title: Policymaking 'under the radar': a case study of pesticide regulation to prevent intentional poisoning in Sri Lanka.
abstract: BACKGROUND
  Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the key policy decisions around regulation are examined.
  
  
  METHODS
  This study was undertaken as part of a broader analysis of policy in two parts-an explanatory case study and stakeholder analysis. This article describes the explanatory case study that included an historical narrative and in-depth interviews.
  
  
  RESULTS
  A timeline and chronology of policy actions and influence were derived from interview and document data. Fourteen key informants were interviewed and four distinct policy phases were identified. The early stages of pesticide regulation were dominated by political and economic considerations and strongly influenced by external factors. The second phase was marked by a period of local institution building, the engagement of local stakeholders, and expanded links between health and agriculture. During the third phase the problem of self-poisoning dominated the policy agenda and closer links between stakeholders, evidence and policymaking developed. The fourth and most recent phase was characterized by strong local capacity for policymaking, informed by evidence, developed in collaboration with a powerful network of stakeholders, including international researchers.
  
  
  CONCLUSIONS
  The policy response to extremely high rates of suicide from intentional poisoning with pesticides shows a unique and successful example of policymaking to prevent suicide. It also highlights policy action taking place 'under the radar', thus avoiding policy inertia often associated with reforms in lower and middle income countries.
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia melissa@sactrc.org.
authors.forename: Melissa
authors.initials: M
authors.lastname: Pearson
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Zwi
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Buckley
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Gamini
authors.initials: G
authors.lastname: Manuweera
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Fernando
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Dawson
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka and School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Randwick NSW, 2502 Australia, Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia, South Asian Clinical Toxicology Research Collaboration, Prince of Wales Hospital Clinical School, University of New South Wales, NSW, Australia, Scientific Support Branch, Secretariat of the Basel, Rotterdam and Stockholm Conventions, United Nations Environment Programme, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and Department of Forensic Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya Sri Lanka and NSW Poisons Information Service, Westmead Childrens Hospital, Sydney, Australia and School of Social Sciences and International Studies, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: McDuie-Ra
mesh_terms: D000288:Administrative Personnel; D000383:Agriculture / Q000331:legislation & jurisprudence; D006801:Humans; D007407:Interviews as Topic; D010575:Pesticides / Q000506:poisoning*; D011050:Policy Making; D011057:Politics; D013188:Sri Lanka / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data; D000092864:Suicide Prevention
chemical_list: D010575:Pesticides
keywords: Sri Lanka; Suicide; agriculture; developing countries; evidence-based policy; health policy; pesticides; policy analysis; prevention