Since the middle of the last century, pesticides have become an integral component of the world's attempt to increase agricultural output and decrease vector-borne disease. However, the benefits of pesticides have come at a cost and their continued use is the frequent subject of debate.
The Intergovernmental Forum on Chemical Safety (IFCS), established in 1994 following the recommendations of the United Nations Conference on the Environment and Development (UNCED, the Earth Summit), was charged with identifying priorities for action on chemical safety and reducing the hazards associated with chemical use (1, 2). IFCS takes the position that substantial use of pesticides is essential to achieve sustainable development. It attempts, however, to find strategies to mitigate the adverse effects that pesticides may have on human health and the environment (1, 3).
IFCS's first meeting provided policy guidance and integrated strategies for implementation of the key areas that were adopted by UNCED in Agenda 21 (1, 2). Its subsequent meetings have evaluated the progress that has been made. In 2000, at Forum Ill, IFCS adopted the Bahia Declaration on Chemical Safety, which identified key goals with target dates for their achievement (4). This declaration was later endorsed by the United Nations Environment Programme (UNEP) Governing Council and forms an important basis for international efforts to manage chemical use. The most recent meeting--Forum IV--took place in Bangkok in November 2003 (5). Major topics for discussion included the safety of children, occupational safety and health, capacity building in the developing world, and acutely toxic pesticides.
This last subject is of particular concern. Since a report from WHO and UNEP in 1990 (6), the scale of the problem caused by acutely toxic pesticides has been readily apparent. The report estimated that more than 3 million people were hospitalized for pesticide poisoning every year and that 220 000 died; it particularly noted that two-thirds of hospitalizations and the majority of deaths were attributable to intentional self-poisoning rather than to occupational or accidental poisoning.
Recent studies from Asia suggest that as many as 300 000 deaths from pesticide self-poisoning may occur in the Asia-Pacific region every year (7, 8). The easy availability and lack of safe storage of pesticides in the homes of the rural poor mean that many acts of self-harm, at moments of acute distress, have fatal and sometimes unintended consequences (8, 9).
Official documents from Forum IV invite assistance in the identification of gaps in the proposed strategies for chemical safety (3). Similar to many previous initiatives aimed at reducing the adverse effects of pesticides, the obvious gap is that there is no mention of the hundreds of thousands of deaths from pesticide self-poisoning that occur each year. Instead, the effort was directed towards occupational poisoning. IFCS appears to be overlooking the evidence on major pesticide mortality: a visit to any rural district hospital in Asia will demonstrate the enormity of the problem. A prospective study in Sri Lanka including 2257 poisoned patients admitted to two peripheral hospitals found that more than 95% of the patients with pesticide poisoning were cases of self-poisoning (Eddleston, submitted).
A working group was set up by Forum III to: "provide initial input on the extent of the problem of acutely toxic pesticides, and provide guidance for sound risk management and reduction, including options for phasing out where appropriate, and report to Forum IV" (10). It would seem reasonable--since pesticide self-poisoning is responsible for so many deaths--to include self-poisoning in the report, but the working group was asked to consider poisoning of pesticide users only, excluding self-poisoning, despite most self-poisoning deaths occurring in the farming communities that buy and use pesticides (8). …