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SMAD. Revista eletrônica saúde mental álcool e drogas

versão On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.10 no.3 Ribeirão Preto dez. 2014 

DOI: 10.11606/issn.1806-6976.v10i3p110


Social determinants of Health and psychoactive drug use 




According to the World Health Organization (WHO), Social Determinants of Health (SDH) are local conditions in which individuals live and work(1) and are social, economic, cultural, ethnic, psychological and behavioral factors that influence the occurrence of health problems and risk factors in the population(2). Consensus regarding the influence of social determinants on health conditions has been historically constructed, reaffirmed in the discussions that took place when establishing the Millennium Development Goals at the end of the 20th century, emphasizing the relationships between the development process and health, focusing on health inequalities through increasing number of studies on poverty and health and mechanisms producing individual, community and macro-environmental inequalities. Health inequalities represent systematic and relevant inequalities between population groups that can be considered avoidable, unjust and unnecessary(3).

In this context, there is an interface between drug use and abuse and a variety of social determinants and should be tackled using actions and policies that take into account its complexity and the serious consequences that affect users, their families and society. Studies indicate that those in younger age groups, those with low levels of schooling, without family role models, with a criminal record and those who are unemployed are vulnerable to psychoactive drug use(4). Because of the illegal aspect, a fine line can be seen in the way actions to tackle the problem are drawn up, now focusing on security, now on public health. 

Moreover, as a public health issue, there is no denying the social determinants of this phenomenon: poverty, violence, lack of State resources and investment, lack of educational and cultural policies to keep children in school and strengthen family and social ties all support the structure on which this problem rests (5).

As is increasingly being acknowledged, drug use poses a challenge, not least due to its multi-faceted character. In this situation, differentiated views and actions are needed based on understanding users as historically and socially constructed subjects.  

In short, interventions focused on drug use at the macro, intermediate and individual levels should take into account the social determinants and involve coordinated inter-sectorial action. Therefore, this issue of the SMAD Journal presents studies developed in Brazil and abroad, offering different perspectives from which to understand drug use and mental disorders, approaching this discussion, directly or indirectly, of the social determinants of health.



Carla Aparecida Arena Ventura
Associate Editor, SMAD, Revista Eletrônica Saúde Mental Álcool e Drogas, and Associate Professor, Escola de Enfermagem da Universidade de São Paulo, São Paulo, SP, Brail, e-mail: