Social change is partly responsible for the falling numbers. Asian women have more freedom and opportunity than before, and thanks to urbanisation fewer have access to the highly toxic pesticides that were once the group’s favoured means of suicide. Social stability has returned to Russia and unemployment is down. Among the old, poverty has declined at a global level faster than among younger people. Social change may also be partly responsible for the rise in America: suicide has risen most among middle-aged, white, poorly educated rural people—the victims of the “deaths of despair” identified by Anne Case and Sir Angus Deaton, Princeton University economists.
Policy also plays a role. When Mikhail Gorbachev introduced restrictions on alcohol in the Soviet Union in 1985, consumption and suicide both plunged; something similar has happened since Vladimir Putin introduced new rules in 2005. Restricting access to easy means to kill oneself can make a big difference because suicide is a surprisingly impulsive act. Of 515 people who survived the leap from San Francisco’s Golden Gate Bridge between 1937 and 1971, 94% were still alive in 1978—which suggests that a suicide postponed is likely to be a suicide prevented. The banning of toxic pesticides has had a clear impact on rates in countries such as South Korea and Sri Lanka. Selling paracetamol and aspirin in only very small quantities has also been shown to reduce rates. Investing in health services—particularly palliative care, which helps make life tolerable for the sick—can make a difference. And if America restricted gun ownership, rates would almost certainly crash. America’s rate is twice Britain’s (which has tight gun controls), half America’s suicides are by firearm, and the difference in rates between states, which range from 26 per 100,000 each year in Montana to five in Washington, DC, is largely explained by variations in levels of gun ownership.