
A non-profit that figured out how to massively cut suicide rates in Sri Lanka - jbreckmckye
https://80000hours.org/2018/03/leah-utyasheva-pesticide-suicide-prevention/
======
tomp
Ok I unfortunately don't have the time to listen to the whole episode, but
whatever hard data is included in the text of the article doesn't look to fit
the title.

 _> the suicide rate in Sri Lanka has dropped significantly. So, from 57
deaths per 100,000 population in ’95, it has dropped now to 17. This is a 70%
reduction. So, it’s a very significant success, in fact the greatest decrease
in suicide rate ever seen._

So the first thing we see is that 70% reduction amounts to the suicide rate
dropping from 0.057% to 0.017%. That would still put Sri Lanka at or near the
top (=most suicidal) according to Wikipedia [1], so I guess it's pretty
significant; it's just that I always view relative percentages with suspicion
("we reduced the death rate by INFINITY percent!" "oh yeah you saved one
life").

Second, if the rate of suicide decreased by 70% in 20 years, that doesn't mean
that it can be 100% percent attributed to lack of pesticides (in fact, I
cannot think of _any_ scenario where that could be true). 20 years is a lot of
time, especially in Asia, so I don't know, maybe it was just the improvement
of the quality of life, or (mental) health-care? _Edit:_ I hope the recording
sheds more light on _why_ they attribute _any_ part of the drop to lack of
pesticides...

Anyways, it's discouraging, and therefore I judge the title as "click-bait-y".

[1]
[https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...](https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate)

~~~
Chathamization
This study seems to take that into account[1]:

> Restrictions on the import and sales of WHO Class I toxicity pesticides in
> 1995 and endosulfan in 1998, coincided with reductions in suicide in both
> men and women of all ages. 19,800 fewer suicides occurred in 1996-2005
> compared to 1986 – 1995. Secular trends in unemployment, alcohol misuse,
> divorce, pesticide use and the years associated with Sri Lanka’s Civil war
> did not appear to be associated with these declines.

Here's another study[2]:

> Overall suicide mortality dropped by 21% between 2011 and 2015, from 18.3 to
> 14.3 per 100,000. The decline in pesticide suicides during this same period
> was larger than for overall suicides: from 8.5 to 4.2 per 100,000, a 50%
> reduction. This was accompanied by a smaller concurrent rise in non-
> pesticide suicide mortality with a 2% increase (9.9 to 10.1 per 100,000).

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154644/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154644/)
[2]
[http://journals.plos.org/plosone/article?id=10.1371/journal....](http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172893)

~~~
manjushri
Their "taking into account" seems like mere handwaving away. How would the
ending of a civil war not be associated with an increase in mental health?

>The decline in pesticide suicides during this same period was larger than for
overall suicides: from 8.5 to 4.2 per 100,000, a 50% reduction

The way they picked these statistics just seems self serving to their thesis.
Another way of looking at the same numbers is that the drop in pesticide
suicides accounted for only 10.75% of the total drop in suicides.

The fact that this study focuses only on the immediate tool used to kill
oneself rather than the plethora of long term contributing social factors that
lead up to a suicide shows a willful ignorance of the root problems.

~~~
robertwiblin
The standards sociological finding is that suicide is more likely to decline
than rise during a war:

"Suicide rates are thought to fall during wartime. Durkheim [1] suggested this
was due to increased social cohesion, while others have suggested that
competing outcomes may be important, with individuals who might otherwise have
died by suicide being more likely to die of other causes [2]. Neeleman [3]
cites this as an example of contextual effect modification, with suicide risk
modified by the likelihood of dying of other causes.

Examples of reductions in suicide rates in times of war have been described
for several time periods and cultures [4-9]. Marshall [10] argued that the
reduction in suicide rates reflected a reduction in unemployment, a recognised
risk factor for suicide [11], rather than a direct effect of war, an argument
offered some support by Lester and Yang [12]. Stack [13] suggested that the
suicide rate decreased as the proportion of the population employed in
military roles increased."

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526726/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526726/)

~~~
manjushri
Did you read the final conclusion of your study?

>Conclusion: In contrast to the established view, our findings suggest that
compared to both the pre-War and post-War periods there was an increased
likelihood of suicide during the Second World War if the overall declining
trend is taken into account.

Moreover, the argument of "increased social cohesion" against a foreign enemy
is not applicable to a _civil_ war, where social cohesion has completely
broken down.

~~~
robertwiblin
That paper disagrees with the established view, but helpfully lays out what
the established view is. Scanning papers on the topic it seems like there's
mixed results war to war, and it depends what other things you try to control
for - I think you could get to saying it's neutral but not that there should
be a strong presumption that a war will suicide.

"the argument of "increased social cohesion" against a foreign enemy is not
applicable to a civil war"

You'd get increased social cohesion among each of the ethnic groups which is
in conflict with the other.

In any case this focus on the Sri Lankan civil war specifically isn't that
interesting - I posted a review article above which includes controls and
studies a wide range of cases across different countries, and concludes
pesticide control has large effects.

------
emiliobumachar
Summarizing, this is about decreasing the effectiveness of suicide attempts,
not their rate.

About a fifth of the world's suicides are done by drinking pesticides. When
removing that alternative, people turn to less effective methods. Those that
fail are unlikely to try again.

Very eye-opening.

~~~
jessriedel
> When removing that alternative, people turn to less effective methods.

Is there data on this? The article mentions that most people contemplate the
decision for less than 30 minutes, so if pesticides aren't accessible they
literally might not try anything else. (Or by "less effective methods", you
might just mean they are less likely to complete suicide, which is true.)

~~~
emiliobumachar
By "less effective methods", I did mean that they'll still try, but probably
fail.

~~~
Anderkent
Or if the method is less immediately available, they may not try at all, as
the longer consideration time is enough to realise they don't actually want to
die.

As they say:

> Leah Utyasheva: Exactly. The research shows that it is in majority of cases
> with pesticide self poisoning, it is an impulsive event, and people think
> for less than 30 minutes before actually poisoning themselves, less than 30
> minutes. And this of course, is a life altering event. And the other thing
> is that apart from low planning, it is also low repetition event. Less than
> 10% of people who tried killing themselves will go on to try to do it again.

------
tjic
There is a an issue in all statistics: "the seen and the unseen". It basically
means "measuring benefits but not measuring costs".

Even if the statistics is accurate.

Even if denying people the right to self-determination is a positive in your
ethical system.

Even if X, Y, Z are true... I still have to ask: what about the COST?
Pesticides exist because they do something useful - kill off pests. They
increase food production and decrease labor.

What if we've saved some lives...but also made 200,000 farmers each spend an
extra five hours a week bent over in their fields, picking bugs off leaves? Or
made them plant more land in order to harvest the same amount of food?

~~~
Anderkent
> Even if denying people the right to self-determination is a positive in your
> ethical system

You are not denying people right to self-determination, in any way. If someone
really wants to have a suicide method handy so that they can commit suicide
immediately when they feel the impulse, you can buy it ahead of the time.

> What if we've saved some lives...but also made 200,000 farmers each spend an
> extra five hours a week bent over in their fields, picking bugs off leaves?
> Or made them plant more land in order to harvest the same amount of food?

Do you have _any_ reason to think any of that is true? If you have to go to a
specialist shop to buy pesticide instead of the grocery store where it's right
next to your food; or if you have to use pesticide that's slightly more
expensive but not toxic to humans, suddenly it's like you need to pick bugs
off leaves?

Measuring costs is a fine idea; and 80000 hours definitely do that. Making up
costs just to seem contrary is something completely different.

~~~
exolymph
GP's point is not that XYZ are the specific costs of reducing pesticide use,
but that costs should be discussed when making policy judgments.

------
DanCarvajal
Well they also had a civil war that lasted for 25 years so I'm sure that
ending helped a bit too.

------
sajithdilshan
This is a classic example for "correlation does not imply causality".

I believe the rate has decreased mainly due to improved education, and other
suicide prevention services by NGOs, not because of the lack of availability
of pesticides.

~~~
Anderkent
Um, there's a very clear causative model: not having toxic pesticide on hand
makes poisoning yourself with pesticide much harder! Did you even read the
article before assuming the two must be unrelated?

------
vanderZwan
> _So, this harm minimization, harm reduction strategy was developed by
> William Haddon, who was a U.S traffic administrator, the head of the U.S
> traffic administration authority, who realized in the 60s that the traffic
> accidents in the United States have gone up, and the fatality of this
> traffic accidents have gone up significantly as well._

> _So, what he suggested is that radically new approach to the problem. He
> says instead of telling people to stop having accidents, and become better
> drivers, he suggested that, “Let’s accept that traffic accidents, road
> accidents will happen, but let’s minimize the harm from them.”_

Tangent: it's interesting how this suggests that getting people to drive
_less_ was not an option in this discussion (which is the most appropriate
analogy to banning really toxic pesticides, I would say). Yet that was one of
the major factors behind why the Netherlands switched to a policy of
encouraging other means of transportation, and why we ended up with our bike
infrastructure (ignoring that the Netherlands also has the geographical
advantage here, being small, flat and typically with compact cities).

------
nickthemagicman
Also Star Wars Battle front was released during that time so that might have
also been the cause.

~~~
wronag1
you can't commit suicide by pesticide, but you can purchase an in-game add-on
where your character can

~~~
nickthemagicman
Exactly. It's cathartic!

------
Talyen42
thankfully, absolutely nothing else changed for this population in 20 years,
so we know this is a legit controlled study

~~~
shaki-dora
Yes! And where would we be without internet commentators mentioning that
“correlation does not prove causation”, and devising intricate interventions
to study in the clueless scientists’ stead?

~~~
manjushri
Maybe I'm missing the humor here, but is doubt due to the lack of a control
group not a crucial element of the scientific method?

------
ketsa
Reading that title I thought they decreased agricultural pesticide usage...

------
exabrial
I'm not sure if the clickbait title was intentional or not, but I flagged it
for now.

~~~
jbreckmckye
Annoyingly, it was edited from something much more timid and factual.

------
alwaysanagenda
Let's do a little digging, shall we?

Who is 80,000 Hours?

[https://en.wikipedia.org/wiki/80,000_Hours](https://en.wikipedia.org/wiki/80,000_Hours)

"[80,000 hours is]...one of the nonprofits funded by startup accelerator Y
Combinator in 2015...William MacAskill is the Founder and President of 80,000
Hours..."

Who is William MacAskill?
[https://en.wikipedia.org/wiki/William_MacAskill](https://en.wikipedia.org/wiki/William_MacAskill)

He is a proponent of Effective Altruism
[https://en.wikipedia.org/wiki/Effective_altruism](https://en.wikipedia.org/wiki/Effective_altruism)

For an article that says it will cover " What types of events are causing
people to have the crises that lead to attempted suicide?"

All the commentary we have is this:

> "Robert Wiblin: Do you know what kinds of events are causing people to have
> these crises and attempt suicide?

> Leah Utyasheva: Well, as I said, quite often it is a cry for help. It is the
> acceptability of using suicide as means of solving certain life problems.
> For example, if a child is having, a student is having problems at school,
> or an old person feeling sick, or a couple argues. So, all this could lead
> to an attempted suicide. And quite often, as I said, people just need a
> little bit more time to think about it, and then maybe they decide that this
> is not a good solution to their problems.

Then they move on. That doesn't sound like a very robust discussion around the
real problem.

More importantly, for such a lengthy discussion about pesticide use, nobody
speaks about who benefits from switching pesticides.

Leah informs us that: "I must point out that the United Nations and the WHO
agencies are highly behind this, and they are supportive of the ban of the
most hazardous substances. There are a lot of guidelines and tools developed
to find out what alternatives to highly hazardous pesticides are available,
and what other substances or agricultural production methods could be used
instead of highly hazardous pesticides."

We have an enormous amount of posturing without a single mention of what the
replacement pesticide should be. It sounds more like the UN and WHO woud like
some kind of "moral" ground to push their own agenda.

I find it all very disingenuous.

