An addiction-prone society The social fundamentals

Anaddiction-pronesociety?ThesocialfundamentalsofdruguseandabuseRichardEckersleyAustralia21Ltd,NationalCentreforEpidemiologyand[e-mail]:nceph.anu.edu.auLayersofinfluencemodelSource:DahlgrenGandWhiteheadM(1991),InAcheson(1998).HealthexpendituresAccountedforanaverage9%ofGDPinOECDcountriesin2004,upfrom5%in1970.•Australia9.2%(2004)to16%(2020).Preventionandpublichealthprogramsreceiveonlyabout3%ofhealthexpendituresinOECDcountries.25%ofhealthexpendituresonpeopleinlast2yearsoflife.‘….drugsarebutoneofanumberofsocialandhealthproblemsthatcansharecommondeterminants…‘….DruguseproblemsandmentalillnessaretheleadingcausesofdiseaseandinjuryinAustraliansaged15to24,andthetwooftenoccurtogether…’MinisterialCouncilonDrugStrategyMonograph2004‘Alcoholisstronglylinkedwithanxietyanddepression,particularlyinthosewhoaredependentonalcohol,andthisincreasestherisksofviolenceandsuicidalbehaviour.’‘…Drinkingamongyoungpeople…increasedthroughoutthe1990s.’MinisterialCouncilonDrugStrategyMonograph2004‘YoungpeopleinAustraliagenerallyenjoyalevelofhealththatisgoodandhasimprovedinrecenttimes,asindicatedbylevelsofmortality,morbidityanddisability’Australia’sHealth2004AIHW‘Despiteoverallhealthimprovements,theinequalitiesinhealthstatusacrossthepopulationhaveremainedverymarkedandinsomecaseshaveincreased.’NoTimetoLose:ThewellbeingofAustralia’schildrenSueRichardson,MargotPrior(eds),2005‘Bycontrast(toXers),Yersareahappy,well-behavedandoptimisticbunch….Thisisahealthydemographic,reportinglowlevelsofpsychologicaldistress.’TheWorldAccordingtoYRebeccaHuntley,2006Deaths,allcauses,males15-24,bySES,1985-87and1995-97Source:Turrell&Mathers,2001149.3136.1100.2129.4107.872.6020406080100120140160per10000085-8795-97YearlowmiddlehighDeaths,allcauses,females15-24,bySES,‘85-87and‘95-9761.946.840.24237.329.9010203040506070per10000085-8795-97YearlowmiddlehighSource:Turrell&Mathers,2001Smoking,women,15-24,bySESquintiles0510152025303540451234519902001Source:Turrelletal,2006Alcoholrisk,women,15-24,bySESquintile0246810121234519902001Source:Turrelletal,2006Alcoholrisk,1995-2005,byageHealthinequalities–morethaneconomicsResearchhasfocusedheavilyonsocio-economicinequalitiesinhealth.Otherwaystoslicehealthinequalitiescake:•Gender•Age/generation•Raceandethnicity•Religion•Marriage•Socialnetworks.MentalhealthproblemsinAustralia,byage1426.621.319.917.512.36.10510152025304-17yrs18-24yrs25-34yrs35-44yrs45-54yrs55-64yrs65+AgeSource:ABS,1998Evidenceontrendsinhealth,wellbeing1.Diminishingbenefitswithrisingincome.2.Increasesinchronicmentalandphysicalillness.3.Perceptionsofdecliningqualityoflife.4.Widegulfsbetweenpromised,probableandpreferredfutures.5.AlternativeindicatorstoGDPshowlittle‘genuineprogress’.Healthtrends-explanations1.Structuralchanges–eg,increasinginequality,workstrains,familybreakdown,urbanisation.2.Culturalchanges–eg,excessivematerialism,individualism.3.Increasingmediaimpacts–eg,violence,envy,greed,disengagement.4.Declineofreligion–‘packages’manysourcesofwellbeing.5.Dietarychanges–eg,lessomega3;implicatedinmooddisorders,heartdisease.Healthtrends–explanations(cont)6.Environmentalchange:‘Thedualtrendsofgrowingexploitationofecosystemservicesandthegenerallydecliningconditionofmostecosystemsareunsustainable…Ecosystemchangesmayoccuronsuchalargescaleastohaveacatastrophiceffectonhumanhealth.’Ecosystemsandhumanwell-being:healthsynthesis.MillenniumEcosystemAssessment,2005Healthtrends-interactionsSocialcausesinteractwithindividual,age,generationalfactors:Genes‘for’depression,anxiety,addiction–expressiondependsonenvironmentalfactors.Psychologicalchanges–eg,moreanxiety,lesscontrol.Foetal,childandadolescentdevelopment–increasedvulnerabilitytorisk.Otherdisorders(comorbidity).Satisfactionvshealth:ATSLarge,longitudinalstudyofVictorianchildren.Atage19-20:Over80%satisfiedwiththeirlives–includinglifestyle,workorstudy,relationshipswithparentsandfriends,accomplishmentsandself-perceptions.50%experiencingoneormoreproblemsassociatedwithdepression,anxiety,anti-socialbehaviourandalcoholuse.Source:Smart&Sanson2005Capitalismandwellbeing‘…theaimsmostconsistentwithAmericancorporatecapitalism(ie,self-interest,financialsuccess,competition)….conflictwithandunderminepursuitslongthoughtbypsychologiststobeessentialtoindividualandcollectivewellbeing.’KasseretalPsychologicalInquiry(inpress)Addictionandsubstitutelifestyles‘…addictiontodruguseortoothersubstitutelifestyleswithinwesternsocietiesisnotthepathologicalstateofthefew,but,toagreaterorlesserdegree,thegeneralcondition.’BruceAlexanderAddictionResearch,2000Culturalfraud‘…individualismandmaterialismarepowerfullyandmutuallyreinforcingintheirnegativeimpacts….theyhaveproducedaselfthatissociallyandhistoricallydisconnected,discontented,insecure;pursuingconstantgratificationandexternalaffirmation;pronetoaddiction,obsessionandexcess.’RichardEckersleyDrugandAlcoholReview,2005Spiritualityandaddiction‘Manyofourhumanactivitiesarecopiesorreproductionsofimpulsesthatareinvisible,hardtodiscern,andpoorl