[Let’s juxtapose this with the NCD (Non-Communicable Disease) of Illicit Drug use – Where should our focus be on drug policy? The following article was posted in October 2020 on Lancet – Public Health. We have simply quoted it verbatim but added our commentary in bracketed inserts. Dalgarno Institute]
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In The Lancet Public Health, Howard Bolnick and colleagues extend this logic in the US context and quantify the proportion of US health-care spending in 2016 that was due to preventable causes [of which drug use is a growing part].
They found that more than a quarter…of health-care spending was due to these preventable illnesses [of which drug use is a growing part].The US health-care system is famously expensive: the USA spends 16·9% of its gross domestic product (GDP) on health care, twice the Organisation for Economic Co-operation and Development average of 8·8%.
Therefore, in absolute terms, the sheer cost of these preventable illnesses [of which drug use is a growing part] is staggeringly high, estimated at US$730·4 billion in the USA alone in 2016. To put this figure into perspective, it is more than the 2019 GDP of 171 countries in the world, or all but the 19 richest countries.
While this analysis is helpful to draw attention to the costs that the USA spends on diseases that it could avoid, [of which drug use is a growing part].it is also drawing attention to a status quo that we have long come to accept: a high proportion of illness and death is preventable, and a lot of money is spent on treatment because we do not do a particularly good job of preventing disease [of which drug use is a growing part].
Why do we continue to accept such a high burden of preventable disease [of which drug use is a growing part], even when the cost of it is known? One could point to the well-trodden discussions about the challenges of prioritising prevention, the immediacy of curative approaches, and the challenge of nurturing investment in avoiding poor health, rather than investment in treatment that gratifies those who are then cured.
The very existence of preventable disease and preventable deaths [of which drug use is a growing part]. should be a rallying cry, a motivation for anyone in any health profession, and really for anyone in a position of responsibility for populations in general. The COVID-19 pandemic has shown that health can come to the forefront of conversations. COVID-19 has resulted in the entire world changing its trajectory during the course of 2020, as national governments worldwide have aimed to prevent the pandemic from spreading. This has put prevention front and centre. Can we not extend the lessons learned in the past year to bring about a permanent doubling down on prevention, putting it at the heart of our conversations on health, well beyond the COVID-19 pandemic? This would require us to embrace the notion that no amount of preventable illness or death is acceptable, and that the $730·4 billion could be repurposed.
[Exactly! If we doubled down on the prevention of drug use, rather than tripling down on the drug use empowering and enabling mechanisms of ‘Harm Reduction’ only that, for the most part only endorse the ongoing promotion of the contagion of the NCD – DRUG USE itself, we can see serious preventative movement. For instance, COVID responses by governments have seen the reduction of drug harms in certain sectors as the result of shutting down vehicles of contagion, such as music festivals, rave events, and night clubs. In these settings, harms and deaths from the NCD of drug use have reduced to zero – complete prevention in these contexts – because one vehicle of contagion (both susceptibility and exposure) has been excised from public arena. As illicit drug use has no health, social or economic benefit, and has no claim as a ‘right’ in the classic human context – but it is a harbinger of non-communicable disease, then public health responses, (not dissimilar with COVID) should be about creating mechanisms that eliminate its capacity to be a contagion, should it not? Of course we realize that social and political will in this context is ‘tougher’ to conjure as this ‘disease’ of drug use has more to do with human agency geared to egocentric, hedonistic, or self-mediating pursuits that have an ‘attractiveness’ that Covid-19 does not; and therein lies the real issue of prevention that has to be addressed! Dalgarno Institute]
Achieving this focus on prevention would require a dramatically different formulation of our global health conversation. It would require that we think about health beyond health care, and that we accept that creating health requires investments in structures that minimise preventable risk factors.
Preventing these risk factors would require an engagement with subsidising the availability of nutritious foods, disincentivising the commercial production of harmful products, [of which drug use is a growing part]. investing in early childhood education that leads to healthy exercise and dietary habits, and creating cities that encourage healthy behaviours. It would also require an acknowledgment of the role of inequalities in wealth and opportunity in the narrowing of paths to better health.
Taken from The Lancet-Public Health VOLUME 5, ISSUE 10, E513-E514, OCTOBER 01, 2020