Public Perceptions of Pesticides & How They Influence Policy:

Case of CKDu in Sri Lanka

By Nalaka GunawardeneScience Writer, Columnist & Bloggerwww.nalakagunawardene.com

Pesticides and Global Health: Research, Collaboration and Impact Workshop

University of Durham, UK: 10-11 Feb 2015

Where I come from… Trained as science writer, worked as journalist for

25 yrs with print, broadcast and web media A ‘generalist’ covering & commenting on science,

environment + sustainable development issues Especially interested in:

Studying public perceptions & how they influence public policy formulation in Lankan context

Spotting and debunking conspiracy theories!

Not specialist in agrochemical issues – but have been interested at local, national & global levels

IDRC Reports: Jan 1992 Story on Nat Poison Info Centre, Sri Lanka

One of my early pieces reporting on Lanka NPIC, written for journal of its then main funder, IDRC of Canada

Going Beyond Reporting, I ask:How Do Public Perceptions Form?

Daily Mirror (Sri Lanka) editorial cartoonist’s view

Lankan public’s info sources on current topics: Note heavy reliance on media

70%

74%

94%

9%

13%

13%

52%

7%

27%

Newspapers and magazines

Radio

TV

Internet

Mobile phone/SMS alerts

Public exhibitions, seminars,etc

Friends, neighbors, colleagues

Educational institutions

Outdoor bi llboards, banners, etc

2010 market research survey covering 1,000 respondents from all districts

Do Public Perceptions matter? Public Perceptions & Reality:

Gaps in understanding world as it is Harder in times of rapid local & global change Most people form opinions on perceptions Perceptions shape public policy, investment Social change requires carefully managing public

perceptions Conundrum: More info, less clarity! Also: myths spread faster today - thanks to

modern communications technologies (ICTs)?

Chronic Kidney Disease of Uncertain aetiology (CKDu)

Baffling scientists on causative factor/s Overwhelming public health system Policy makers’ challenge: best response? Mass media coverage adding to confusion:

No reliable statistics wild speculations Activist-journalist nexus biased reporting Coverage often sensationalist (esp in local lang)

CKDu as ‘prism’ of Lankan society: revealing many tensions, divides, insularity, etc.

CKDu in Lanka: A Brief History… Started: North-Central

Prov, since spread wider Mostly affected: male

farmers, 30-60 yrs All cases in ‘Dry Zone’:

(lighter colour on map) No of cases living with

CKDu: 400,000+ Cumulative deaths: est.

20,000 (in 20+ yrs)Map courtesy: BBC Online, 2012

CKDu: Not to be confused with regular kidney disease (still majority of cases)

CKDu: A Mysterious Disease

Infographic courtesy: Centre for Public Integrity, USA

CKD vs. CKDu

Infographic courtesy: Centre for Public Integrity, USA

Part of a global trend?CKDu: Cases reported from Central

America, Southern India, Sri Lanka Is there a common causative factor?

CKDu: A ‘Silent Emergency’Public health & humanitarian crisis…

Thousands of patients needing kidney dialysis (3-4 times/week)

Each dialysis session: LKR 12,000 (USD 100) Most patients too poor to afford private

care; turn to public health system Sri Lanka has <200 kidney dialysis units (for

population of 21m) Treatment costing 5% of annual public

health budget (and rising) Economic cost: growing…productivity lost Social impacts: rural poverty rising, despair

Long and elusive search for causative factors…

Environmental exposure? Excessive Cadmium or Arsenic High Fluoride in groundwater Aluminium utensils + Fluoride water Naturally occurring hard water Cyanobacterial toxins in water Bioaccumulation of pesticide residues

Lifestyle-related exposure? Locally brewed liquor Ayurveda medicinal concoctions

Genetic predisposition?

CKDu & Agrochemicals nexus:Suspected; on trial; or proven guilty?

Mid 2011: New hypothesis saying CKDu “caused by excessive Arsenic in imported pesticides & chemical fertilizers, when combined with calcium in hard water”

Info & opinions released online & in news media BEFORE any peer-reviewed papers or scientific debate

One scientist involved claims “Divine Revelation” (from native God Naatha) helped them arrive at this hypothesis!

Divine Insight

must still be

put through

scientific peer

review…

If not, it will

be like this

‘Miracle’

Cartoon by

Sidney Harris!

Divine-assisted Science?Some Lankan media’s scepticism…

Cartoon by Awantha Artigala inDaily Mirror (Sri Lanka): 20 June 2011

One newspaper, independent Ravaya (ravaya.lk), stands apart from rest of Lankan media in questioning CKDu-Arsenic claim

Enter the Eco-Activists… Unproven Arsenic hypothesis triggers some

environmental & public health activists into sudden agitation…

They call for blanket ban on “all highly toxic pesticides” (that’s a lot!!)

Also claim there is a vast multinational conspiracy to “poison Lankan nation”

Most media uncritically peddles such claims Legitimate case for pesticide regulation

diluted by hype and myth Average, non-technical citizens confused

Sky-is-Falling Alarmist Chicken Licken seems to be a role model for some Lankan journalists!

Environmentalists poisoning the public mind with ultra-green views?

Typical green position: Green Revolution big mistake Agrochemicals came with it They should be banished or

severely restricted CKDu seems to be linked to

agrochemicals (never mind how) Just use this public scare to ban

all pesticides! End justifies the means?

“Poisoners of Our People: Beware - Arsenic in your food!” Mihimandala eco magazine, July 2011

Dig Deeper & Probe Further…But proceed with CAUTION!

Ceylon Medical Journal review article, Dec 2011: “It is timely that the available, credible, scientific

evidence on CKDu (published in peer-reviewed journals) is collated and analysed, and the difficulties faced in establishing causality are discussed.”

Cause of CKDu might be “multi-factorial” Caution: Mere associations “should not be

considered to be of causal importance without documented evidence of proof”

Full paper: http://tiny.cc/CKDuCMJ

WHO-GOSL Study during 2009--2011Published: BMC Nephrology 2013, 14:180

WHO-GOSL CKDu Study’s Main Conclusions…

“The results of this cross-sectional study indicate that multiple agents may play a role in the pathogenesis of CKDu.

Herbal medicines and indiscriminate use of analgesics are unlikely to be causative factors of CKDu.

Results show chronic exposure of people in the endemic area to low levels of cadmium through the food chain and also to pesticides. They may also be exposed to lead and arsenic through the food chain.”

WHO-GOSL Study’s Main Conclusions…contd.,

Significantly higher urinary excretion of cadmium of individuals with CKDu…

Indicating cadmium is a risk factor Deficiency of selenium and genetic

susceptibility seen in individuals with CKDu suggest that they may be predisposing factors for the development of CKDu when people are exposed to nephrotoxins

More research is recommended

WHO-GOSL Study: Aug 2013 Paper ends with…

“Steps are being taken to strengthen the water supply scheme in the endemic area as well as the regulations related to procurement and distribution of fertilizers and pesticides.

“Further studies are ongoing to investigate the contributory role of infections in the pathogenesis of CKDu.”

Activist pressure through media…

Political activists take up CKDu: blames govt of inaction to ban “all arsenic-containing agrochemicals”

Registrar of Pesticides (govt regulator) called a “multinational agent” in an alleged ‘toxic conspiracy’

Blame Game continues!

Fringe group demands ‘compensation’ from UN-FAO for "promoting agrochemicals" on behalf of multinational companies; gets global media coverage disproportionate to validity of his claim

BBC, 13 Dec 2013

www.bbc.co.uk/news/world-asia-25355698

Mass Kidney Failure amplified byMass Media Failure in Sri Lanka?

Healthy kidney: filters waste & excess water

Healthy, vibrant media: separates fact from fiction; provides clarity & context

What causes mass MEDIA failure in Sri Lanka?

What can cure this ailment? I posed this at a science

communication symposium in Oct 2012…

CKDu coverage in LK Media:Advocacy or Activist Journalism?

Advocacy Journalism Supportive of a public

interest cause Sustained coverage (story

is kept alive) Journalists ask critical

questions, verify info Accommodates diverse &

dissenting views; no one is blocked out by media

Creates an inclusive platform for debate, seeking solutions

Activist Journalism: Supportive of a public

interest cause Sporadic media coverage Journalists become

‘embedded’ & uncritical Selective amplification of

info & opinions Dissenting/divergent views

ignored/attacked Solutions???

Too much finger pointing,Too little reflection!

TOO MUCH time & energy spent looking for a ‘Villain’

TOO LITTLE media attention on: Healthcare needs of those already

living with CKDu Economic, social & emotional needs

of affected families How to prevent more people falling

sick: need for safe drinking water

NOT ENOUGH questions on overall agro policies that heavily favour high external inputs

‘Villains’ named thus far… Pesticide producers (always seen as

western multinationals) Govt regulator: Registrar of Pesticides Ministry & Dept of Agriculture (still

promoting high external input farming as official agro policy)

Moderate scientists who are evidence-driven (faulted for not accepting conspiracy theories!)

Sceptical Journalists asking questions (ditto)

A modern-day dilemma:Policy making on the run?

Multiple pressures from: affected persons; social or eco activists; political opponents; media, etc.

24/7 news cycle (TV news channels+social media): no time to weigh pros & cons

Policy makers need to be SEEN AS DOING SOMETHING all the time (never mind efficacy)

Evidence-based, measured approach abandoned Populism & short-termism dominate Can lead to: aggravation, stagnation or even

backsliding

Media as part of the solution?My own role in CKDu coverage

Our choice in covering a complex issue like this: Indulge in scaremongering & myth-making? OR -- Support search for evidence-based solutions?

I have opted for latter! My approach in covering CKDu & related issues:

Balancing public health, agriculture & env interests Amplifying findings & views of peer-reviewed science Acknowledging uncertainties & need for more study Not romanticising indigenous knowledge Not idolising Lanka’s small, subsistence farmers (they

are not as hapless as they seem!)

Seeking evidence, clarity, focus…

Ceylon Today, 12 August 2012

Full text at: http://wp.me/p3zUD-2vS

My coverage of National Symposium on CKDu convened by National Academy of Sciences Sri Lanka 10 Dec 2013

My suggested approach…

Need to revisit & rethink 90% state subsidy for chemical fertiliser…?

Ceylon Today Sunday column

26 Aug 2012 http://tiny.cc/ELDS

Chemical Fertilizer Subsidy:How did we became so addicted?

State subsidy for chemical fertilizer: started 1962 (Green Revolution legacy)

Continued for much of past 50 yrs Since 2005: 90% subsidy for N,P, K Costs ~ LKR 50b (USD 380m)/year Too political to rationalise! V. cheap fertilizer = farmers not

thrifty massive agri runoffs Organics just can’t compete!

LK farmers’ gross overuse of pesticides: what can be done?

Changing nature of pesticide trade:Rise of Chinese toxic exports

Perils of dissent:It’s a lonely & hazardous path!

Few fellow journalists keen on holistic or balanced approach to issues (prefer ‘villains’!)

Environmental activists’ wrath: for my not peddling their views uncritically!

Ultra-nationalists decry: “Western/multinational agent” & “traitor” (typical Rajapaksa-era labels)

Incl in dubious list of ‘Poisoners of Sinhala Nation’ Public perceptions are shaped by vocal groups:

Media Failure poisoning of PUBLIC MIND!

Breaking News!Presidential Election: 8 Jan 2015

Maithripala Sirisena: LK Health Minister 2010-2014

Contested against incumbent President Rajapaksa on a platform of good governance

His campaign manifesto had specific refs to CKDu + questionable CKDu stats + repeated multinational conspiracy theories…

www.maithripalas.com/wp-content/uploads/2014/12/Manifesto-English-for-proof-reading.pdf

“While agrochemical companies have expressed dissenting opinion using certain scientists who had been bought over…”

Sirisena Manifesto

Sirisena Manifesto:specific pledge…

“…immediately prohibit the import and distribution of agrochemicals that were identified as causing kidney diseases”

Maithripala Sirisena manifesto, p30

Sirisena Manifesto:Towards an organic Lanka…

Good aspiration, but a long way to go…

FiBL’s World of Organic Agriculture (2014 ed) says: Sri Lanka had 19,517 ha under organic farming in 2012: <2% of total farmland

Above: Excerpt from Maithripala Sirisena Manifesto, p31

President Sirisena’s Challenge…“Now in office, president Sirisena faces the hard task of balancing the interests of public health, food security and farmer welfare. Paddy farmers, long accustomed to a massive state subsidy on chemical fertiliser, are unlikely to give that up without a fight.”

- Nalaka Gunawardene, in “Balancing History, Myths and Populism”SciDev.Net 31 Jan 2015: http://shar.es/1oiOn2

Summing up:CKDu as a ‘prism’ of Lankan society

Applicability & limits of indigenous knowledge

Need for full disclosure in public science Lack of public TRUST in govt/official sources Loss of public respect for scientists &

medical profession due to public spats Policy paralysis from single-issue activism Too few public intellectuals speaking out Even fewer NEUTRAL platforms for debate

Possible Research questions? Is there a rise in public distrust of modern

science as a result of Green Revolution’s legacy? Has CKDu been leveraged by Sinhala ultra-

nationalists in its efforts to ‘saffronise’ science and its institutions?

Is there a co-relation between apparently higher levels of pseudoscience in Sri Lanka today and the recent rise of ultra-nationalism?

Should indigenous knowledge systems be subject to rigorous scrutiny or accepted on faith? Why not?

Blog: www.nalakagunawardene.comEnglish column archive:

https://collidecolumn.wordpress.com

Twitter: @NalakaG

This is a contested space:Always open for reasonable debate!