrimination and that we all benefit from living in a more equal society.’ The government commits to ensuring equal access to health and to education, and lists measures to ensure equality and social inclusion for women and men, Travellers, members of the lesbian, gay bisexual and transgendered community, workers, members of minority ethnic groups and immigrants, and people with disabilities. 
Although the drugs issue is addressed in the chapter on Fairness, at no point is policy to tackle the illicit drugs problem mentioned in conjunction with either equality or the concepts and principles understood to underpin fairness. The drugs issue is included the section entitled Justice and Law Reform, and four broad objectives are listed:
o   to introduce a combined drugs and alcohol strategy (a ‘national addiction strategy’),
o   to provide ‘renewed impetus to the fight against drugs’,
o   to ensure that the drugs strategy ‘once again becomes relevant and effective’, and
o   to enhance, where possible, ‘the demand reduction strategies’.
Although not as clear or unambiguous as recent statements on drug policy by the governments in Britain and Denmark,7 the new Irish government’s stated objectives suggest, as much by omission as inclusion, that a shift in emphasis may be occurring. This is borne out by the 12 ‘key priorities for short-term implementation’ listed alongside the four objectives, which focus on supply reduction, prevention and rehabilitation; just one action refers to harm reduction, increasing the number of needle exchange programmes as well as the number of rehabilitation places throughout the country.  
The new government’s reallocation of responsibilities for Ireland’s drugs policy, detailed elsewhere in this issue of Drugnet Ireland, does not help to clarify its thinking on the nature of the links between the drugs problem and other social policy issues. Prior to the February election,  responsibility for drugs policy had come to be located  in the same government department as community and local development, equality and social inclusion policy, suggesting a common goal or shared aspiration among all these policy domains.  The new government’s transfer of functions sees these four policy areas separated once again and assigned to four different government departments.
How the Department of Health will approach its new function of co-ordinating the national drugs strategy remains to be seen. In their study of the links between health, social problems and inequality, Wilkinson and Pickett argued that policy makers should integrate health and social problems as elements of a single policy problem – inequality – rather than approach them as separate issues:
Attempts to deal with health and social problems through the provision of specialized services have proved expensive and, at best, only partially effective. ... Rather than reducing inequality itself, the initiatives aimed at tackling health and social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it creates. The unstated hope is that people – particularly the poor – can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure, obesity or drugs. (pp. 238–9)
1. Wilkinson R and Pickett K (2010) The spirit level: why equality is better for everyone. Published with revisions and a new postscript. London: Penguin Books.
2.The authors obtained data on drug use in the 22 countries, as reported in the World drug report compiled annually by the United Nations Office on Drugs and Crime, and plotted this against the level of income inequality in the countries, as reported in the Human development report compiled annually by the United Nations Development Programme.
3. A full account of the criticisms and the authors’ responses may be found at [no longer available]
4. Fine Gael and the Labour Party (2011) Government for national recovery 2011–2016. www.taoiseach.gov.ie
5.An exception is the strategic plans of the newly-established regional drugs task force, completed in 2005, some of which explicitly discussed the relationship between illicit drug use and social exclusion and inequality. See Pike B (2006) RDTF strategies push out the boundaries. Drugnet Ireland, (20): 11–12.
6. See, for example, the National Drugs Strategy 2001–2008 (Department of Tourism, Sport and Recreation, 2011) para. 6.1.9, and the National Drugs Strategy 2009–2016 (Department of Community, Rural and Gaeltacht Affairs 2009) para. 6.21.
7. McKeganey N (2011) From harm reduction to drug user abstinence: a journey in drug treatment policy, Journal of Substance Use, 16(3): 179–194, traces a recent policy shift in Britain from the goal of harm reduction to one of drug user abstinence, while Houborg E and Bjerge B (2011) Drug policy, control and welfare, Drugs: education, prevention and policy 18 (1): 16–23, describe  how the welfarist political rationality that underpinned Denmark’s drug ‘policy space’ in the 1970s and 1980s has been superseded over the last two decades by a ‘New Right’ political rationality combining a tough-on-crime policy with the marketisation of drug service provision.
Item Type
Publication Type
Irish-related, International, Open Access, Article
Drug Type
All substances
Issue Title
Issue 38, Summer 2011
Page Range
pp. 8-10
Health Research Board
Issue 38, Summer 2011
Accession Number
HRB (Electronic Only)

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