India’s impending public health crisis, suicide

• Every 4 in 10 people that commit suicide around the world are Indian, and every 7 in 10 are between the ages of 15-39.
• India’s suicide death rates (SDRs) not only vary by gender, but also by state, where southern states exhibit a higher percentage of SDRs in comparison to northern states.
  
• Learning from its Asian neighbors, like Sri Lanka and China, India needs to implement policies to curb the current trend on the rise.

It’s normally diseases like cancer, tuberculosis and HIV/AIDS that considered to be the biggest threat to life. But, a new study by Lancet Public Health shows that there may be a bigger health crisis looming at the horizon for India - suicide.

Every 4 in 10 people who commit suicide around the world are from India. And, between the ages of 15-39, 7 out of 10 individuals are Indians. India may be a big country, but it only accounts for 17.8% of the global population so even in a relative sense, the suicide rates are high.

Considering that suicide was a criminal offence up until 2017, it’s possible that these figures are on the low side due to the incidence of under-reporting.

The study put forward by Lancet is a part of the India State-Level Disease Burden Initiative carried out in collaboration with the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME) under the Ministry of Health and Family Welfare.

Age differentials

The overall suicide rate may be high, but it’s particularly worrying when looking at India’s younger generation between the ages of 15 years to 39 years. Not only is it at 71.2%, but it’s also the leading cause of death for that age group. Road accidents, heart disease and tuberculosis all fall short in comparison to the threat posed by suicides.

Gender differentials

The incidence of suicide is higher among women in India than it is between men. Where Indian women account for 36.6% of global suicides, Indian men account for 24.3%. According to the report, the majority of the suicides are committed by married women in comparison to the proportion of unmarried women.

The report also explains that this may be because, in cases of arranged marriage or early marriage, the environment is less protective against suicide for women. Not to mention the pressure of young motherhood, low social status, domestic violence and economic dependence.

Geographical distribution

When looking at the state-wise distribution of suicides, the southern states have higher incidences of suicides than the northern states of India. The suicide death rate (SDR) per 100,000 in Karnataka is 30, in Tamil Nadu is 29.8 and in Andhra Pradesh, it’s 25. The states of Jammu and Kashmir, Mizoram, Meghalaya, Nagaland, Delhi, Punjab, Jharkhand and Bihar all recorded an SDR of less than 10 people per 100,000.

The report wasn’t able to determine the exact causal relationship as to why the SDRs vary from state to state. One theory is that because some of the states with a lower rate of suicide also exhibit better socioeconomic indicators, the states with a higher rate of suicide have young people who face greater challenges when trying to achieve their life goals.

Possible solution

It wasn’t long ago that China and Sri Lanka were also staring at high suicide rates. Those countries faced similar challenges like poverty, joblessness and high debt burdens creating rampant suicide.

Targeting the means of suicides is an effective way to reduce the mortality rate. And, in lower/middle-income countries, a case can be made for the ease of access to highly toxic pesticides. In Sri Lanka, implementing pesticide bans drastically reduced the number of suicides in the country.

In China, the age of urbanisation drastically reduced the SDR showing a 20% drop in 10 years. Different research attributes this to higher incomes, better education, less family pressure and, especially, reducing the ease of access to pesticides.

Perhaps India needs to embark on similar policy measures in order to control its increasing SDR as well as focus on social measures that will improve the quality of life for the worst affected segments.

For the younger generation, particularly, an increase in employment opportunities and better access to education would go a long way in helping them reach their aspirations and lead happier lives.