…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.
Dr Leah Utyasheva
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How people kill themselves varies enormously depending on which means are most easily available. In the United States, suicide by firearm stands out. In Hong Kong, where most people live in high rise buildings, jumping from a height is more common. And in some countries in Asia and Africa with many poor agricultural communities, the leading means is drinking pesticide.
There’s a good chance you’ve never heard of this issue before. And yet, of the 800,000 people who kill themselves globally each year, 20% die from pesticide self-poisoning.
Research suggests most people who try to kill themselves with pesticides reflect on the decision for less than 30 minutes, and that less than 10% of those who don’t die the first time around will try again.
Unfortunately, the fatality rate from pesticide ingestion is 40% to 70%.
Having such dangerous chemicals near people’s homes is therefore an enormous public health issue, not only for the direct victims, but also the partners and children they leave behind.
Fortunately researchers like Dr Leah Utyasheva have figured out a very cheap way to massively reduce pesticide suicide rates.
In 2016, Leah co-founded the first organisation focused on this problem – The Centre for Pesticide Suicide Prevention – which recently received an incubation grant from GiveWell. She’s a human rights expert and law reform specialist, and has participated in drafting legal aid, human rights, gender equality, and anti-discrimination legislation in various countries across Europe and Canada.
In this episode, Leah and I discuss:
- How do you prevent pesticide suicide and what’s the evidence it works?
- How do you know that most people attempting suicide don’t want to die?
- What types of events are causing people to have the crises that lead to attempted suicide?
- How much money does it cost to save a life in this way?
- How do you estimate the probability of getting law reform passed in a particular country?
- Have you generally found politicians to be sympathetic to the idea of banning these pesticides? What are their greatest reservations?
- The comparison of getting policy change rather than helping person-by-person
- The importance of working with locals in places like India and Nepal, rather than coming in exclusively as outsiders
- What are the benefits of starting your own non-profit versus joining an existing org and persuading them of the merits of the cause?
- Would Leah in general recommend starting a new charity? Is it more exciting than it is scary?
- Is it important to have an academic leading this kind of work?
- How did The Centre for Pesticide Suicide Prevention get seed funding?
- How does the value of saving a life from suicide compare to savings someone from malaria
- Leah’s political campaigning for the rights of vulnerable groups in Eastern Europe
- What are the biggest downsides of human rights work?
Keiran Harris helped produce today’s episode.
If you subscribe to our podcast, you can listen at leisure on your phone, speed up the conversation if you like, and get notified about future episodes. You can do so by searching ‘80,000 Hours’ wherever you get your podcasts.
Below you’ll find the full interview, brief summary and extra resources to learn more.
Table of Contents
Three key points
“In Sri Lanka the situation was as such that the suicide rate had increased dramatically after the introduction of highly hazardous pesticides into the agriculture — as the result of the green revolution in 1960s. The suicide rate increased from five per 100,000 people to 24 per 100,000 people in 1976, and then peaked at 57 incidences for 100,000 people in 1995.
So, this is a staggering increase in suicide rates. And you can see a direct correlation with the increase in the pesticide use. So, when my colleague Prof. Michael Eddleston and the pesticide registrar at that time noticed this trend, they thought ‘what kind of intervention could help?’ So, from 1984 to 2011, there was a lot of pesticides that were banned in Sri Lanka. So, in ’94, the most toxic insecticides Parathion and Methyl Parathion were banned, and then unfortunately this became substituted by less toxic one, but still people died from further highly hazardous pesticides that they started using as a substitute.
When those five other highly hazardous pesticides were banned, the rapid increase in suicide has stopped, but also another, Endosulfan, another very toxic pesticide was substituted as means of suicide. However, when this was banned in ’98, and further class two pesticides were banned in 2008 to 2011, the suicide rate in Sri Lanka has dropped significantly. So, from 57 instances to a 100,000 population in ’95, it has dropped now to 17. And this is a 70% reduction in suicide rate. So, this is a very significant success, and this is the greatest decrease in suicide rate ever seen.”
“The strategy that we are employing is harm reduction or harm minimization. So, what this means is that instead of trying to tell people, “don’t commit suicide,” which is also, of course, a fair statement, we want to reduce the harm when people still go and try to kill themselves. 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.” So, the inside of the car — that was a death-trap previously — he decided to redesign the inside of the car. So, when the traffic accident happened, it would not be deadly to a person.
So, he designed the steering wheel so that it would not pierce a person to death, but would just collapse and not inflict much harm to the driver. And the same happened to the car hood, which became collapsible, and would not just cut the driver in half. So, this is the harm minimization approach which we’re also advocating for.”
“I see saving someone from suicide very similarly to saving someone from a different disease or from a different … from a road traffic accident for example. I don’t think that’s that different — we’re preventing harm to health and to life of a human being. And the fact that many people decide not to kill themselves if they are prevented from suicide is very telling. These are just vulnerable people, who at the moment of suicidal crisis happen to have this horrible substance next to them. That’s why this horrible substance should be removed from close availability. Some people take a drink, but some people who maybe have many more stresses in the moment of crisis, decide to go for the ultimate means.
So, I think this is not that different than any other intervention that saves lives and saves health. For example, saving someone, or helping someone in the case of non-communicable disease will take years and years. Better habits, more exercise, less alcohol, or less harmful use of alcohol and such. This is extremely cost effective, because you just remove the substance, and the person may live a healthy life ever after, and not attempt this again.”
Articles, books and blog posts discussed in the show
- Centre for Pesticide Suicide Prevention
- GiveWell’s review of CPSP which caused them to provide an incubation grant
- The impact of pesticide regulations on suicide in Sri Lanka
- Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence.
- Preventing deaths from pesticide self-poisoning—learning from Sri Lanka’s success
- Presentation: Preventing deaths from pesticide self-poisoning – Leah Utyasheva – EA Global London 2017
- Pesticides are a leading suicide method – World Health Organization
- The global distribution of fatal pesticide self-poisoning: Systematic review
- UN urges on release of first global report on suicide prevention
- The global burden of fatal self-poisoning with pesticides 2006-15: Systematic review
- Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
- Reducing Injuries and Their Results: The Scientific Approach, Susan P. Baker and William Haddon, Jr., 1974
- Do Gun Buybacks Save Lives? Evidence from Australian Panel Data
- Schistosomiasis Control Initiative
- We can use science to end poverty faster. But how much do governments listen to it?
- Ofir Reich on using data science to end poverty and the spurious action/inaction distinction
- Michelle hopes to shape the world by shaping the ideas of intellectuals. Will global priorities research succeed?
Robert Wiblin: Hi listeners, this is the 80,000 Hours Podcast, the show about the world’s most pressing problems and how you can use your career to solve them. I’m Rob Wiblin, Director of Research at 80,000 Hours.
Today’s episode covers a problem I had never heard of before and indeed was shocked to find existed – suicide by pesticide consumption in the developing world.
I wanted to talk to Leah in order to find out more about the practical challenges involved in starting a new project to tackle a problem in the developing world; how to prove that a policy intervention works; and how to get policy changes implemented in a country very different from the one you grew up in.
Today’s episode isn’t brought to you by Blue Apron, the delivery service that sends you fresh ingredients and incredible recipes so you can make fabulous meals at home.
If you’re looking for other podcasts to listen to, can I suggest The Assassination from the BBC, and Serial Podcast, season 1. Both series represent lengthy investigative journalism about unsolved murder cases – in the first the assassination of Pakistani politician Benazir Bhutto, in second the killing of a Baltimore high school student in the 90s. Will either of those help you do more good in the world? Unless you’re going to get involved in Pakistani politics, probably not, but they are both some of the most compelling things I can remember listening to.
Without further ado, I bring you, Leah Utyasheva.
Robert Wiblin: Today I’m speaking with Leah Utyasheva. Leah is a human rights expert and law reform specialist. She’s participated in drafting legal aid, human rights, gender equality, and anti discrimination legislation in various countries across Europe and Canada. She’s worked a great deal with legal decision makers, including the legal community, civil society, and parliamentarians. And in 2016 she helped to start the Centre for Pesticide Suicide Prevention, which works to reduce the number of pesticide suicides worldwide, which recently received an incubation grant from GiveWell. So, thanks for coming on the podcast Leah.
Leah Utyasheva: Thanks for having me.
Robert Wiblin: We’ll get to talk later about how our listeners might also be able to start their own nonprofit from scratch, to solve our problem that not many people are working on. But first, tell me about the problem of pesticide suicide.
Leah Utyasheva: Yes, Thanks Rob. This issue is not relatively known in the west, but it is a major significant problem in the poor countries of South-East Asia, some countries in Africa. A lot of people, out of 800,000 people who die of suicide every year, a staggering 20% die of pesticide self-poisoning. As I said, it is a major clinical and public health issue, and it affects close 150,000 people every year. And we think that it is also a significant under estimation, because this issue is very stigmatized, people prefer not to talk about it. There are lots of prejudices related to suicide.
So, if someone in the family kills themselves, families prefer not to talk about it. So, this issue goes vastly un-reported as well.
Robert Wiblin: So, how large is the scale of the problem?
Leah Utyasheva: So, as I said, out of 800,000 people who died of suicide every year, close to 150,000 people die of pesticide poisoning. So, this is one fifth of all suicides in the world.
Robert Wiblin: Wow, I’ve never heard of anyone killing themselves by using pesticides. Is this something that only happens in poor countries, or is it just a thing that happens in rural areas?
Leah Utyasheva: Well, means of suicide that people use differ from country-to-country. For example, in the United States, the majority of people who decide to kill themselves do this by firearms. In Hong Kong, where most people live in high rise buildings, jumping from heights is the prevalent means of suicides. In poor agricultural communities, in low income countries, a big percentage of population is engaged in farming. So, they have easy access to high toxicity, lethal means of killing themselves, pesticides. So, this is why pesticides are used for suicides so much more often in low income, rural communities, where people for their subsistence, they’re engaged in farming.
Robert Wiblin: So, this is a particularly effective means of suicide, is that right? So, people are far more likely to succeed if they have a suicide attempt with pesticides?
Leah Utyasheva: Exactly, exactly. Means of suicide that people use in the west and in low income countries, in South-East Asia, are very different because of their toxicity. If people in Europe take medicine in overdose, the fatality of this attempts is very low. It’s less than 1%. For example, if people take analgesics tranquilizers, the case fatality is less than 1%, less than one person out of 100 will die.
In South-East Asia, or in other agricultural countries where this is happening, the case fatality of pesticide self poisoning is anywhere from 40 to 70%. For example, one mouth full of Paraquat, which is a powerful pesticide, it’s 20ml, it’s highly deadly, with case fatality from 60 to 70%. So, 6 out of 10 people will die as a result of Paraquat self poisoning.
Robert Wiblin: Wow, I guess this is quite similar to attempts in the United States to reduce access to guns, because they’re such a successful way of killing yourself, it’s such an effective way of killing yourself that, of people who try to kill themselves, if they do it with a gun, they have a good shot of succeeding, and if you take away the guns they’re likely to use a method that actually doesn’t work.
Leah Utyasheva: Exactly Robert, that’s very good parallel. Also, in the agricultural communities where pesticide poisoning is happening, people can not get to healthcare facilities often. Quite often it takes several hours, maybe days to get to a healthcare facility. So, people die painful deaths, because they’re still breathing before they even can reach the hospital. So, this is why we’re working to reduce this, their access to this lethal means of poisoning in rural communities.
Robert Wiblin: I’m from Australia, and in the 90s a whole lot of new gun control was put in place as a result of a mass shooting. And looking back 10/15 years later, it probably reduced the murder rate. Although, the murder rate was so low to begin with, that it was a bit hard to tell. But there was really strong evidence that reducing access to guns had cut the suicide rate by quite a bit.
Leah Utyasheva: Yes, exactly. So, not all pesticides are highly harmful. Some of them are more harmful to insects, some of them are more harmful to weeds. So, which we’re working on, is to reduce the people’s access to most harmful pesticides, such as highly toxic pesticides. Usually the WHO categorizes pesticides into four types of toxicity. 1A, 1B, two and three. So, class one pesticides are banned in most countries in the world already, but there’s a number of class two pesticides with very high case of fatality, as I mentioned, for humans.
So, we’re working to reduce the availability of those. And I must say, quite often these pesticides are sold in shops, together with food or other everyday items. So, they really, really are available for people in crisis. And what I must say is that, it’s not that this people self harm more, it’s that the fatality of the means that they use is quite staggeringly different.
For example, if one person out of 200 patients dies in the UK as a result of suicide, one in 10, or one in five dies in India. So, here we’re talking about the different case fatality for the means of suicide that people use.
Robert Wiblin: So, it’s not that the rate of attempts to kill yourself are higher in these places, it’s just that people are far more likely to succeed if they try.
Leah Utyasheva: Exactly. Of course, the rate of suicide, or attempted suicide also differs from country-to-country. It is not equal, but the incidences may be not that different. For example, in Europe than in South-East Asia, it’s estimated 350 attempts to a 100,000 of population. However, the fact that the people die so much more often is very upsetting.
And also, I want to point that it is likely that these people don’t necessarily want to die. Quite often, suicide is attempted at the moment of life crisis when people just don’t know how to deal with a stressful situation, or sometimes it’s a cry for help. It is a means of communication. So, if a suicide is more strongly associated with mental health, and mental health problems in the west, it’s not the same in other countries in the world. In other countries in the world it may be a means of communication, may be means of coping with the stressful situation.
Also, it is important to know that such problems as gender violence, conflict, unemployment, financial struggles, child abuse, are also strongly associated with suicide.
Robert Wiblin: I was going to ask that. How do you know that most of the people who are attempting suicide don’t want to die? Is it because when they fail, that they’re unlikely to try again?
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. Of course in some cases substitutions of means happening. Let’s say if the deadly pesticide is not available at the moment of crisis, then someone may go and try to use a less lethal means of killing themselves.
However, this is as I said, research shows that this is happening very infrequently. And also what is important to note, is that if people use a less lethal means of suicide, there is a higher chance of survival for them.
Robert Wiblin: Might it not be the case that banning these pesticides could affect crop production, or are there really good alternatives, and there’s not much reason to be using them anyway.
Leah Utyasheva: Yes, we are only working on this one particular problem at the moment, and we’re advocating for banning the highly hazardous pesticides. There are very good alternative to those pesticides, we’re not advocating to ban all pesticides once and for all. We’re talking about banning the most harmful pesticides, and substituting them with less lethal substances. And those are available, and those are widely known. 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.
Robert Wiblin: Right, there’s not much benefit to using these specific ones then, and they’re not cheaper or more effective, or something like that?
Leah Utyasheva: No, exactly. No, they may be slightly cheaper because they’re older pesticides. The new varieties may be more expensive, however as economic counting shows, economic customers shows, quite many of those pesticides are used in excess anyway. The research shows that a lot of this pesticides are used in over excess. They’re used maybe two, three times more than there is a need. They’re used too often, and they’re highly hazardous, which they don’t need to be.
So, the total amount of the pesticide use needs to be reduced, and they need to be less harmful too for human beings.
Robert Wiblin: So, they’re also hurting people aren’t attempting suicide. They’re hurting people who are incidentally exposed near farms.
Leah Utyasheva: Exactly, yes. Exactly, they’re hurting people who are accidentally exposed. There’s a lot of occupational exposure, and there are also accidents such as when 23 children died in India when they ate a free lunch, which was cooked with oil that was stored in an empty pesticide container. So, tragedies like this happen, and this is a cost of highly hazardous pesticide use, however, in our case, which we found is that means reduction is what we’re suggesting, means reduction is a highly effective way of preventing pesticide suicide all over the world.
So, means reduction is when you reduce the access to this highly hazardous means. So, if the means are not immediately accessible in the moment of suicidal crisis, suicidal feelings might pass before the alternative means are accessed. And as I mentioned before, people may use a slightly less lethal alternative, and increase their chances of survival.
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.
Robert Wiblin: Let’s talk about the research you’ve done on how effective it is to reduce the effectiveness of the means that are available to people. Do you have any estimates of how much it costs to save a life by trying to prevent suicide?
Leah Utyasheva: Yes. So, we’re planning to do this work, following the very successful input in Sri Lanka. So, this is where my colleague, Prof. Mike Eddleston has worked for many years. First he worked as a physician treating patients who self poisoned, trying to save their lives, however, what he found was that this is not a very effective means of saving lives. Because in quite many respects, in quite many cases, it could be too late, and people die after a day or two after reaching hospital. However, what he found is that if you reduce the access to this means, people do not go on to commit suicide as much.
So, in Sri Lanka the situation was as such that the suicide rate has increased dramatically after the introduction of highly hazardous pesticides into the agriculture — as the result of the green revolution in 1960s. The suicide rate increased from five per 100,000 people to 24 per 100,000 people in 1976, and then peaked at 57 incidences for 100,000 people in 1995.
So, this is a staggering increase in suicide rates. And you can see a direct correlation with the increase in the pesticide use. So, when my colleague Prof. Michael Eddleston and the pesticide registrar at that time [Gamine Manuvera 00:14:04] have noticed this trend, they thought what kind of intervention could help? So, from 1984 to 2011, there was a lot of pesticides that were banned in Sri Lanka. So, in ’94, the most toxic insecticides Parathion and Methyl Parathion were banned, and then unfortunately this became substituted by less toxic one, but still people died from further highly hazardous pesticides that they started using as a substitute.
When those five other highly hazardous pesticides were banned, the rapid increase in suicide has stopped, but also another, Endosulfan, another very toxic pesticide was substituted as means of suicide. However, when this was banned in ’98, and further class two pesticides were banned in 2008 to 2011, the suicide rate in Sri Lanka has dropped significantly. So, from 57 instances to a 100,000 population in ’95, it has dropped now to 17. And this is a 70% reduction in suicide rate. So, this is a very significant success, and this is the greatest decrease in suicide rate ever seen.
So, those people, of course, there was a team working on this, but this people saved close to 93,000 lives in several years, and the estimate of this savings is quite significant. So, it’s maybe from two to seven dollar per DALY, saved in this situation.
Robert Wiblin: Wow, there was 70% reduction in suicide across Sri Lanka as a whole?
Leah Utyasheva: Yes, not only pesticide suicides, but 70% reduction in suicide rate at all. Yes.
Robert Wiblin: That’s extraordinary, and it lines up just with exactly the dates where these pesticides were withdrawn?
Leah Utyasheva: Exactly, yes. Exactly. And this incredibly successful interventions are mirrored in Bangladesh and South Korea where the highly hazardous pesticides were banned and suicide rate has decreased significantly.
Robert Wiblin: Has anyone written a paper where they’ve tried to estimate exactly how many lives you’d expect to save, and how much it costs? If indeed really costs anything, other than the advocacy required by some activists.
Leah Utyasheva: Well, of course, introducing this public policy feature will cost quite a lot of money, because first you need to go ahead and estimate which pesticides are used for suicides in this particular country. So, here I must say, there could not be just one list of pesticides that you just decide to ban, and this will work for every country. Each country uses their own brand names. Maybe it’s generic names, maybe it’s different compounds, different mixtures and solutions that different active ingredients of pesticides are produced.
So, each country needs to do its own research in terms what substances are used for suicide. And then, of course there will be some cost of implementing those bans. I must say that it’s important to also monitor what substances are sold in shops, because quite often there is illegal trafficking of pesticides, and some substances that are not legally registered within the country, may find their way to farmers markets and shops in the country.
So, all this needs to be counted as a cost of the intervention. However, we estimate that the successful intervention could cost as much as $400 per life saved, and this is what happened in Sri Lanka. And it could be an extremely, extremely effective intervention in terms of cost effectiveness.
Robert Wiblin: Is it expensive for you? Because perhaps you have to lobby against the manufacturers of these pesticides?
Leah Utyasheva: Right now we’re starting work in two countries, in India and Nepal, and we exactly selected those countries because we think that we could implement a highly cost effective intervention in those countries. We have a good network due to my colleague Prof. Michael Eddleston’s long work in the region. We have a good network of pesticide registrars that understand the situation, and that are onboard with our goals. And we also have a good network of United Nations experts, who as I mentioned previously, have designed the cost effective and the best policy interventions to prevent suicide, and ban highly hazardous pesticides.
So, due to that we think that we could be effective in doing this in those two countries. But what we’re planning to do is to first collect information from 20 hospitals in India and 10 hospitals in Nepal, and based on that information we present policy choices, clear policy choices to decision makers in these countries. And of course, we’ll work with civil society, and we’ll work with other stakeholders to engage them as well.
Robert Wiblin: How do you estimate the probability of successfully getting law reform in a particular country?
Leah Utyasheva: It depends, of course, it depends on the country, it depends on how ready the civil society is to support our ideas. It depends on how ready the decision makers are to … How accepting they are to their ideas.
Robert Wiblin: Have you generally found politicians to be very sympathetic to the cause, and open to banning these pesticides?
Leah Utyasheva: Usually I would say yes, because the countries we’re planning to work with, and we work with now, have low capacity, and they have low budgets for this particular intervention. Usually there’s one or two people working in the pesticide registrar office, and they’re overworked, they have little support, they have little knowledge how to use those highly sophisticated tools that the UN develops for them.
And they are very eagerly engaged in conversation and in planning on how they could do their work more effective, and how they can bring more good to the country. Of course, a lot more attention is currently being paid to environmental harms, to occupational exposure, to incidental exposure of children, residues of pesticides … Residues in food. This is why I think this issue is so neglected.
Because not when so much talk is devoted to pesticide harms, people don’t talk and don’t know about suicide by self poisoning with pesticides, and people don’t know that this issue could be quite easily resolved with just taking some highly hazardous pesticides away from the market. This is why I think this is, to some extent, is a social justice and equality issue. Because people who are mostly affected by it are poor farmers in low income communities, who quite often don’t have a voice, and can not express, and express their own sorrow and their problems. So, in many respects it is a call from help, which has so far been unanswered.
Robert Wiblin: Who else is working on this problem?
Leah Utyasheva: I’m not aware of any other organization which is working on this problem. As I said, a lot of organizations are working on environmental impact, occupational exposure, but very little is spoken and known about pesticides suicides.
Robert Wiblin: It sounded like the World Health organization had written some reports, but they don’t really have anyone dedicated to it.
Leah Utyasheva: No. There are groups of people working on pesticide use reduction within the WHO and within the FAO, the Food and Agricultural Organization of the United Nations. But they also do approach this from a different angle, not like us. So, our work is multi faceted. It is approaching this issue from a human rights perspective, from a quality perspective, but also of course, from the perspective of taking means reduction perspective, which means taking this pesticides from wide availability of vulnerable population.
So, the strategy that we are employing in this, is harm reduction or harm minimization. So, what this means is that instead of trying to tell people, “don’t commit suicide,” which is also, of course, is a fair statement. We want to reduce the harm when people still go and try to kill themselves. 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.” So, instead of having the inside that was a deathtrap previously, he decided to redesign the inside of the car. So, when the traffic accident happened, it would not be deadly to a person.
So, he designed the steering wheel so that it would not pierce a person to death, but would just collapse and not inflict much harm to the driver. And the same happened to the car hood, which became collapsible, and would not just cut the driver in half. So, this is the harm minimization approach which we’re also advocating for.
Robert Wiblin: So, your co-founder was initially just trying to help people directly as a doctor in Sri Lanka?
Leah Utyasheva: Yes, exactly.
Robert Wiblin: And it sounds like they’ve had vastly more impact by working on advocacy and policy reform, like 10,000 time more impact.
Leah Utyasheva: Definitely, yes.
Robert Wiblin: So, this is potentially a good example of how can have a lot more impact by trying to have more systemic change, rather than just going person to person.
Leah Utyasheva: Definitely, definitely. Law reform and policy reform are an extremely efficient ways of preventing lots of inequality and human rights violations in the world. I worked with decision makers and policy people all over the world, on many issues. And what I found is that a lot of bad policies, such as for example preventing women with children staying in the shelters, or preventing people from … People who use drugs from buying clean syringes. These are bad policies, but there is so much … They developed more with … Not because of ill will, they developed because people don’t know better, decision makers don’t know better.
They are negligent about what problems real people face. Usually they come from the same gender, from the same social group, mostly male, mostly well educated, mostly in their middle ages, and they don’t care about vulnerable groups. They don’t care about marginalized groups. However, if they’re told about the effects this particular policy, let’s say, is having on vulnerable and marginalized groups, they could listen. And it would be more effective if they’re told that it will improve the cost effectiveness of their work if they’re shown that their public image will be better viewed by the constituency, or by their boss, and so on.
So, in the policy work, it is important to understand that influencing the decision makers go along way if you show them the way to do it, which could be beneficial for them as well.
Robert Wiblin: Do you think that you’ve been very successful in getting law reform, because you’re among the first people to speak up about this issue? So, there was just a lot of potential to reform things very quickly, if someone actually went and spoke to politicians?
Leah Utyasheva: It depends on the issue. On this issue, I believe that this situation will change quickly, because there is a need for it to change, because people who work in pesticides registrar offices, they know that there’s a need to do it, and they can see that this can be done easily, and it can be done effectively and efficiently.
I believe that the major problem that they face, is that they have low capacity, they don’t have the means to do it. But of course it could be different with other problems.
Robert Wiblin: When your co-founder, Prof. Eddleston, was weighing up, or he was directly treating people in Sri Lanka, and then he was considering going into policy reform. Was there really much question for him whether it would be more effective, or was it just obvious as soon as he thought about it that, that was the way to go?
Leah Utyasheva: No, I think it’s years and years that required to come up with this particular course effective intervention. For many years he worked on providing antidotes to people on figuring which substance is more toxic, which substance is less toxic. So, there was a lot of work on the personal level, when he worked one-on-one with the patients. And then, for a very long time, I believe he and his group worked on social intervention, which also could be one way of solving this problem.
So, for a long time, the WHO and the international association of suicide prevention advocated, and the industry as well, advocated for the so called safe pesticide storage. When you put pesticides in boxes and bury this boxes either in the field, or keep them locked inside your home.
So, it was advocated, it was suggested that this is a highly effective solution to remove the highly hazardous pesticides from the immediate availability of people in suicidal crisis. So, it was said if you lock the pesticides, then people need to go and look for a key, maybe the key is stored someone else, maybe someone else, old, has the key.
However, this intervention has shown, as a result of long multi year and multi stakeholder study, it was shown that is not that effective as people had thought. This study had just been published in The Lancet this year. And there are a couple of significant issues with that approach. First, some people, instead of storing their pesticides in the field or in the shed, brought those boxes in their house. So, it brings pesticide even closer to people. Second, the box, even though it’s locked, could be easily crowbarred and opened.
And third, the locking of the boxes had reduced over time, and there is research showing that after several years, the locking of the boxes had significantly reduced, and not many people actually did have them locked. And then other issue is that in many instances, people bought pesticide specifically for the act of poisoning, not necessarily those were the pesticides, that substances that were already stored in the house. So, this was another intervention that was suggested as an effective, which actually did show that it’s not that effective.
So, there had been a lot of research, and a lot of trying different alternatives on how to reduce the numbers of suicide. And this, the regulatory means control, the way was shown to be more successful, and this is the way that WHO also suggest to use. So, the means reduction is very widely accepted way of suicide prevention. So, in Hong Kong I mentioned before that lots of people jump from heights. Barrier installations to prevent people jumping from heights, proved to be extremely successful in reducing the numbers of suicide. Installing platform screen doors to limit access to the railway track also proved to be very successful in reducing jumping in front of the train.
And then detoxification of gas in the UK, where a lot of people killed themselves by poisoning by gas had been proved to be very successful as well. So, it reduced the suicide rate in the UK by between 19% and 33%.
Robert Wiblin: People were sticking their heads in ovens and getting gassed that way?
Leah Utyasheva: Exactly. Yes. So, this is called means reduction, as a suicide prevention, and this is extremely successful in a number of ways, with all suicides. The same as we talked before, the reducing availability of guns in the U.S.
Robert Wiblin: I’m very interested to dive into this gradual research process. It sounds like Prof. Eddleston went through. He spent what, 10 or 20 years trying different approaches for preventing people from killing themselves with pesticides. Did he try anything else other than the lock boxes and banning?
Leah Utyasheva: I believe that my co-founder has worked on this issue in Sri Lanka, but I think quite soon it became obvious that means control is the best way of going with this in Sri Lanka, because [Gamine Manuvera 00:31:06] who had been the pesticide registrar and Prof. Michael Eddleston, they worked on this in ’94 when the banning of pesticides started. Sorry, did I say ’84?
Robert Wiblin: I think so, yes.
Leah Utyasheva: ’84. Yes, in ’84. I think they tried different solutions to the problem in Paro and it’s the means control one that is shown to be most effective. And right now, he and his research group is working on a similar situation in Bangladesh, and we are thinking, we’re hoping that we will be able to work in more countries than Nepal and India, hopefully in Sub-Saharan Africa, and possibly in Taiwan and some other countries.
Robert Wiblin: Why did so many groups recommend that people lock the pesticides in boxes if there was so little evidence that, that actually helped, and it sounds like it doesn’t. And to be honest, it doesn’t even really make sense to me. Because couldn’t people just always unlock the box, and get the pesticides if they wanted to kill themselves?
Leah Utyasheva: Yes, exactly. It seems to me that this was a solution also pioneered by the industry. That a lot of money had gone into advocating for this solution, and into promoting it in the poor communities. However, industry must understand that if they stop producing the highly hazardous pesticides, and work on other more effective solutions, they will still stay in business, they will be still highly necessary, because food production still does need pesticide to stay in place.
Robert Wiblin: They can just switch to producing a different pesticide.
Leah Utyasheva: Exactly.
Robert Wiblin: How important was it to have strong evidence from an experiment in order to convince policy makers to change the law, and other people to get onboard with this whole project?
Leah Utyasheva: That was exactly important, and I think this why our approach to solving this problem is also unique, because we work with hospitals, with academic groups, academics, on providing highly precise information, on providing results of randomized control trials that point in this direction. So, I think it is exactly important to monitor, and to provide the best academic studies behind this.
Robert Wiblin: What are the biggest challenges you face as an organization?
Leah Utyasheva: Well, we’re a new organization, and we’re just getting off the ground, and this is where such amazing groups as GiveWell and Open Philanthropy project are very important, because they help us get off the ground, and they helped us to start our work. We’re hoping that we will be able to provide evidence of our cost effectiveness, and of our work, so that we have a very precise estimate on the cost effectiveness and tractability of this problem.
Robert Wiblin: Was it difficult to get registered in Sri Lanka, or in India, or in Bangladesh, and to actually get a presence there?
Leah Utyasheva: We actually don’t have a presence there yet. We’re working with partners who will hire people on our behalf. And this, I think, is also very important, that rather than be seen as outsiders, we will work with local decision makers, local civil society, people who are already on the ground, and we will engage them, give them the capacity to do this work themselves, and maybe provide some more, just means for them to do this.
But it’s important that we’re not coming from the outside with our knowledge, but we are working with the people who are in the country, who are directly impacted with this, and who already possess local knowledge.
Robert Wiblin: What motivated you to start a charity specifically, rather than continue operating, I guess, as Prof. Eddleston had been before?
Leah Utyasheva: Now we’re not only approaching this from the academic perspective, we’re working from policy perspective, from a human rights perspective, and we’re hoping, as I said, to engage decision makers, and engage civil society. So, it’s not … It goes beyond the academic research, it goes beyond randomized control studies. It goes more to working with the community in the country to solve this problem.
Robert Wiblin: And the reason you wanted to start the charity was, basically, you saw this enormous problem that you had a solution to, that was demonstrated to work, that no one else was implementing. So, it was just really right to have an organization to seize the mantel and push that really hard?
Leah Utyasheva: Yes, no one else was talking about it. So, we thought we’ll do it.
Robert Wiblin: Did you consider joining a different group and convincing them to champion the issue?
Leah Utyasheva: No, not so much to be honest with you, because we decided that it’s important for us to work on this ourselves, and rather than convincing someone else to do it, we can do it ourselves and grow organically from here. So, we’re hoping to have more people later on to work on this and work in more countries. But we are targeting a unique problem, which no one else in the world seems to work on. So, why would we join another organization, it’s not necessary for our purposes.
Robert Wiblin: Yes. You can just excel at this one thing, which is your focus, and you don’t have to get bogged down in broader bureaucracy.
Leah Utyasheva: Exactly.
Robert Wiblin: Would you, in general, recommend starting a new charity to people? Is it more exciting than it is scary?
Leah Utyasheva: Well, I think it’s definitely exactly exciting, and it’s not scary at all. And I would definitely recommend people to start new charities if they’re passionate about any particular subject. Because those are the best charities that grow grass roots, and that grew from people’s passions and people’s desires to solve some particular problem. So, this is the best charities, and the most effective charities that there are.
Is it hard to start a charity? I find that it’s not that hard to do that in the west, because all you need to do is just to go in and register a not for profit corporation. However, in some other countries in the world, where the government do view a civil society activity with suspicion, it may be more problematic. So, in some countries of Eastern Europe or Asia, specially central Asia, that could be big problem of course.
However, in the west, I find that it’s fairly straight forward and it is easy, so one just needs to register a not for profit corporation, and then go from there. Of course, if one wants to register a charity, things become a little bit more complicated because charities need higher oversight, and there are more requirements to the board of directors of this organization, and there are more requirements to the operations side of this, reporting sides of this.
Robert Wiblin: So, you haven’t found it stressful, potentially worrying that you’re not going to get the money that you need, or you won’t be able to find the hires that you need?
Leah Utyasheva: Well, maybe all this stresses are still ahead of us, but so far we are enthusiastic that we will get through it.
Robert Wiblin: Fantastic, that’s good to hear. If any listeners are thinking of starting a new non profit, it’s one of the paths that we recommend, at least if you have an intervention that’s demonstrated to work, that you can’t do any other way because no one else is working on it. It does seem like starting something from scratch and then growing it up, and filling a gap in the market is one of the ways that you can potentially have a really huge impact, and solve a problem that no one else is going to solve.
Leah Utyasheva: Definitely, I think that’s the case. I totally agree.
Robert Wiblin: Is it hard for you to work as Europeans in Sri Lanka and India? Are there cultural issues that make it challenging?
Leah Utyasheva: No, I don’t think so. I think our will to do well, and we’re basing ourselves on very widely known best practices and best solutions to the problem. And we’re working with exceptional group of people in India and Nepal, who are also passionate about what they’re doing. We’re working with Christian medical hospitals in India, and a group of doctors in Nepal, who are extremely concerned with this issue, and who want to solve it, or help contribute to solving it. So, there are no difficulties.
Of course, as I said, we’re very cognizant of the fact that we don’t want to be seen as outsiders and coming with our best knowledge. We do bring them the means, and we suggest solutions that have worked in other culturally similar to them countries. So, we believe that this will work, and of course the approach will be adjusted in each particular country. For example, if somewhere civil society is more on this issue, is more interested, is more prepared to take this issue on, we’ll work more closely with the civil society.
If in Nepal we can work more closely with the pesticide registrar, and to try to solve this by just taking out of registration several pesticides, which could lead to enormous cost effective results, maybe we’ll go this way, because we have good connection with the pesticide registrar, and we are on the same page with how this could be solved.
Robert Wiblin: Do you get local people to go and represent your views to politicians directly, or would you go to those meetings yourself?
Leah Utyasheva: Both. Both, I think we will work with local people and we’ll do it ourselves as well.
Robert Wiblin: You’re not the only charity that has been founded recently to tackle an issue that almost no one else was dealing with, and was started by and academic who’d studied the issue. There’s also the Schistosomiasis Control Initiative. Are you in touch with them very much?
Leah Utyasheva: We know about them, but we haven’t been in touch yet. We’re planning to do though.
Robert Wiblin: Do you think that it was important to have an academic as the founder and leader? Does that give you a lot more credibility?
Leah Utyasheva: I think so. I think so. We have Prof. Eddleston’s entire academic knowledge as a background to our work. He has worked on this for many years, he has researched the best ways, and he knows everything about this issue. So, it gives us leverage to present our views. It gives him the ability to speak the same language with pesticide registrars, with WHO, and with the FAO, with the UN agencies. So, I think it’s exactly important to have an academic as a head, definitely. Especially in our case.
Robert Wiblin: Can you walk me through the process that you went through to get it off the ground? I imagine at first you had Prof. Eddleston, and then he found you, is that right?
Leah Utyasheva: Yes, and personally, myself, it bothered me very deeply that after so many years working in a social justice and human rights area, I didn’t know anything about this issue. And so, this was the case also I talk in Canada, or the United States, when people don’t know about this issue. And this is such a significant issue, which kills close to 150,000 people every year. So, the only answer that I can get for myself is that this is really an issue of social injustice and inequality. Where such an important issue is overlooked by many who are not affected by it.
Robert Wiblin: So, you had Prof. Eddleston, and then I guess he had the academic background, and the knowledge of the interventions, and the problem. And he found you because you were an expert in policy and legal reform?
Leah Utyasheva: Yes.
Robert Wiblin: And then, did you have a lot of meetings to decide what’s going to be the strategy, “Who else do we need to hire?” What does that look like?
Leah Utyasheva: We worked for a long time online, just thinking about how this will be done, and which would the best way to set it up. We also had a co-founder Austin Forester, who I want to credit for his amazing job in starting this. He worked with us in the beginning to set up the charity, to help with the website, to help with many other things that were very important. Unfortunately later on he quit. But yes, we worked for more than a year trying to figure out how this organization will look.
Eventually we decided that it will be better if the organization was under the auspices of the University of Edinburgh, because as such we can use resources that the university has, and we can start with very little resources in the beginning, to try to channel all our resources into the countries that we work in, in India, Nepal, and maybe some other countries very soon. Rather than to set up a big organization with fundraising, sectors, departments, and media departments, and so on.
Robert Wiblin: I see. So, by connecting yourself to the university, you can use their legal infrastructure, and their fundraising ability, and things like that. So, it saved you on the operations?
Leah Utyasheva: Exactly, yes.
Robert Wiblin: Yes, it was good to hear a shout out to the person who helped do, I guess, the incorporation, and setting up the website and all of that. I think-
Leah Utyasheva: Yes, we actually …
Robert Wiblin: I think that could be really underrated, and it’s not necessarily the case that because you’re an academic expert in an intervention area you’re able to do all of those operational things. You almost always need someone who’s willing to do that difficult work, and that has to be done before you can really accomplish anything.
Leah Utyasheva: Exactly, yes.
Robert Wiblin: How did you get your first money? Because this is often an issue for getting an idea off the ground. You might have people who know a lot about the issue and are very skilled, but they’ve got not money, and you need to match them up with someone who cares about the issue and has money.
Leah Utyasheva: Exactly. Here I want to credit James Snowden, who when he heard about this problem, became passionate, and just totally engaged in the issue. So, James Snowden of GiveWell have given us a lot of help, and a lot of support into getting the grants from GiveWell, and the Open philanthropy Project. So, this was amazing working with him, and trying to understand how Effective Altruism works, and all the respect that I feel for you guys is amazing. You’re amazing. So, there are clear parallels between the academic work that my colleague has done before, and the requirements, and the interest that Effective Altruism has into proving the tractability, neglectedness, and cost effectiveness of the interventions over the problem.
So, in our case it was very easy to provide the evidence, because this is how we think ourselves, this is what we look for, into, when we designed our strategies. This is what we wanted to achieve, the precise economic value, the results of the trials, and the proof that this will work, the monitoring and implementation system. So, this all goes very parallel and very close to our hearts.
Robert Wiblin: GiveWell was more or less the first significant money that you got then?
Leah Utyasheva: It is, yes.
Robert Wiblin: And that’s what allowed you to actually start the project more or less?
Leah Utyasheva: Exactly. Exactly, yes.
Robert Wiblin: Did you try to raise money from anyone else first, and how did that go?
Leah Utyasheva: We approached the UK DFID (UK Department for International Development), but we haven’t gotten any response from them so far. We’re planning to do this again, and we’re planning to raise more money from other charities, also our work in Sub-Saharan Africa. And we’re planning to work closely with the United Nations Environment Program and FAO, to look for more money in the future. This is why we would also like to get help of a experienced fundraiser who could help us approach more charities. But we also would be happy to work individual donors. So, whoever wants to give us $10, we’ll extremely happy with that.
Robert Wiblin: Did you look around for private donors who might be able to support you and had a passion for this issue?
Leah Utyasheva: No, we haven’t. So, if you have any, or any of your listeners, Rob, has any ideas about how to look for private funders, or any particular names, please let us know. That would be extremely helpful for us.
Robert Wiblin: Do you know how long this grant from GiveWell is going to last you?
Leah Utyasheva: Two years.
Robert Wiblin: Two years, okay. So, you’ve got a reasonable amount of time to hopefully have some success and get some things done, and then hopefully get the grant renewed and find other supporters?
Leah Utyasheva: Yes, that’s the case, yes.
Robert Wiblin: There could be potential donors listening in. So, I might ask some questions that they might pose, or that I would think about if I was considering donating to you.
Leah Utyasheva: Okay.
Robert Wiblin: So, you’ve got this pretty strong track record, where in the past you’ve managed to get these policy reforms at low cost and so you’re saving lives for only a few hundred dollars, it sounds like. But how do you know that you’re going to be able to repeat that success? Maybe you just got lucky the first time?
Leah Utyasheva: It’s possible, so we will see. We will try our best, and we’ll see, and we’re hoping that in two/three years we’ll know if this exactly works, or if it’s not. However, the evidence is from several countries, it’s not only Sri Lanka. The same evidence comes from Bangladesh, from South Korea, that this works. And saves money for as little $5 per DALY, or from seven to $2 per DALY, and this amazing. This is very cost effective.
Robert Wiblin: So, that’s very cost effective, and if it were true, it would be more cost effective than a lot of other things that GiveWell recommends. But if it were closer to some of the other charities, I might wonder how good is it to prevent someone from killing themselves, versus, saving a life from Malaria? So, people who attempt suicide, their lives might be worse, and also in a sense they’re choosing to kill themselves, they’re not being killed by a disease that they didn’t want to have.
So, you might think that it’s somewhat less valuable to prevent someone from killing themselves than to save them from disease, and in that sense it would be less cost effective. What do you think of that?
Leah Utyasheva: This is a great point, and great question, thank you. I see saving someone from suicide very similar to saving someone from a different disease or from a different … From a road traffic accident for example. I don’t think that’s that different, we’re preventing harm to health and to life of a human being. And the fact that many people decide not to kill themselves if they are prevented from suicide is very telling. Those are just vulnerable people, who at the moment of suicidal crisis happen to have this horrible substance next to them. That’s why this horrible substance should be removed in close availability. Some people take a drink, but some people who maybe have many more stresses in the moment of crisis, decide to go for the ultimate means.
So, I think this is not that different than any other intervention that saves lives and saves health. For example, saving someone, or helping someone in the case of non-communicable disease will take years and years. Better habits, more exercise, less alcohol, or less harmful use of alcohol and such. This is extremely cost effective, because you just remove the substance, and the person may live a healthy life ever after, and not attempt this again.
Robert Wiblin: So, if I was considering donating to you, I might think, “Well, you’ve got this great plan in theory, but are you going to be able to attract the staff and the skills that you need to really implement this plan extremely well? What kinds of skills do you need, and do you think you’re going to be able to find the people that you need to grow and scale up?”
Leah Utyasheva: Right now we’re looking for volunteers with all sorts of skills. We’re looking for people who can help us with communications. We’re looking for people who can help us with fundraising plans and so on. And of course, we are looking for people who could help us within the countries that we work in. However, I don’t know if many listeners from India and Nepal are subscribed to your podcast.
Robert Wiblin: There’s probably a few, but not a lot.
Leah Utyasheva: Yes, but if you know about the problem in your own country, I know that probably people with different backgrounds are listening to the podcast. Go and find out if this is a problem in your own country and see how you can help, if there are any organizations working on this problem. If you know that this is a problem in a particular country, let us know, we will be very happy to engage with people about what can be done in other countries, which maybe not on our horizon yet.
Robert Wiblin: What kind of roles do you envisage yourself hiring for in the next few years?
Leah Utyasheva: Communications, fundraising, policy work, as well as government relations and so on.
Robert Wiblin: Okay, so let’s talk about your background a little bit. You’re doing something that’s really challenging now, trying to scale up in an organization, working on a problem that basically no one has worked on before. So, you have to be pioneers, and have to be quite creative. How do you think you got to the position where you’re able to do something that challenging? How did you grow your skills over time?
Leah Utyasheva: For many years I worked on issues that vulnerable groups of people face. I worked on access to justice for women and low income families. I worked on access to justice for people who use drugs, on access to medicine for people living with HIV Aids. Migrants, recently I worked on issues that migrants face. So, all my work was related to vulnerable marginalized groups, and trying to improve their social situation, and human rights protection of those groups. And most of my work was concentrated on policy and on law reform, because I have a legal background, and I have experience in drafting legislation, and approaching decision makers. Working with parliamentarians, judges, lawyers, on a particular intervention.
So, this is what I have been doing, and this is where my skills come into this particular organization, that we will be able to hopefully, to design an intervention which is effective, and which helps the most vulnerable groups.
Robert Wiblin: Are there any roles from your past that you could talk about where you feel you where really challenged and you gained a lot of knowledge from working in it?
Leah Utyasheva: I worked with human rights protection, for people who used drugs and LGBTIQ people in Eastern Europe. And this was extremely challenging, because these groups are considered to be almost criminals, especially in relation to people who use drugs, definitely, they’re considered to be criminals, offenders. And the same goes for people who, they’re called non traditional sexual orientation in Eastern Europe, non traditional sexual orientation. So, the name itself says it all, of course. So, it was very challenging to persuade decision makers, parliamentarians, to see these people as human beings, and to approach their wellbeing, try to improve their wellbeing. And to approach their human rights the same as the human rights of the majority of the population.
And this reinforced my passion for working, and trying to give voice to the people who don’t have it. To those people who maybe don’t even know that they have a problem. But their own way of solving their problem is drinking pesticide. So, this is why I’m passionate about this. And for a year now, or a little bit more than a year, I worked on this just because I just couldn’t get away from this issue, because I think it’s so under reported, under talked about. But it’s such a significant issue for one of the most vulnerable groups that there is.
Robert Wiblin: Did you manage to have any direct success in your previous job? So, get any laws passed, or real changes in practices?
Leah Utyasheva: Definitely. Definitely, yes. We were successful in getting access to medicine for people living with HIV in Eastern Europe. I worked successfully on improving the legislation related to Visa and travel for people living with HIV, because in several countries, people living with HIV were banned from entering. If you couldn’t your HIV free status, you couldn’t enter, you couldn’t get a Visa to a country. So, those are banned … This legislation is repealed in most countries that it existed.
I was quite successful in improving domestic violence legislation in Russia and other Soviet Union countries. The same with access to justice for victims of domestic violence, and for marginalized groups generally. When you need to pay for getting a lawyer, or improving … If someone is charged with offense, how they can get free legal help. So, I worked on that as well.
Robert Wiblin: And all of that experience carries over to what you’re doing now?
Leah Utyasheva: Definitely. Definitely, it’s the skill that’s maybe, I talked before, that how you can approach decision makers. You need to help them understand how this will benefit themselves. Yes, unfortunately this is the sad truth, but you need to show them the cost effectiveness of the intervention. You need to show them that they look better in the eyes of the world, or in the eyes of their boss, or something like this. And then it’s easier to convince them.
Robert Wiblin: How does it benefit politicians? It’s just that they’re well regarded if they do a good job?
Leah Utyasheva: Well, differently. Right now there’s sustainability development goals that every country needs to perform. And suicide reduction is one of those sustainability development goals. So, it’s very important for the country to look good in the eyes of the society, of the global society. So, they need to act on those goals and reduce suicide rate for example.
Robert Wiblin: Politicians really care about those international goals, rather than lining their own pockets, or just looking good to their voters?
Leah Utyasheva: Some do definitely. Yes, the best of them I suppose do. Then you can show them the cost effectiveness. Pesticide self harm, and pesticide poisoning in general have enormous public health effect on the health system. They put strain, enormous strain on the health system. And actually, I have some numbers on that. So, it will benefit their department, their country in general. It will benefit other people who may need to go to the hospital with a different disease, but the very limited resources of this hospital, the 60% of them are taken with pesticide poison patients.
So, there’s different levels of cost effectiveness of this. If you reduce the harm from highly hazardous pesticides, a lot of valuable resources will be freed. Not only in public health sector, but also in employment there will be more healthy people to [crosstalk 00:58:03].
Robert Wiblin: To work, yes, and pay taxes that the politicians can then spend.
Leah Utyasheva: Exactly, exactly.
Robert Wiblin: I guess it also leaves families and children in a very difficult situation.
Leah Utyasheva: Both, pesticide suicide has an enormous impact on families and societies.
Robert Wiblin: What are the biggest reservations that the politicians have, and did your skills allow you to overcome those concerns?
Leah Utyasheva: To be honest with you, I think the worst argument against this is just, they have limited resources, and they can’t find resources to solve this problem. But of course, the fact that you mentioned before, that this patients are maybe disliked by both politicians and doctors, because they inflict this harm upon themselves, they’re responsible. They seem to be responsible for this, which are argue against this, because according to the international human rights law, the government, the state is responsible for protecting the health and the life of their population. So, if we look at this from the human rights perspective, all this people need is access to healthcare.
They need access to good mental health care, they need access to hotlines in the case of suicidal crisis. They need to be able to access psychiatrist consultation and such. And of course, this countries have much lower resources in all this respects than rich countries. Yes, so it’s a battle for limited resources. And in this situation, it’s the removing of this most harmful pesticides, is a cost effective option to solve this problem.
However, I must say that it’s important to understand that suicide is a very nuanced and very complicated, complex, societal, individual, national problem. So, much more is needed to solve this problem. It’s not only removing highly hazardous pesticides from the wide availability of people in crisis. A strategy is needed that would improve mental healthcare, healthcare in general, and how people cope with life stresses. Also, research shows that ethical media reporting is extremely important, how you present suicides in media is extremely important to reducing the numbers of suicide.
Robert Wiblin: Do, you think it’s partly the taboo about suicide that’s causing this issue to be neglected? Because people lack sympathy for those who try to kill themselves?
Leah Utyasheva: That could be the case in some countries, could be not the case in some other countries. But definitely, taboo and prejudice against this plays a big, big role. Definitely, yes. And in some countries, I must say in some countries, religion plays a protective role, but in others it’s not. So, it depends on the country, depends on the people, on media reporting as well.
Robert Wiblin: Yes, I’ve looked at the stats on suicide and what seems to cause it. And it’s an unusual health issue, in that is seems very unrelated to economic issues. It seems extremely culturally specific. That some countries have very high rates of suicide, and others have very low. And the main reason doesn’t seem to be how well people are doing, or in a material sense.
Leah Utyasheva: That’s definitely the case, yes.
Robert Wiblin: If someone wanted to work on this issue of pesticides suicide, are there any particular topics that you’d be enthusiastic for them to be studying, or organizations that they might be able to work in first that would prepare them to do a good job?
Leah Utyasheva: It’s not easy to say. Suicide prevention is a multi faceted program, and different fields involved into it. It’s suicide prevention, it’s wider public health issues, environmental protection comes here also somehow, reduction of pesticide use. And also better chemical management in general, and it’s also a question of human rights and social justice, general inequality. So, you can approach this issue from all of those perspectives. I’m not scientist or a medical doctor. But obviously one may go to study medicine, biology, psychiatry, to work on suicide prevention. As I mentioned before, my colleague Prof. Eddleston, is a toxicologist and a medical doctor, who for many years worked in Sri Lanka, treating patients and saving lives.
But also studying public health, global health, international development could be good areas to start in if one wants to work in the developing countries, and helping solve the problems that those developing countries are faced. But I think it’s less important what one studies, it’s more important what one does with the degree. I think it’s important to study what ones like, and what you feel good about, medicine, mathematics, law, whichever that is. But if you think about vulnerable groups, and vulnerable population, non majority groups, how you can make your degree work to help this groups, to give voice to the groups that usually don’t have a voice.
And this can be done in any country, and of course even in high income countries such as Canada, the United States, the UK, there are lots of people who need help. However, of course, one can help many more people in developing countries with interventions, which will be much more cost effective.
Robert Wiblin: So what did you study?
Leah Utyasheva: I studied law in Russia. And then I did comparative constitutional law and human rights law, which I studied at Central European University in Budapest, and later on in the UK at the University of Newcastle upon Tyne.
Robert Wiblin: How did you find law as a student? Was it a good fit for you?
Leah Utyasheva: No. Maybe no. Maybe it wasn’t a fantastic fit, because it was a little bit to dry, and I have problems with maybe devoid of a real life problems that made me passionate. So, that’s why I went into human rights, and into social justice work. Because I found it a little bit dry to work on contracts, or to work on marriages and acquisition documents and such. So, this is why I work on legal issues, or policy issues that are related to law. And that’s what I find fulfilling and interesting. Because here you can see the difference, of course, it may take a while, but you can see the difference that your efforts has made, and hopefully they improved lives of people.
And I’m fortunate to say that some of my work has resulted in improving life of the vulnerable and marginalized groups.
Robert Wiblin: What’s the biggest downside of working on pesticide suicide, and I guess some of the other human rights work that you’ve done before?
Leah Utyasheva: I would say generally about human rights, the downsides are probably the fact that it’s not very well paid, and the other thing is that it takes a long way to, in many respects, it takes long way to really see the change. Hopefully, this issue will be different, and I’m hoping very much that this be the case, because hopefully we will see the results of our intervention quite early on. For the two years we will just work on setting up the system that we think, hopefully, will work. But for the next maybe two or four years, we’re hoping to see the results of our intervention. But usually it is the fact that it takes a long time to really achieve a change in the public policy.
Robert Wiblin: I thought that you might say that the biggest downside is that you’re working with very grim problems, and difficult problems, especially if you’re thinking of homophobia in Eastern Europe, or people who are killing themselves. Is it very draining emotionally?
Leah Utyasheva: No. No, I would say no, because you work with amazing people. You work with amazing people who are drug users, just happen to be drug users. They just happen to live with HIV, or they happen to experience domestic violence. It doesn’t make these people sad, or it doesn’t mean that this people are any different from other people. Quite often you actually learn a great deal from this people. The resilience they have, the amazing will to live, and to be happy still, despite all the problems that they face.
And I think it’s the same with suicide victims. It’s not that they’re sad, or that they’re desperate. Quite often it is, of course, some people with mental health issues are sad, but not always, they’re not always sad. And as I said, a lot of people who kill themselves, or try to kill themselves in South-East Asia and other low income countries, do this in the moment of suicidal crisis, and they’re amazing people apart from that. Of course, understanding the extent of this problem, and understanding the human cost of the wide availability of pesticide is grim and sad, but this is what gives me passion, and what gives me enthusiasm, inspiration to work on this issue. That it is possible to solve this, and it is possible to improve the lives of this people by a great deal.
Robert Wiblin: Thanks so much for coming on the show. It’s going to be very interesting to hear how the charity matures over the coming years, and what kind of results you manage to get. Hopefully we can talk about it again in a couple of years once you’ve had some more experience, and hopefully are a whole lot larger.
Leah Utyasheva: Thank you so much Rob. Thank you.
Robert Wiblin: My guest today has been Leah Utyasheva. Thanks for coming on the 80,000 Hours podcast Leah.
Leah Utyasheva: Wonderful, thank you.
Robert Wiblin: On the 80,000 Hours site this week we released a detailed guide to a new path we recommend for having a large social impact: becoming a China specialist.
We also wrote about opportunities to earn to give in law in the UK, and why we usually don’t recommend them.
You can find both of those on our blog at 80000hours.org/blog.
The 80,000 Hours podcast is produced by Keiran Harris. Thanks for joining, talk to you next week.