Global campaign to prevent deaths from pesticide self-poisoning

Global campaign to prevent deaths from pesticide self-poisoning

Treatment of poisoning

Acute pesticide self-poisoning hospitalizes over 2 million people every year and kills around 200,000, the vast majority in low- and middle-income countries (LMIC). Following modernization of agriculture in the 1960s during the Green Revolution, highly hazardous pesticides (HHPs) were introduced into rural households, causing an epidemic of fatal self-poisoning. Since this time, pesticide self-poisoning has killed an estimated 14 to 16 million people worldwide. Many of these deaths occur in young people, resulting in the annual loss of an estimated 10-14 million disability-adjusted life years (DALY) and immense familial and community stress.

The World Health Organisation (WHO) recognises pesticide poisoning to be one of the two most important global means of suicide, making its prevention a global public health priority. Our research has shown that improved government regulation to reduce the availability of HHPs has dramatically reduced pesticide suicides in South Korea, Bangladesh, and particularly Sri Lanka. This approach offers a highly cost-effective means to rapidly reduce pesticide poisoning.

In Sri Lanka, the national suicide rate increased from around 8/100,000 in 1960 to 57/100,000 in 1989, with pesticides responsible for over 80% of all suicides [1]. Remarkably, pesticide regulation by the Department of Agriculture - sequentially identifying the most problematic pesticides and then replacing them in agriculture with alternatives (marked with arrows in the figure) - has resulted in a rapid fall in total (not only pesticide) suicides. The rate is now 17/100,000 and continues to fall.

Research has shown that pesticide regulation, and consequent reduction in availability of highly toxic pesticides and pesticide suicides, has been responsible for the vast majority of this reduction in suicides [1, 2]. Between 1995 and 2015, pesticide regulation saved an estimated 70,000 lives at a cost of $1.7/DALY. Importantly, this had no effect on the cost of agricultural inputs or outputs [3].

Unfortunately, this reduction has not been replicated across Asia. A campaign is required to spread good practice across the region, monitor effects, and coordinate research. Major and rapid reductions in deaths from pesticide self-poisoning are possible.

The WHO and Food and Agriculture Organisation (FAO), as well as UN rapporteurs, have recognised the importance of regulating HHPs for preventing poisoning and suicides and reducing environmental harms. The FAO in particular has focused on the issue and recently published guidelines that recommend removing all HHPs from agricultural practice. To help with the provision of necessary information, it has developed a Toolkit for Pesticide Regulation for use by national regulators. However, the FAO does not have the resources to work with individual regulators and it is likely that their time will be spread thinly across different workload priorities, reducing the impact of the Toolkit. Human resources to carry out an assessment of a country’s pesticide needs, followed by drafting of legislation to implement it, is in short supply in the countries most affected by pesticide poisoning.

We are therefore collaborating with the WHO, FAO and United Nations Environment Program (UNEP) to establish a global campaign to directly support pesticide regulators in their needs’ assessment and pesticide regulatory work. This campaign will work alongside and coordinate with UN efforts to maximize effect. In particular, it will directly support the FAO-led Strategy on Highly Hazardous Pesticides passed in 2015 by the countries attending the Strategic Approach to International Chemicals Management (SAICM) conference.

We work with a small group of experts working alongside pesticide registrars and other stakeholders in South and South East Asia to: a) raise awareness and initiate public dialogue about the harms of HHPs; b) conduct economic and public health analysis into the continued use of HHPs, and mapping of the national regulatory framework; c) support pesticide regulators in using the FAO Toolkit with the goal of phasing out HHPs; and d) build national capacity related to drafting, implementing and enforcing pesticide regulations.

With the removal of HHPs from agricultural practice, pesticide suicides should fall from 200,000 per year to less than 50,000. We estimate that this will take between 5 and 10 years. Taking the more conservative time period, and a steady reduction over this time, a mean of 75,000 lives per year will be saved over 10 years, at a cost of £4 million, or USD 6 million (based on a £400,000 per year project cost). The cost per life saved would be USD 8. There will be additional benefits in the reduction of unintentional poisoning of children and of pesticide sprayers and in the reduction of environmental contamination with highly hazardous pesticides.

 

Donations:

We actively seek donations to help with this work. Your gift will be used to support this global campaign by the University of Edinburgh in collaboration with the United Nations.

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Key References for this work:

Minimum Pesticide List. Lancet 2002

Pesticide self-poisoning. BMJ 2004

Variability in case fatality after pesticide self-poisoning. PLoS Medicine 2010

 

References:

1.   Gunnell D, Fernando R, Hewagama M, Priyangika WDD, Konradsen F, Eddleston M. The impact of pesticide regulations on suicide in Sri Lanka. Int J Epidemiol 2007; 36: 1235-42.

2.   Knipe DW, Metcalfe C, Fernando R, Pearson M, Konradsen F, Eddleston M, Gunnell D. Suicide in Sri Lanka 1975-2012: age, period and cohort analysis of police and hospital data. BMC Public Health 2014; 14: 839.

3.   Manuweera G, Eddleston M, Egodage S, Buckley NA. Do targeted bans of insecticides to prevent deaths from self-poisoning result in reduced agricultural output? Environ Health Perspect 2008; 116: 492-95.