Pesticide ingestion is the second most common means of suicide in the world - of the more than 800 000 individuals who die from suicide each year (one death every 40 seconds), 10-20% die from pesticide self-poisoning. Conservative estimates suggest that there are 100-150,000 deaths from pesticide self-poisoning worldwide each year. It is mainly a problem affecting poor agricultural communities in Asia, Africa and Latin America, where farmers have direct access to highly hazardous pesticides and frequently use them on their fields. In some countries, high concentration pesticides are sold in convenience stores next to food and other commonly used items.
In many low-income countries, the number of pesticide suicides increased dramatically with the Green Revolution and the consequent introduction of pesticides to small scale farming in the 1960s. The overall suicide rate (from any means) more than quadrupled in some countries as a result of the this change in farming.
Countries, communities and families suffer tremendous individual, social, and economic loss and suffering as a result of pesticide suicides
World Health Organization. Preventing suicide. A global imperative. Geneva: WHO; 2014. See http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf
WHO, Fact Sheet on Suicide (2017), Available at http://www.who.int/mediacentre/factsheets/fs398/en/.
Knipe DW et al.Suicide prevention through means restriction: impact of the 2008-2011 pesticide retrictions on suicide in Sri Lanka. Plos ONe 2017, 12: e0172893. See https://www.ncbi.nlm.nih.gov/pubmed/28264041
Highly hazardous pesticides (HHPs) are defined by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) as pesticides that are acknowledged to present particularly high levels of acute or chronic hazards to health or environment according to internationally accepted classification systems such as the WHO Recommended Classification of Pesticides by Hazard, or Globally Harmonized System of Classification and Labelling of Chemicals, or their listing in relevant binding international agreements or conventions (Stockholm or Rotterdam Conventions, Montreal Protocol). In addition, under Criterion 8, pesticides that appear to cause severe or irreversible harm to health or the environment under conditions of use in a country may be considered to be, and treated as, highly hazardous.
There is no single international list of HHPs because pesticides falling under criterion 8 will differ by country according to the conditions.
Ingestion of HHPs for self-harm is much more likely to result in death than ingestion of a non-HHP pesticide.
FAO/WHO Joint Meeting on Pesticide Management. International Code of Conduct on Pesticide Management. Guidelines on Highly Hazardous Pesticides. http://www.fao.org/3/a-i5566e.pdf
Globally Harmonized System of Classification and Labelling of Chemicals http://www.unece.org/trans/danger/publi/ghs/ghs_welcome_e.html
WHO Recommended Classification of Pesticides by Hazard. http://www.who.int/ipcs/publications/pesticides_hazard/en/
Research clearly shows that banning or gradually phasing out highly hazardous pesticides can dramatically reduce suicide rates in agricultural communities. Success stories include South Korea, Bangladesh and Sri Lanka (see Case Studies tab).
Many suicides are impulsive - most are done with less than 30 minutes planning, with people using whatever means is at hand. Suicidal crises are often acute – reducing the toxicity of available pesticides allows people to survive the crisis and then obtain help from their community or counselling. Relatively few go on to try again at a later time or with a different method.
Restricting access to lethal means of suicide (for example, banning and removing highly hazardous pesticides from agricultural practice through legislation and importation limitations) is a highly cost-effective way to prevent suicide. We estimate that more than 60% of suicides by self-poisoning with pesticides could be prevented through restricting access to HHPs.
Sri Lanka is an important success story showing how banning the most harmful pesticides can reduce the numbers of pesticide suicides. With the introduction of pesticides into everyday use in the 1970s, the annual suicide rate in Sri Lanka increased from 5 per 100,000 population over 8 year ofage to 24/100,000 in 1976, and to an astonishing 57/100,000 in 1995. The government’s pesticide regulator starting banning the most highly hazardous pesticides in 1984, slowing down the rate of increase. Further bans in 1995,1998, and 2008 has brought the overall suicide rate down by 75%, to the current rate of 17/100,000.
Importantly, the HHP bans of 1995 and 1998 have not been associated with any apparent effect on agricultural cost or yields, and switching to other means of suicide has been insignificant.
Other success stories include South Korea (see Case Study or this publication) and Bangladesh (see Case Study).
WHO, 2016. The Public Health Impact of Chemicals: Knowns and Unknowns.
WHO, 2009. Violence Prevention. The Evidence: Guns, knives and pesticides: reducing access to lethal means.
WHO page on suicide http://www.who.int/mental_health/prevention/suicide/pesticides/en/accessed March 3, 2017.
Knipe D, Gunnell D, Eddleston M. Preventing deaths from pesticide self-poisoning - learning from Sri Lanka’s success. Lancet Global Health 2017, in press.
A high proportion of pesticide suicides are impulsive, with people contemplating harming themselves for less than 30 minutes. In fact, most persons who engage in suicidal or self-harming behaviour are ambivalent about wanting to die, with the act serving as a response to psychosocial stressors. Self-harm is used as communication – expressing for example pain, hurt, shame or anger. The great majority who now survive the act in Sri Lanka – because the pesticides ingested are no longer lethal – go on to lead successful productive lives.
Replacing the often lethal HHPs with less toxic alternatives allows more people to survive the acute stress and receive the community and medical help they need.
This is clearly shown by the Sri Lankan experience in which the bans of HHPs resulted in a remarkable 75% overall reduction in suicide. People who no longer died from pesticide poisoning with the less toxic pesticides did not then go out to kill themselves with another lethal method such as jumping off a bridge. This is because the spontaneity of pesticide poisoning results in the nearest pesticide often being drunk, with little thought. If this is highly hazardous, many people die. If it is less hazardous, because HHPs are no longer available, the person will survive.
We also believe that people with mental illness require mental health services and support to get better and live fulfilling lives.
Deisenhammer E, Ing C, Strauss R, Kemmler F, Hinterhuber H, Weiss E, The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a auicide attempt? J Clin Psychiatry 70:1, January 2009.
Conner KR, Phillips MR, Meldrum S, Knox KL, Zhang Y, Yang G, Low-planned suicides in China. Psychol Med. 205 Aug; 35 (8): 1197-204,
Eddleston M, Karunaratne A, Weerakoon M, Kumarasinghe S, Rajapakshe M, Sheriff MH, Buckley NA, Gunnel D, Choice of poison for intentional self-poisoning in rural Sri Lanka, Clin Toxicol (Phila) 2006; 44(3):283-6.
WHO Restricting Access to the Means for Suicide, at http://www.who.int/mental_health/prevention/suicide/pesticides/en/.
Reducing access to highly dangerous means of suicide is recognised to be an excellent way to reduce deaths. Commonly used pptions include restricting access to guns, knives, bridges and other open high areas, dispensing only small quantities of pharmaceuticals, and banning and removing highly hazardous pesticides from agricultural practice through legislation and import limitations.
Other measures to reduce suicide include responsible reporting of suicide in the media, such as avoiding language that sensationalizes suicide and avoiding explicit description of methods used, and early identification and management of mental and substance use disorders. Follow-up care by health workers through regular contact, including by phone or home visits, for people who have attempted suicide, together with provision of community support, can also be effective.
WHO, 2014. Preventing Suicide. A Global Imperative. http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf
There are alternatives to the use of highly hazardous pesticides in agriculture. After 21 of the most highly hazardous pesticides were banned in Bangladesh, there was a shift towards use of less hazardous pesticides. Similarly to Sri Lanka, there was no apparent effect of the ban in Bangladesh on agricultural productivity.
In addition to using less toxic pesticides, other methods of agriculture that minimise the use of pesticides have been introduced into Bangladesh. Integrated pest management (IPM) is a combination of all available and appropriate pest control techniques and measures that discourage the development of pest populations and minimise risks to human health and the environment. Studies of IPM show that it can increase farmers’ yields and reduce their expenses.
There are three main international treaties on the management of chemicals and hazardous waste that cover life cycle management of chemicals and pesticides. The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal (1989), the Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade (1998), and the Stockholm Convention on Persistent Organic Pollutants (2001) all have as their primary objective the protection of human health and the environment. These conventions all identify pesticides that need to be restricted in use.
There is a growing international consensus on phasing out HHPs from agriculture - for the protection of human rights, public health, and the environment, and to achieve the United Nations Sustainable Development Goals. Both the World Health Organization and the Food and Agriculture Organization have shown their commitment to pesticide risk reduction, including the progressive removal on HHPs from agriculture.
A recent report from the United Nation’s Special Rapporteur on the Right to Food and the Special Rapporteur on Human Rights and Hazardous Substances and Waste provided an extensive analysis of the impact of the HHPs on human rights. It affirmed that “Hazardous pesticides impose substantial costs on Governments and have catastrophic impacts on the environment, human health and society as a whole, implicating a number of human rights and putting certain groups at elevated risk of rights abuses".
The report concluded that international community should "Generate policies to reduce pesticide use worldwide and develop a framework for the banning and phasing-out of highly hazardous pesticides;" Sources FAO’s site on Highly Hazardous Pesticides, at http://www.fao.org/agriculture/crops/thematic-sitemap/theme/pests/code/hhp/en/. UN Human Rights Council, The Report of the Special Rapporteur on the Right to Food, 24 January, 2017, A/HRC/34/48. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/017/85/PDF/G1701785.pdf?OpenElement
We are currently working in the WHO’s South-East Asian region with pesticide regulators to assess the impact of HHPs in their countries, initiate public dialogue, and identify the most harmful pesticides that need to be banned to protect people’s lives.
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The issue has been neglected for so long. However, change is occurring with major benefits for rural communities across the world.