Regulatory control of highly hazardous pesticides to prevent self-poisoning
Authors: Kevin Chien-Chang Wu, Ying-Yeh Chen
Journal: The Lancet Global Health (2017)

In 2012, self-poisoning with pesticides caused 110 000 deaths, accounting for a seventh of all suicides globally.1Mew EJ Padmanathan P Konradsen F et al.The global burden of fatal self-poisoning with pesticides 2006-15: systematic review.J Affect Disord. 2017; 219: 93-104Summary Full Text Full Text PDF PubMed Scopus (230) Google Scholar Although this figure indicates a prominent reduction in deaths from pesticide self-poisoning over the past decade, which accounted for 30% of suicides (approximately 300 000 deaths per year) in the 1990s,2Gunnell D Eddleston M Phillips MR Konradsen F The global distribution of fatal pesticide self-poisoning: systematic review.BMC Public Health. 2007; 7: 357Crossref PubMed Scopus (589) Google Scholar self-poisoning with pesticides nevertheless remains among the most prevalent means of suicide worldwide. Restricting access to suicide means is the suicide prevention strategy with the strongest empirical support.3Yip PSF Caine E Yousuf S Chang SS Wu KCC Chen YY Means restriction for suicide prevention.Lancet. 2012; 379: 2393-2399Summary Full Text Full Text PDF PubMed Scopus (333) Google Scholar Many current efforts to restrict pesticides initiated by WHO and the International Association for Suicide Prevention have industry support and focus on the safe-storage approach4WHOSafer access to pesticides for suicide prevention: experiences from community interventions.http://apps.who.int/iris/bitstream/10665/246233/1/WHO-MSD-MER-16.3-eng.pdfDate: 2016Google Scholar (eg, the distribution of lockable storage boxes to farmers or villages). This approach, however, has little empirical support.4WHOSafer access to pesticides for suicide prevention: experiences from community interventions.http://apps.who.int/iris/bitstream/10665/246233/1/WHO-MSD-MER-16.3-eng.pdfDate: 2016Google Scholar, 5Konradsen F Dawson AH Eddleston M Gunnell D Pesticide self-poisoning: thinking outside the box.Lancet. 2007; 369: 169-170Summary Full Text Full Text PDF PubMed Scopus (34) Google Scholar Alternatively, legislative national bans of highly toxic pesticides have consistently been shown to have a prominent and sustained effect in reducing both overall suicides and pesticide-associated suicides.6Cha ES Chang SS Gunnell D Eddleston M Khang YH Lee WJ Impact of paraquat regulation on suicide in South Korea.Int J Epidemiol. 2016; 45: 470-479Crossref PubMed Scopus (74) Google Scholar, 7Knipe DW Chang S-S Dawson A et al.Suicide prevention through means restriction: impact of the 2008-2011 pesticide restrictions on suicide in Sri Lanka.PloS One. 2017; 12: e0176750Google Scholar In the Lancet Global Health, David Gunnell and colleagues report their findings8Gunnell D Knipe D Chang S-S et al.Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence.Lancet Glob Health. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S2214-109X(17)30299-1PubMed Google Scholar from the first systematic review of the effect of legislatively controlling access to pesticides on reducing suicide mortality, which add further evidence to support means restriction in suicide prevention.3Yip PSF Caine E Yousuf S Chang SS Wu KCC Chen YY Means restriction for suicide prevention.Lancet. 2012; 379: 2393-2399Summary Full Text Full Text PDF PubMed Scopus (333) Google Scholar Their approach was to review studies of policy regulations that did not depend on an individual's compliance (eg, regulations that restricted access to, or banned, pesticides). Means restriction is less likely to succeed if the mechanism of restriction relies on cooperation of the individual.3Yip PSF Caine E Yousuf S Chang SS Wu KCC Chen YY Means restriction for suicide prevention.Lancet. 2012; 379: 2393-2399Summary Full Text Full Text PDF PubMed Scopus (333) Google Scholar The findings from the systematic review suggest that policy efforts should be shifted towards the regulation of highly toxic pesticides. The effects of regulatory control on crop yields and method substitution were assessed by Gunnell and colleagues, but no evidence was shown of an effect on the number of suicides or on crop yields. A major limitation of their review was the shortage of data from China and India, two countries with the largest agricultural populations and greatest use of pesticides.1Mew EJ Padmanathan P Konradsen F et al.The global burden of fatal self-poisoning with pesticides 2006-15: systematic review.J Affect Disord. 2017; 219: 93-104Summary Full Text Full Text PDF PubMed Scopus (230) Google Scholar The 27 studies included in the review came from five low-income and middle income countries (LMIC), and 11 high income countries (HIC). Given the smaller agricultural populations and lower exposure to pesticides in HIC compared with LMIC, the effect of regulatory control of pesticides might have been underestimated. Moreover, there might be some legislative controls in LMIC that might not have been accounted for in the review; future studies should investigate such controls. The review highlights the importance of using the law as an instrument for suicide prevention. Above and beyond legislative control of pesticides, there is an urgent global need for the collection and analysis of a variety of suicide-prevention laws and regulations. With continuous effort, the effective components of the laws could be pinned down and effectively used to prevent suicide.9Attaran A Pang T Whitworth J Oxman A McKee M Healthy by law: the missed opportunity to use laws for public health.Lancet. 2012; 379: 283-285Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar Nonetheless, we must also be cognisant of external validity, and duly consider how differences in political economies and sociocultural contexts might modify the effectiveness of similar legal statutes, and demand appropriate, socioculturally tailored approaches to legal translations of suicide-prevention research.10Chen JA Courtwright A Wu KC The role of stigma and denormalization in suicide-prevention laws in east Asia: a sociocultural, historical, and ethical perspective.Harv Rev Psychiatry. 2017; (published July 11.)DOI:10.1097/HRP.0000000000000160Google Scholar Finally, to ensure the success of good suicide-prevention laws, we need more research on the law-making processes, including transparency, stake holders' engagement, rhetoric and framing, political feasibility, and policy windows. We welcome this first systematic review8Gunnell D Knipe D Chang S-S et al.Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence.Lancet Glob Health. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S2214-109X(17)30299-1PubMed Google Scholar of the effectiveness of national laws banning highly lethal pesticides as a means of suicide prevention. With current evidence, policy makers should take more rigorous action to ban hazardous pesticides to save hundreds of thousands of lives. We declare no competing interests. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidenceNational bans on highly hazardous pesticides, which are commonly ingested in acts of self-poisoning, seem to be effective in reducing pesticide-specific and overall suicide rates. Evidence is less consistent for sales restrictions. A worldwide ban on the use of highly hazardous pesticides is likely to prevent tens of thousands of deaths every year. Full-Text PDF Open Access