New article argues for urgent need to challenge regulatory inconsistency

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New analysis led by the University of Edinburgh, with colleagues from Cambridge and Bristol, draws attention to significant discrepancies in the ways in which products associated with the risk of fatal self harm are regulated.

The paper, published 10th June, in the open access journal PLOS Global Public Health, notes that governments put up railings and barriers and regulate supplies of certain drugs to prevent people from dying by suicide. But other products associated with fatal self-harm, such as firearms, pesticides, and alcohol remain widely available and publicly promoted. The difference in approach to regulation needs to be addressed to make progress in preventing suicide.

Every year more than 720,000 people die from suicide, the majority in low- and middle-income countries. In some cases, governments and societies have been willing to act to prevent suicide by changing the environment or restricting the sale of some products, such as placing barriers to prevent jumping, or preventing access to large amounts of pharmaceuticals, approaching the products as problematic.

But for other products known to be associated with suicide, such as gambling, firearms, and alcohol, and highly hazardous pesticides (HHPs), access remains much less restricted. The products are seen as safe when used appropriately, and people who use the products are considered the potential problem.

To draw attention to these different approaches, which they argue is undermining effective suicide prevention globally, the authors – which include Professor Rebecca Cassidy, Cambridge’s William Wyse Professor, Department of Social Anthropology – explored the ways that common approaches to the regulation of gambling, alcohol, opiates, firearms and HHPs, create situations that are unsafe but favourable to the commercial actors who profit from the sale of these products while blame is shifted on to the so-called “misuse” or “abuse” of the products.

The authors show that gambling and alcohol use are actively promoted in many countries with sophisticated marketing as well as the power these industries hold over regulatory agencies, while the public is blamed for misuse. In the case of opioids, the industries backing the drugs downplayed addiction risk and emphasized people’s misuse of the drugs as the problem. More people die from firearms in the U.S. than all other self-harm methods combined, but the firearms industry lobbies for access, and mental health is blamed for self-harm. Finally, pesticide poisoning is one of the most common forms of fatal self-harm, particularly in low- and middle-income countries, while the industries manufacturing them claim they are safe if used correctly, and that they are necessary in the countries where they are commonly used.

While the authors note that different factors can contribute to someone’s self-harm, and access to these products does not explain all suicides, they suggest that treating known harmful products as “safe if used correctly” deserves more scrutiny, and that prevention of fatal self-harm requires viewing products linked with suicide as the problem, not the people who use them.

Lead author Dr May van Schalkwyk summarises: "Many products are known to be associated with suicide but the way that they are regulated varies. For example, to save lives, barriers are erected, and restrictions are placed on the sale of pharmaceuticals. But when it comes to some commercial products including gambling, alcohol, pesticides, opioids and firearms, a different approach is taken. People, rather than products, are presented as the problem, and industries are encouraged to ‘self regulate’ rather than being subjected to effective restrictions on product design, marketing and availability. Our article explores this variation and suggests that a more consistent approach could save lives."

Co-author Professor Rebecca Cassidy adds: "My contribution focuses on gambling, and the ways in which ideas of ‘responsible gambling’ and moderation of self have been used to support light and self-regulation of the industry, as opposed to a public health approach based on the prevention of harm. Working with colleagues who are experts in alcohol, pesticides and firearms helps us to explain why regulation is not simply based on evidence of harm, but on the conventions that shape interactions between the state and particular industries. The broader aim of the piece is to bring a comparative perspective, so central to anthropology, into public health, so that we can find new ways to think about the relationships between evidence and policy, and ultimately, to support arguments for change."


Reference
van Schalkwyk MCI, Knipe D, Cassidy R, Tyrell K, Collin J, Eddleston M (2026) Seeing the similarities: Applying a coherent lens to harmful products as drivers of suicide. PLOS Glob Public Health 6(6): e0006437. https://plos.io/4wOH2jH

Rebecca Cassidy is William Wyse Professor in the Department of Social Anthropology, University of Cambridge. Rebecca is the author of Vicious Games, a book that explores relationships between gambling and governments. It is based on over a decade of fieldwork with gambling businesses around the world.