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  • The Registrar of Pesticides noted this


    The Registrar of Pesticides noted this effect of herpes simplex virus type 1 and started banning the most toxic HHPs, initially parathion and methylparathion, in 1984. The exponential rise in total (not just pesticide) suicides then stopped (); the rate began to fall rapidly after 1995, when five further HHPs were banned, including two organophosphorus insecticides, methamidophos and monocrotophos, that had become particularly popular after the 1984 bans. Unfortunately, agricultural practice, and therefore self-poisoning, switched to an organochlorine insecticide, endosulfan, which had to be banned in 1998. After this ban was introduced, the suicide rate fell further (). The realisation that dimethoate, fenthion, and paraquat had become responsible for the majority of pesticide deaths in the 2000s resulted in them being banned in Sri Lanka during 2008–11. This ban, together with small improvements in medical management, resulted in further decreases in the total suicide rate (), as well as reductions in case fatality for pesticide poisoning in hospital wards. 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 herpes simplex virus type 1 10% by 2020. Given that Sri Lanka achieved a 70% reduction 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.