Thursday, September 09, 2004

WHO's Business Is Suicide?

The World Health Organization is calling for action to deal with the growing problem of suicide worldwide:
Suicide kills more people each year than road traffic accidents in most European countries, the World Health Organization is warning. And globally, suicide takes more lives than murder and war put together, says the agency in a call for action.

The death toll from suicide – at almost one million people per year – accounts for half of all violent deaths worldwide, says the WHO. “Estimates suggest fatalities could rise to 1.5 million by 2020,” the agency warned on Wednesday.
I have two complaints about this article. First, it claims that reducing access to suicide methods will reduce the suicide rate:
"It's important to realise that suicide is preventable," points out Lars Mehlum, president of the International Association for Suicide Prevention. "And that having access to the means of suicide is both an important risk factor and determinant of suicide."

The most common methods for committing suicide include swallowing pesticides, using firearms and overdosing on painkillers. Curbing access to these methods is a crucial factor in preventing suicide.
Now, if you’re going to make a claim like that, it would nice to have a little evidence. As it happens, I’ve done some research on this topic, and the evidence just isn’t there. Despite numerous studies, support for the conclusion that reducing access to a suicide method will reduce the suicide rate is mixed at best. Studies have frequently found a statistically significant relationship between access to a method and suicides by that method, but rarely have studies found a statistically significant relationship between access to a method and total suicides.

Second, WHO abuses terminology to justify its prescription for global action:
"Suicide is a tragic global public health problem,” says Catherine Le Gal├Ęs-Camus, WHO’s assistant director general for non-communicable diseases and mental health. “There is an urgent need for coordinated and intensified global action to prevent this needless toll."
Now what, exactly, qualifies any given health issue as a “public health problem”? Suicide seems to me a quintessentially private matter. Yes, suicides do adversely affect the families, friends, and coworkers of the suicidal person. But the same is true of nearly anything that takes a person’s life, especially in a traumatic fashion. If the term “public health” is to have any meaning distinct from just “health,” either (a) there should be some non-trivial element of contagion involved, or (b) the issue should be closely connected to some public facility, such as the sewer system or public highways. At a minimum, the health problem should have substantially greater external effects than the typical illness.

Even if one buys that suicide is a public health problem – perhaps because suicides sometimes occur in clusters, indicating some degree of “psychological contagion” – what warrants WHO’s call for international action? Nothing about suicide makes it a “global” problem, except the mere fact that it occurs in every country. So does acne. Suicide is not transmitted from country to country. The suicide rate of one country is of no special concern to other countries, except in the trivial sense that compassionate people have a tendency to care about other humans’ deaths. Suicide is no more a matter of international concern than obesity – another fundamentally individual or (with a major stretch of the imagination) national concern that WHO has nonetheless dubbed a “public health problem” and a “global epidemic.” Looks like WHO has a chronic case of mission creep.


Anonymous said...

Something relevent via Volokh Conspiracy:

Jason B.

Anonymous said...

Public Service Announcement

Poor nutrition is a causative factor in mental depression (which of course can lead to suicide). For instance, a deficiency of B3 (niacin=nicotinic acid) can lead to Pellagra. Pellagra is clinically manifested by the 4 D's: photosensitive dermatitis, diarrhea (digestive problems), dementia, and death. Most multi-vitamin preparations contain niacinamide which is similar to niacin and doesn’t cause uncomfortable flushing. But, Niacin has beneficial effects that niacinamide doesn’t. Niacin can improve one’s lipid profile; that might help prevent clogging off the arteries. Niacin can also help alleviate mental problems including depression (see dementia above). It might also help with chronic fatigue and skin problems (see dermatitis above). Fortunately there is a form of niacin (complexed with inositol, another B vitamin) that doesn’t cause flushing and is available in any good vitamin store called no-flush or flush-free niacin. Sadly, most doctors don’t understand (mal) nutrition a lick and will just prescribe anti-depressants, which is just going to mask the underlying problem. There are sound nutritional reasons to keep our kids from overdoing the sugary junk food too.


Anonymous said...

Oh, I forgot--niacin can help your memory too!

Anonymous said...

I do not think that acne is a global phenomenon, i.e., I do not think it as an affliction found in every country. Some countries without it are even filthy.

Also, The trauma to friends and family after a suicide are often far greater and far reaching. That is, they may be plagued not only with a grief and a sense of loss, but also guilt, which in turn may lead to more suicides. Also, after one person kills himself, others may garner the nerve to do it, too. They may think to themselves that "this is how we deal or punish."

Re: niacin, I haven't researched it lately, but, while niacin has many beneficial effects, it can also cause some of the same problems as prescription cholesterol-reducing drugs.

Glen Whitman said...

I'm sure you can find at least one person with acne in every country. That the incidence of acne differs from country to country is another thing acne has in *common* with suicide; suicide rates differ substantially across countries.

It's certainly true that suicide can have a traumatic effect on families, more traumatic than many other causes of death. I still don't see how that makes it a public health issue, unless you adopt an overly broad definition of public health that would include pretty much any health issue (in which case why use the adjective "public"?). And it certainly doesn't make suicide a matter of *global* concern. The psychological contagion effects you mention are generally limited to localized areas -- e.g., a rash of suicides at a particular high school or college. There's no evidence I know of that shows contagion of suicide from, say, the U.S. to Mexico. And in any case, the contagion is one of ideas, not pathogens.

Anonymous said...

In this case, WHO's "mission creep" is easy to understand: it's public-choice in action. WHO is calling on the world's goverments to implement regulatory schemes promoted by the personal friends of WHO bureaucrats. WHO wants to "curb access to" pesticides, firearms, and painkillers, right? That is to say, they want to prevent the economic use of pesticides (the Green agenda), outlaw the private possession of firearms (the Oppressive Governments Everywhere/ Generalized Leftist agenda), and restrict access to painkillers, probably as part of a general scheme to limit drug dispensing to licensed pharmacies that require prescriptions from licensed doctors (the Medical Professional/ Heath Bureaucrat agenda).

It would be pure luck if any of the measures WHO promotes saved any lives, but all of those measures are calculated to make life richer and more satisfying for bureaucrats, health professionals, and leftists. Since WHO is a bureacratic organization staffed by health professionals and leftists, whose friends are all bureaucrats, health professionals, and leftists... what would you expect?

Anonymous said...

Unfortunately it seems that the WHO report misses on explaining why the suicide rate is expected to go up. Suicide is more a social issue than a health issue, i.e., suicide is a catchy trend--suicide becomes more acceptable to those contemplating their options when they hear of other suicides.

The point of suicide being a global issue is that it can be dealt with in a coordinated fashion--whether it's through education, counselling, etc.--not that suicide is a globally contagious.

Glen Whitman said...

Why does it need to be treated in a coordinated fashion? Or, more to the point, why does the coordination need to occur at the global level? The only justification I can think of has to do with psychological contagion (the perception of suicide as more acceptable because more are observed to do it) -- and as indicated earlier, such contagion is limited to localities.

Anonymous said...

Again, "global" is a misnomer here--I can't imagine how WHO can effectively run a globally coordinated effort with limited human and monetary resources. I think the typical modus operandi is to have programs running in a handful of localities producing know-how that is eventually transferred to local groups in other countries (the coordination part).