Dr. Simon Hatcher
Over the course of my career, I’ve been privileged to work in several low income countries, both clinically and to support post-graduate education. More recently, I’ve been regularly providing support at a psychiatric hospital in Vietnam. Unlike countries such as Canada, when discussions of suicide occur in these places the first questions clinicians ask usually don’t involve asking about overdoses of prescribed medication or hanging. Instead, much more commonly patients will be asked about ingesting pesticides.
Global estimates of the percentage of suicides using pesticides vary, ranging from 20% to 30%. In low-income countries, pesticides are also aggressively marketed to farmers and agriculturalists, and are readily available in roadside stores. Given this situation, it seems evident that if one really wanted to reduce the prevalence of suicide worldwide, the prevention of these deaths would be a good place to start.
However, this is where things get a bit murky. We know that preventing access to the means of suicide is one of the most effective ways of preventing suicide deaths. One way to do this is to provide lockable pesticide storage boxes – a bit like lock-ups for firearms – which prevent people impulsively accessing the chemicals. This is the approach favoured by the pesticide industry. However, this puts the onus on the farmer, and doesn’t actually seem to work. A cluster randomized trial recently published in The Lancet found no evidence that storage boxes in rural Sri Lanka had any effect on pesticide poisonings. An alternative approach is to have country wide bans on the sale of certain pesticides. A new systematic review in The Lancet by David Gunnell et al found that “National bans on commonly ingested pesticides in five of the six countries studied …. were followed by reductions in pesticide suicides and, in three of these countries, falls in overall suicide mortality”. They conclude that “A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year”.
September 10th was World Suicide Prevention Day, with events continuing into the month of September, and we have evidence that national bans on pesticides work to reduce suicide. But Syngenta – a Swiss multinational agribusiness that sells more than half its pesticides to developing countries – is a sponsor of World Suicide Prevention Day. Isn’t this a bit like tobacco companies campaigning to prevent lung cancer?
So, if you want to make a difference in suicide rates around the world, why not take a minute and donate to the Environmental Justice Foundation’s Eradicating Toxic Pesticides campaign (https://ejfoundation.org/what-we-do/pesticides) or the Pesticide Action Network (http://www.panna.org/)? After all, it’s what the evidence says works to reduce the tragedy of suicides around the world.
 Pearson M, Metcalfe C, Jayamanne S et al. Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial. (published online Aug 11.) Lancet. 2017; http://dx.doi.org/10.1016/S0140-6736(17)31961-X