Policy responses and drug-related deaths: Towards a study of structural determinants of health in Sweden, UK and Ireland

Background
In Europe, over the past two decades, countries have experienced high and/or rising rates of drug-related deaths (DRDs) often concentrated in areas of high deprivation. During the same period, evidence on income inequalities and welfare state retrenchment have been associated with evidence of a flattening or reduction in wellbeing, supporting calls for more attention to the social and structural determinants of health. This presentation reports on a project aiming to explore the influence of structural determinants of health on DRDs.
Methods
The presentation focuses on a comparison of Sweden, UK and Ireland. The 2019 EMCDDA Drug Report placed these three countries among the eight European countries with the highest death rates per million population in 2016 or 2017. The presentation gives an overview of trends in each country regarding DRDs in the past 15 years and reviews key literature offering explanations of these trends.
The second section focuses on a comparison of the situation in the comparator countries in the year 2018, selected as pre-Brexit and pre-COVID. Key concepts are reviewed including: structural determinants of health; social indicators; austerity; drug-related deaths. The history of the development of social indicators is recounted. A literature review identifies key explanations of the structural determinants of DRDs including: ideas of welfare state retrenchment; deindustrialisation, labour market restructuring, area deprivation; community disorganisation; and diseases of despair. These theories help to identify relevant indicators to compare the situation in Sweden, UK and Ireland in 2018. Data are assembled in order to make comparisons.
Results
Differences exist between the three countries on a range of variables such as: DRDs; gini coefficient; life expectancy; poverty; area concentration of poverty; unemployment; homelessness; labour force drop-out rates; redistributive taxation; social expenditure; social protection coverage/eligibility and replacement rates; availability and access to drug treatment, rehabilitation and harm reduction; drug-related offences; rates of imprisonment. These cluster to reveal similarities and differences between the countries.
Conclusion
Identifying and collating comparative indicators is a complex process. Social indicators are perhaps most useful when viewed as ‘can openers rather than labels’. Ideas for further research are presented. 
Public policy is one important determinant of population health. Some have argued that countries with social democratic regimes, higher public spending and lower income inequalities have populations with better health. Evidence from this comparative study of countries with differing social policy histories and different drug policy regimes helps to explain how far this axiom helps to explain rates of DRD.