A vendor in a pesticide shop reaching out to grab a bottle of pesticide from a display shelf.

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Tackling global suicide

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As the World Health Organization (WHO) celebrates its 75th year, on World Health Day 2023, we explore how researchers at the University are working closely with the organisation to tackle one of the most common causes of global suicide.

Warning: this article discusses suicide and self-harm. To access support, and a local helpline visit: www.findahelpline.com

The World Health Organization has reached the grand old age of 75, marking three quarters of a century of work dedicated to global health. Its life achievements have been numerable and significant, including a leading role in the eradication of smallpox and the development of an Ebola vaccine. However, around the time of WHO’s 15th birthday, a new threat to global health exploded onto the scene – the threat of pesticide suicide.

A lethal means of self-harm

The Green Revolution of the 1960s quickly introduced widespread use of pesticides in small-scale farming. This sea change in agriculture was particularly felt in rural farming communities in the Global South. Communities across South-East Asia, Africa and Latin America – often home to vulnerable people living in poverty – were given unrestricted access to a wide range of pesticides. These products were sold in local shops without controls and often stored in homes and gardens in easy reach of family members.

Farmers regarded pesticides as ‘medicine’ for their crops, but many of these ‘medicines’ are highly toxic to humans, posing a significant threat to human health.

In particular, the arrival of pesticides posed a very specific threat to people at risk of self-harm. They had been given easy access to a wide range of poisonous substances, many of which were lethal when ingested.

In just a couple of decades, pesticide poisoning became, and remains, one of the most common methods of suicide worldwide.

Remarkably, considering the scale of the crisis, it remains a largely unknown issue to those living in the Global North, where the same access to lethal pesticides does not exist. In fact, 77% of global suicides occur in low- and middle-income countries.

To date, an estimated 14 million lives have been lost from pesticide self-poisoning.

Image shows a man spraying pesticides in a field.
Man spraying pesticides on a field

Suicide prevention

According to the WHO, suicide prevention is ‘a global imperative’ and it has been a major focus for the organisation for decades. In 2008, it launched its Mental Health Gap Action Programme, including suicide as one of the priority conditions.

Fast forward to 2021, when the WHO published LIVE LIFE – its implementation guide for suicide prevention in countries. This landmark publication includes six pages dedicated to one key intervention: limiting access to the means of suicide. The main example given is bans on acutely toxic highly hazardous pesticides.

A research-based solution that works

In its report, the WHO recognised what research from the last couple of decades has shown, that bans on highly toxic pesticides are the most effective way to prevent deaths from pesticide self-poisoning. A prominent figure involved in this research is Professor Michael Eddleston, who holds a Personal Chair in Clinical Toxicology at the University.

Image shows Michael Eddleston standing around a group of his colleagues.
Michael Eddleston working with colleagues in Sri Lanka

Professor Eddleston, who has worked on pesticide suicides for more than twenty years, particularly in Sri Lanka, saw first-hand how government action to reduce the availability of lethal pesticides there dramatically reduced pesticide suicides.

He first became aware of the issue as a student on a summer placement in a Sri Lankan hospital. He had been taken on to study snake bites but was alarmed by the number of patients being admitted because of pesticide self-poisoning.

“I ended up standing on the medical wards and just watching, seeing what was coming through the doors,” he recalls. “I realised that patient after patient was coming in with pesticide poisoning. That is what started me off, seeing these patients and realising that there was no one working on this.”

Michael began working with colleagues in Sri Lanka, including researchers, clinicians and policymakers, supporting their work to identify lethal pesticides and introduce new bans.

In 1988, Sri Lanka suffered from one of the highest per capita suicide rates in the world, with pesticide poisoning accounting for more than 70% of all suicides.

Between 1980 – 2010, Sri Lanka implemented a series of policies designed to limit access and availability of pesticides responsible for deaths. This included bans on 36 highly hazardous pesticides.

Sri Lanka’s new regulations contributed to one of the greatest falls in suicide rates ever seen in the world, with a staggering 80% drop in pesticide suicides, a 70% drop in the overall annual suicide rate, and an estimated 93,000 lives saved over 20 years.

At the Future Policy Awards 2021, often referred to as the ‘Oscar on best policies’, Sri Lanka was awarded a special accolade in recognition of its policies to regulate highly hazardous pesticides.

The academic evidence

A similar decline in deaths has also been seen in other countries where bans on acutely toxic pesticides have been implemented, including South Korea and Bangladesh.

So, why do bans work?

Evidence from academic studies, conducted by Professor Eddleston and international colleagues, has shown that means matters – when lethal means are made less available or less deadly, suicide rates by that method decline. Research also finds that there is not always an intention to die – many people ingest pesticides as an act of self-harm and do not actually intend to die. Additionally, acts of pesticide self-poisoning are usually impulsive, with more than half of people deciding to self-harm less than 30 minutes beforehand. It has also been uncovered that people are unlikely to reattempt – most people who survive pesticide self-poisoning will not go on to die by suicide at a later date.

Furthermore, when implemented correctly, there has been no adverse impact on agriculture.

Image shows bottles labelled 'poison' lying on the ground.
Bottles labelled ‘poison’ lying on the ground

A unique initiative

Professor Eddleston’s research made it clear to him that regulation was by far the most effective means of preventing deaths from pesticide poisoning.

He also saw a need for an organisation that focused on identifying problematic pesticides and encouraging effective pesticide regulation globally. In 2017, he secured funding and launched the Centre for Pesticide Suicide Prevention (CPSP) – a research and policy initiative based at the University.

Six years later, CPSP remains the only global initiative dedicated to preventing pesticide suicides.

Image shows Michael Eddleston taking part in the UN’s Joint Meeting on Pesticide Management in 2022.  
Michael Eddleston taking part in the UN’s Joint Meeting on Pesticide Management in 2022

Collaborating with the WHO

Since its inception, CPSP’s work has been entwined with that of the WHO. The University’s Centre works in countries where pesticide self-poisoning is a recognised and significant health problem.

It works in collaboration with national policymakers to collect data on pesticide poisonings and deaths, identifying the products responsible. This information is then passed on to regulators, helping them to implement reforms aimed at phasing out dangerous pesticides.

CPSP and WHO have established a strong partnership to enable this work, with the WHO helping to identify and engage with priority countries for CPSP to work with. This partnership is now well established, leading to some significant activity, including a working group in Nepal, looking at how to advance pesticide suicide prevention; a collaborative partnership between CPSP, WHO, the UN’s Food and Agriculture Organization and Pan American Health Organization, to work on pesticide suicide prevention across the Americas; and CPSP is also working closely with the WHO to support the development of guidelines to improve treatment of poisoned patients.

Towards a greener, safer planet

By the time the WHO marks its centenary in 25 years’ time, it would be hopeful to think that pesticide suicide is no longer the major global health problem it currently is. After all, we know that suicide is preventable, and we have the solution in our hands. However, for this to be achieved, several things need to happen.

Firstly, countries that have a problem with pesticide suicide must take action to ban and restrict access to lethal pesticides.

Secondly, countries that manufacturer and export lethal pesticides – many of which are countries that have already restricted their use at home – must put self-interest aside and support international action on highly hazardous pesticides.

By removing all acutely toxic highly hazardous pesticides from agricultural practice, it is estimated that global pesticide suicide rates will fall rapidly from 150,000 deaths a year to less than 20,000.

It would also stop these pesticides from causing harm to the environment, contributing to a greener, safer planet.

The University is committed to playing its role in helping to make this happen.

Picture credits: Heshani Sothiraj Eddleston, Arjun MJ and The WHO.