Fresh from her attendance at the 19th European Symposium for Suicide and Suicidal Behaviour, Lisa Schölin reflects on how the actions of industries, from firearms to pharma, can contribute to the high burden of suicide.
This article discusses suicidal behaviour. If you have questions on self-harm or feel suicidal, call 116 123 to speak to a Samaritan (UK) or use this link to find an international helpline.
Can commercial companies influence suicidal behaviour? Do they have a role in suicide prevention? These are questions recently posed to speakers and audience members at a session on ‘commercial determinants of suicide prevention’.
The session formed part of the European Symposium for Suicide and Suicidal Behaviour in Copenhagen and is one that I helped to organise. It is an unusual topic for discussion at a conference on suicidal behaviour, but highlighted some very important issues.
Understanding how industries can impact people’s health
In public health, we tend to talk about ‘social determinants of health’. These are the various social factors influencing health status and opportunities in life. This includes for example age, gender, employment status, living environment and health-related policies.
The commercial determinants of health are the ways that commercial actors’ strategies and practices, including design and marketing, and products impact on health and the environment.
The activities and products of certain industries, from the tobacco, alcohol, and unhealthy food to the fossil fuel and lead industries, for example, have profound implications for health and health equity.
This is an emerging field of research which seeks to understand how actions by industry can impact on people’s lives and health.
For our session, we were particularly interested in starting to think through how certain industries influence suicidal behaviour and the implications for suicide prevention.
Firearms industry and pain medication regulation
The first two speakers, Dr Nason Maani and Professor Keith Hawton, focused on two particular methods of suicide – firearms and medication overdoses.
Nason noted some highly concerning marketing practices of the firearms industry, which has also capitalised on social movements (e.g. MeToo and death of George Floyd) by targeting its advertising to women and people of colour to further enhance its profits.
While the shocking and blatant advertising of firearms presents a rather bleak situation in the USA, Keith shared a success story from the UK, outlining suicide prevention policies directed at reducing suicide deaths from analgesic overdose.
In the 1990s, after evidence emerged of high incidence of pain medication self-poisoning cases, the pack size for a type of analgesic was reduced. This was extremely successful, with Keith’s research showing a significant reduction in the suicide rate associated with this means of overdose.
Later, concerns about use of another pain medication in self-poisoning suicides led to its withdrawal from the market in the UK. This resulted in a 61% reduction in suicide deaths involving this specific medication, with, reassuringly, no increase in suicides involving other pain medication.
Keith also raised issues around stockpiling of pain medication in homes in the context of COVID-19 and the public health messaging about symptom control and avoidance of having unnecessary medication in households.
A member of the audience asked whether Keith experienced any push back from pharmaceutical companies when they found out about his research. Although he hadn’t experienced this directly, a colleague said they had been approached early on in their public health career to become an advisor, with promises of remuneration.
Industry partnerships and conflicts of interest
The third speaker was Professor Jeff Collin, from University of Edinburgh, who has been researching conflicts of interest for many years. He highlighted how partnerships between public health bodies and industry-funded actors can undermine policymaking processes and run counter to public health goals overall.
I am familiar with how, for example, the alcohol industry has for a long time tried to influence the narrative around alcohol and prevention of harm. What was however new to me were examples Jeff gave of partnerships relevant to suicide prevention, and other examples have been acknowledged before.
What stuck with me was Jeff’s notion that it’s easy for us as researchers, or for people working in advocacy or health promotion, to think that working with the industry can be a positive thing as it may influence their practices to the better. However, history tells us that this is rarely the case and that such partnerships can instead serve to help industries present themselves as a legitimate part of the solution to public health problems instead of drivers of these same problems.
Rethinking the practices of industry
The session was introduced and rounded off by Dr May van Schalkwyk and Dr Duleeka Knipe. They are working on a conceptual framework to explore commercial determinants of health in suicide prevention.
The model, to me, shows clearly not only that multiple industries are relevant in suicide prevention but also how these work in synergy with various levels of suicide prevention.
What seemed to resonate with many attendees was how industries tend to promote interventions that place the responsibility for suicide prevention on the individual (i.e. an individual’s responsibility to lock away guns or pesticides), deflecting away from their own responsibilities.
One participant asked whether partnerships with industry may be the only avenue to bring industry into supporting suicide prevention initiatives. The response from Nason was that this is not necessarily the case. Firstly, because it legitimizes them as a partner (as Jeff had noted), and secondly because it can have reverberating effects, such as driving research agendas.
Paving the way for future research
This was perhaps the first time a suicide behaviour and suicide prevention conference hosted a workshop on commercial determinants of health, but it will hopefully not be the last.
I felt a growing sense of understanding in the room on how the actions of industries can contribute to the high burden of suicide.
More work is required on this growing field of research, but I think it is important that we continue to have these discussions exploring the different factors that can influence our health.
The session took place on Wednesday 24 August at the European Symposium for Suicide and Suicidal Behaviour in Copenhagen. It was organised by CPSP in partnership with the University of Bristol and London School of Hygiene and Tropical Medicine. Special thanks to Dr Melissa Pearson, Dr Duleeka Knipe and Dr May van Schalwyk who assisted with the planning of this workshop.
Find out more about the work currently being undertaken by researchers featured in this article: