Pesticide Suicides: What More Evidence is Needed to Ban Highly Hazardous Pesticides?
The Lancet | Open Access | Published:March, 2021 | DOI:https://doi.org/10.1016/S2214-109X(21)00019-X
Of particular concern are pesticides that fall into one of the eight criteria from the UN Food and Agricultural Organization and WHO 2008 Joint Meeting on Pesticide Management, which resulted in classification criteria for highly hazardous pesticides.
Many of the pesticides used for suicide fall into the first seven criteria, which are based on a hazard classification from their inherent toxicity, or they are listed on an international convention. Criterion eight, however, is more nuanced, such that evidence is needed to illustrate that the active ingredients and formulations of the pesticide have shown a high incidence of severe or irreversible adverse effects on human health or the environment, such as suicide data. Yet these data are not globally recognised or used as evidence of a pesticide leading to a negative health outcome.
aptly illustrate the cost-effectiveness of national banning of highly hazardous pesticides linked to suicides, using the methods of WHO-choosing interventions that are cost-effective (ie, WHO-CHOICE). Lee and colleagues highlight two key strategies for preventing pesticide suicides, which are to invest in mental health treatments or to remove access to highly hazardous pesticides. Their study clearly shows that the estimated cost of and time for an effect to be realised through mental health interventions is not as justifiable as the national elimination of highly hazardous pesticides. It should be noted that banning highly hazardous pesticides is not anticipated to completely prevent pesticide suicides, but rather, as Lee and colleagues rightly state, to induce a shift to less fatal suicide attempts with less toxic pesticides.
This in turn allows longer-term mental health interventions to be accessed. The article contributes another angle to the increasing evidence that removing access to highly hazardous pesticides is key for protecting the health of vulnerable populations such as children, workers, and people with suicidal thoughts, ideation, or plans. This research also raises the question of whether we really need any more evidence to trigger the banning of highly hazardous pesticides.
Yet, these findings are not always a catalyst for implementing stricter regulations or bans.
This trend is evidenced by suicide data not being permitted for use when a country submits risk assessment data to advocate for listing a pesticide under the Rotterdam Convention. A listed pesticide triggers a process of prior informed consent, whereby an importing country must be informed of the exporting country’s regulatory status for the pesticide in question. There needs to be a move away from this separation of unintentional and intentional pesticide exposures and poisoning data,
towards using both as evidence for decision making. The result of this separation has been to exclude poisoning and mortuary data linked to pesticide suicides from regulatory and policy decision making. Furthermore, research has indicated that pesticide exposures could have a role in depression leading to pesticide self-harm.
The work of Lee and colleagues,
and others, suggests that suicide data should be used for evidence-based policy making, particularly for poor and marginalised communities in LMICs exposed to highly hazardous pesticides.
Crucially, as Lee and colleagues emphasises, all access to highly hazardous pesticides should be eliminated with urgency, whether this is achieved legally through a ban, withdrawal of registration, or non-renewal of registration of a pesticide, or whether a company is urged voluntarily to withdraw a product.
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