Sri Lanka s pesticide regulations appear to have

Sri Lanka\'s pesticide regulations appear to have contributed to one of the greatest decreases in suicide rate ever seen. Having peaked at 57 per 100 000 people over 8 years in the early 1990s, its incidence is now 17 per 100 000 each year, a 70% reduction, and continuing to fall. Using regression modelling techniques similar to those used previously, we estimate that 93 000 lives were saved in Sri Lanka between 1995 and 2015 (). The annual costs for the Office of the Registrar of Pesticides in the early 2000s was about US$200 000 (Manuweera G, Secretariat of the Basel, Rotterdam, and Stockholm Conventions, personal communication). Considering only direct costs, each life was therefore saved at a cost of $43. With the median age at death from pesticide poisoning for women and men being 27 and 42 years, and life expectancy 79 and 72 years, respectively, with men comprising 77% of suicides, the numbers of disability-adjusted life-years (DALYs) saved can be estimated at 3·26 million, at a direct cost to the government per DALY of $1·23 (). In 2013, 194 of WHO\'s member states adopted the Comprehensive Mental Health Action Plan 2013–2020, which has the target of reducing the suicide rate by 10% by 2020. Given that Sri Lanka achieved a 70% HMBA Linker manufacturer in total suicide rate, at remarkably low direct costs and without apparent effect on agricultural yield, improved pesticide regulation offers a clear route towards rapid attainment of this target.
The call by Luke Allen and Andrea Feigl (February, 2017) to reframe non-communicable diseases (NCDs) is welcome. The lack of focus on these increasingly important causes of morbidity, impairment, and mortality, with their commensurate increasing consumption of health and societal resources and reduced economic contribution, is inappropriate and damaging for all the reasons Allen and Feigl cogently argue. Few things that are described in the negative as what they are not obtain the understanding or action they deserve. Would we call for more non-lay people and non-retail products to address the non-static numbers of persons with non-normal mobility and physiology?
The debate opened up through the Comment by Luke Allen and Andrea Feigl is timely and welcomed. The framing of non-communicable diseases (NCDs) has been an ongoing challenge for those working on prevention and one that has not been fully addressed or resolved.
Luke Allen and Andrea Feigl issue an impassioned call to reframe non-communicable diseases (NCDs). They argue that “non-communicable” insinuates “less important” relative to infectious diseases, producing a dearth of NCD attention and funding. Granting a priori precedence to infectious diseases as the primary concerns for mortality and biosecurity risks undermining broader collaborative contributions aimed at promoting health equity.
Reframing non-communicable diseases (NCDs) to “spur a sense of urgency” and “focus attention on effective system-wide interventions” makes sense. With almost three-quarters of NCD deaths now occurring in low-income and middle-income countries (LMICs), the increasing burden of NCDs already has severe economic consequences that impoverish families, jeopardise health systems, and hinder social and economic development. However, development assistance still does not prioritise NCD prevention and control for a number of reasons. Foreign policy is commonly based on national interest and NCDs are not popularly understood to pose tangible threats to donor countries. Donor agencies appear to find investing in infectious disease control easier to justify to tax payers. In times of increasing nationalism, isolationism, and protectionism, focusing a substantial part of development cooperation on NCDs will be even more challenging. NCDs should gain more traction in the development agenda as a fundamental socioeconomic development and justice issue. The rise of NCDs is driven by globalisation, through unfair trade and irresponsible marketing (eg, those targeted at children), and unplanned urbanisation. These increase people\'s exposure to shared risk factors (eg, junk food, tobacco smoke). Other social determinants—poverty in particular—increase people\'s exposure to risk factors, while NCDs may keep people trapped in chronic poverty. NCDs and injuries collectively constitute over a third of the disease burden among the poorest populations. The highly inequitable distribution and impact of NCDs and their risk factors also warrant the attention of development policy.
In their Comment in , Eugene Richardson and colleagues criticised the tendency of many analyses of the Ebola epidemic (eg, a WHO report) to ignore that it may be rational for a patient with a fever to avoid an Ebola treatment unit. They use the prisoner\'s dilemma to explain such non-cooperative behaviour. The prisoner\'s dilemma, however, is not the most appropriate analytical framework for this situation. It involves two parties, each with their own interests, while the patient\'s dilemma might better be understood as a game against nature, ie, without a rational and self-interested opponent. We suggest that the threshold approach introduced by Pauker and Kassirer better explains the described phenomenon. The threshold model prescribes a probability of disease at which treatment becomes a better option than no treatment. The threshold is a function of the relative effects of the possible actions and compares the benefit of treating a true Ebola patient against the harm of treating a non-Ebola patient. In this example, exposure to the virus from contact with other (true) Ebola patients represents the harm condition. Using the mortality numbers provided, the benefit is the mortality reduction for true Ebola patients (70·8%–64·3%=6·5%), while the harm is the mortality increase for patients without Ebola (16·1%–0·2%=15·9%). The treatment threshold is calculated as harm/(harm+benefit). Given these data, the treatment threshold is 71·0% (). If individuals with suspected Ebola assume that their probability of having Ebola is below this threshold—eg, Richardson and colleagues assume a probability of 50%—the rational behaviour from the individual\'s point of view is to not seek treatment.