In about 40 countries round the world (including the UK), government-supported national programs have been established to deliver co-ordinated, multi-sectoral action to reduce the incidence of suicide in the population. The drive to reduce the overall suicide rate is necessary but not sufficient: it’s also vital to acknowledge and tackle the underlying inequalities which leave the socioeconomically disadvantaged at greatest risk.
Over the last two decades there has been growing international consensus about the need to address these inequalities
The persistence of large inequalities in health – even in countries with long-standing social, healthcare and other policies aimed at creating more equality in well-being – demonstrates deep roots in systems of social stratification. To be poor or economically disadvantaged means greater risk of ill-health and shorter life expectancy (WHO Commission on Social Determinants of Health, 2008).
Over the last two decades there has been growing international consensus about the need to address these inequalities, not least because many are “unnecessary … avoidable … unjust and unfair, so that the resulting health inequalities also lead to inequity in health.” As a result, the goals of public health policy, particularly in post-industrial Western countries, have widened from a narrow focus on improving overall population health to reducing inequalities in the social distribution of health.
With respect to the prevention of suicidal behavior, however, there has been a nearly universal failure to target reduction of inequality in the formulation of national strategies, including in the nations of the UK.
How important is this failure to apply an equity lens to suicide prevention strategy and activity? I have conducted a review of worldwide research on socioeconomic inequalities in suicidal behavior. The weight of evidence points to the association between socioeconomic inequalities and suicidal behavior across a range of indicators.
- There is a significantly higher risk of suicide among unemployed people compared to those in work.
- There is substantial evidence of a positive association between economic recession and suicide, particularly from studies carried out in middle- and high-income countries. This extensive literature covers a period of more than eighty years, from the Great Depression of 1929-32, via the Asian economic crisis of 1997-98, to the global 2008–2010 economic recession.
- There is strong evidence of an inverse relationship between occupational social class and risk of suicide: the lower the social class position, the higher the rate of suicide.
- A study of socioeconomic inequalities (measured by educational level and housing tenure) in suicide in ten European populations found that lower educational attainment tends to increase the risk of suicide among men (but to be protective against suicide among women) and among tenants, compared to homeowners, for both men and women.
- In a systematic review of socioeconomic characteristics of regions and their suicide rates, the majority of studies found that more impoverished communities tend to have higher suicide incidence.
- The results of an empirical study conducted in Scotland confirm that the influence of individual social class is far stronger than the influence of area-level socioeconomic deprivation in accounting for suicide-related inequality. The suicide rate among those in the lowest social class living in the most deprived areas is approximately ten times higher than the rate among those in the highest social class in the most affluent areas.
If governments are to tackle inequalities in suicide, they will have to face and resolve many policy challenges. Foremost among these is the choice of the strategic approach to reducing inequality.
It is not simply the poorest who experience less than optimum health; there is a gradient of risk across the whole population
It is not simply the poorest who experience less than optimum health; there is a gradient of risk across the whole population. Governments need to be clear whether they are seeking to improve the health of the most disadvantaged in absolute terms, reduce the health gap between most disadvantaged and the most advantaged/ average, or reduce the gradient of health inequalities associated with socioeconomic inequalities (whereby the lower an individual’s socioeconomic position, the worse their health). Each of these strategic approaches has strengths and weaknesses.
The approach to tackling inequalities in suicide depends on the over-arching philosophy of health inequality reduction that is adopted by government. Concentration on reducing the overall level of suicide in society or on reducing suicide risk only among the most disadvantaged may result in little change in relative risk between the most and least privileged, and may even result in an increased relative risk by widening inequalities. On the other hand, the development and delivery of effective public policy interventions that reduce poverty, boost educational performance, improve housing conditions, and reduce unemployment would address the fundamental sources of disadvantage faced by many population groups, leading to a reduction in their risk of suicide.
Please note – Springer Nature is a publishing company and therefore does not provide direct medical advice. Whilst the research provided above is a useful resource, it should not replace direct consultation with a medical practitioner. Additional information and contact details can be found on the World Suicide Prevention Day homepages here.