Public perceptions of pesticides & how they influence policy: Case of CKDu in Sri Lanka Presentation by Nalaka Gunawardene To International workshop on "Pesticides and Global Health: Research, Collaboration, and Impact" Department of Anthropology University of Durham, UK 10-11 February 2015

1. Public Perceptions of Pesticides
& How They Influence Policy:
Case of CKDu in Sri Lanka
By Nalaka Gunawardene
Science Writer, Columnist & Blogger
www.nalakagunawardene.com
Pesticides and Global Health:
Research, Collaboration and Impact Workshop
University of Durham, UK: 10-11 Feb 2015

2. 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

3. 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

4. Going Beyond Reporting, I ask:
How Do Public Perceptions Form?
Daily Mirror (Sri Lanka) editorial cartoonist’s view

5. 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 billboards, banners, etc
2010 market research survey covering 1,000 respondents from all districts

6. 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)?

7. 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.

8. 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

9. CKDu: Not to be confused with regular
kidney disease (still majority of cases)
CKDu: A Mysterious Disease
Infographic courtesy: Centre for Public Integrity, USA

10. CKD vs. CKDu
Infographic courtesy: Centre for Public Integrity, USA

11. Part of a global trend?
CKDu: Cases reported from Central
America, Southern India, Sri Lanka
Is there a common causative factor?

12. 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

13. 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?

14. 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!

15. Divine Insight
must still be
put through
scientific peer
review…
If not, it will
be like this
‘Miracle’
Cartoon by
Sidney Harris!

16. Divine-assisted Science?
Some Lankan media’s scepticism…
Cartoon by
Awantha
Artigala in
Daily Mirror
(Sri Lanka):
20 June 2011

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

18. 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!

19. 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

20. 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

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

22. 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.”

23. 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

24. 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.”

25. 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’

26. 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/

27. Mass Kidney Failure amplified by
Mass 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…

28. 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???

29. 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

30. ‘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)

31. 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

32. 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!)

33. Seeking evidence, clarity, focus…
Ceylon Today, 12 August 2012

34. 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

35. My suggested approach…

36. Need to revisit & rethink 90% state
subsidy for chemical fertiliser…?
Ceylon Today
Sunday column
26 Aug 2012
http://tiny.cc/
ELDS

37. 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!

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

39. Changing nature of pesticide trade:
Rise of Chinese toxic exports

40. 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!

41. 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/Man
ifesto-English-for-proof-
reading.pdf

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

43. Sirisena Manifesto:
specific pledge…
 “…immediately prohibit
the import and
distribution of
agrochemicals that were
identified as causing
kidney diseases”
 Maithripala Sirisena
manifesto, p30

44. 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

45. 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

46. 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

47. 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?

48. Blog: www.nalakagunawardene.com
English column archive:
https://collidecolumn.wordpress.com
Twitter: @NalakaG
This is a contested space:
Always open for reasonable debate!