How It's Done
GLOBAL LIFE INDEX
The overarching mission of the Global Life Index is to publish a yearly index where individual countries are scored on how well they handle and prevent suicide.
The index done by JOSHI, the Journey for Obstructing Suiciding and Helping Intervention follows the example of the World Peace Index. The World Peace Index grades countries around the world on how peaceful they are by determining violence rates, instances of war, and the like. They do this to encourage nations to enact more policies intended to create a more peaceful society.
With the GLI, we want to encourage nations to enact more policies and better policies to prevent suicide by grading them and comparing them to other nations. The founder calls this process “the grade school method.” With this method, nations see their score and react by wanting to improve their ranking, stay where they are, or not care about their score. Just like grade school. In grade school, they have teachers giving those grades to the students. The GLI is like the teacher. The nations also have "family members" back at home who have to deal with the "scored students". Those "family members" are the citizens of the countries. Those "family members" decide how to deal with the score given to the country. Will they ask the "student" to change or not? Will they change themselves to ensure their "student" improves? After the GLI gives the scores, it is up to the citizens living in the country and especially the citizens in government to get the nation to improve so that lives can be saved.
The founder used to live in Utah where there is an initiative called 0 Fatalities working to make it so no one dies in a car accident ever again. He used to look at their billboards and think “why aim for the impossible?” As he thought about it, he realized with future improvements in car safety, there could really be a day with zero fatalities. Could there be a day with zero suicides?
Suicide is a complex issue and needs creative solutions. It involves the suicidal person, but also overarching environments, personal biologies, random situations, and so much more. With so much on the plate, this does not mean there is no hope. The road to a suicide rate at 0 or incredibly close to 0 may take decades or centuries. If nothing is done, it will take eons. With this in mind, let's look at the scores and do what is needed to improve so lives can be saved.
The below explanation reads like a college paper. A simpler explanation can be found in the GLI 2022 tab.
How scoring works?
The Centers for Disease Control and Prevention released a packet which presented a “compilation of strategies to achieve and sustain substantial reductions” of suicides. This packet helped JOSHI decide what indicators would be used to calculate the GLI score.
Reference: Preventing Suicide: A Technical Package of Policy, Programs, and Practices. Centers for Disease Control and Prevention. 2017.
Suicide rates and rate changes
In addition to information from the packet, JOSHI used the most recent suicide rate and the suicide data of a decade ago. This is to show the suicide rate now and whether the graded nation succeeded in lowering their suicide rate in the last decade. These indicators present whether there has been progress, and grades the nation on whether they have been trying and succeeding in lowering past suicide rates. This indicator is put in the score calculation as the suicide rates themselves, and the 10 year decade changes are in the score as rates of change represented as -1 to 1. To account for differences between male and female suicides, we also use the different gendered rates. To account for age, we also use the Global Burden of Diseases' suicide rates. For calculation purposes, if data is blank, the world average is used. Nations in the data are generally considered to be nations and have data included in the Global Burden of Disease data or the Global Health Observatory data. Some nations did not have data from GBD or GHO (Greenland, and some pacific nations), and they had data come from other sources.
This data came from the following sources.
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020.
Rates also taken from 2009 results.
Global Health Observatory: Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva, World Health Organization; 2020.
Explained below are the proposed strategies that came from the Centers for Disease Control and Prevention and the indicators the GLI uses that were inspired by these strategies. Some of them are not scored on because some proposed strategies are incredibly rare in all countries. The data is converted to be on a scale either from 0 to 1 or -1 to 1 (sometimes a bit over or a bit under) for the calculation. This gives more weight to the actual number of suicides, but still rewards or demerits nations on their progress of preventing suicide.
Strengthening Economic Supports
The Centers for Disease Control and Prevention recommend economic supports are strengthened to prevent suicides that may be encouraged by the result of a drastic economic change in one’s life. They explained that “studies from the U.S. examining historical trends indicate that suicide rates increase during economic recessions marked by high unemployment rates, job losses, and economic instability and decrease during economic expansions and periods marked by low unemployment rates, particularly for working age individuals.” Factors such as “job loss, long periods of unemployment, reduced income, difficulty covering medical, food, and housing expenses, and even the anticipation of financial stress may increase an individual’s risk for suicide” or lead to other health problems. They recommend communities strengthen household financial security and have housing stabilization policies. In addition to helping people have home stability, they also recommend helping the homeless with food, medical care, job training, child care, and other expenses for daily living.
To measure household financial security, we use the Economic Decline Index that measures the strength of a nation's economy and the nations rank on homelessness with data provided from Wikipedia. Homelessness data overall needs to be more widespread.
We also use the Political Stability Index to measure the stability of a nation's government. This can also be applied to other areas of the data.
The data came from the following sources:
The Global Economy Economic Decline Index
Strengthen Access and Delivery of Suicide Care
The CDC recommends strengthening access and increasing delivery of suicide care in order to prevent and decrease suicide rates. They recommend the approach be done in three ways: covering mental health in insurance policies, reducing provider shortages, and having safer suicide care through system changes.
Safer suicide care through systems changes and covering mental health in insurance policies are indicated by the expenditure of mental healthcare compared to the full healthcare expenditure of a nation. If a nation does not have information on this, the world average is used in calculation. In 2021, we used data on whether a nation has public healthcare, but as it did not ascertain to whether it allowed public healthcare for mental healthcare, we did not use it for 2022.
The CDC says that “implementation of evidence-based treatments, continuity of care, and continuous quality improvement” are vital. The evidence-based treatments and quality improvements are not able to have an indicator because of lack of data, but continuity of care can be indicated by the stability of a nation shown in the political stability index referenced earlier as well as the stability of their economy. Why? If a person's finances are safe, their healthcare access may be safe, or if a person's nation is stable enough to keep public healthcare going then the mental healthcare might continue.
Reduction of provider shortages is scored by how many mental health care workers there are for every 100,000 persons. This score takes the amount of psychologists and psychiatrists in a nation and adds them together, then divides the total by 200. Why 200? this is because the top scorer pertaining to amount of mental health professionals is Argentina at 244 (per 100,000). This is to ensure Argentina gets a kudos on the scale but also to fit the data to our scale of generally rewarding nations on a scale of 1.
The data came from the World Health Organization.
Create Protective Environments
The CDC recommends that a community ensure there is a protective environment to ensure there are less means to kill oneself because “modifying the characteristics of a physical environment to prevent harmful behavior such as access to lethal means can reduce suicide rates. They give three approaches: (1) “reduce access to lethal means among persons at risk of suicide”, (2) have “set organizational policies and culture” and (3) having “community-based policies to reduce excessive alcohol use.”
The GLI measures the reduction of lethal means by measuring the gun suicide rate and converts it to our scale where most nations are between 0 to 1. If it is above the average then one point is added. If below, a point is subtracted.
JOSHI uses the alcohol-attributable fraction or AAF as the indicator of results of “community-based policies to reduce excessive alcohol use." AAF is the proportion of deaths that would be avoided if alcohol consumption was removed. As alcohol is already widely regulated and widely available, JOSHI needed an indicator that showed the impact of alcohol on a nation’s population instead of just how much alcohol a nation drinks. This indicator is also highly important because “acute alcohol use has been found to be associated with more than one-third of suicides and approximately 40% of suicide attempts.”
The data comes from the following sources:
Data on gun suicides comes from the University of Australia. AAF data comes from the World Health Organization Global Health Observatory.
The CDC recommends that a community ensure a more connected society to prevent suicides. This does not mean more connected as in more technology, this means an engaged community who join together to combat suicide. They recommend this be done with peer norm programs and community engagement activities. The CDC notes that there is limited evidence, but “existing studies suggest a positive association between social capital (a measure by social trust and community/neighborhood engagement), and improved mental health.” There is not enough data to include this as an indicator.
Teach Coping and problem-solving skills
The CDC recommends a community put coping/problem-solving skills into curricula to ensure a potential suicide victim will turn to coping or solving the problem instead. These skills are very important, but there is not yet prevalent data on if countries put this in their curricula. It is assumed this is very rare.
Identify and support people at risk
The CDC recommends that to identify and support people at risk of committing suicide that communities integrate gatekeeper training, crisis intervention, treatment for people at risk of suicide, and treatment for people who may re-attempt after failing to commit suicide. Gatekeeper training is not yet widespread and so will not have an indicator.
There was data included for in 2021 but after further review, it did not seem likely to fit the above recommendation and we may need to wait for more data that may fit.
The specific treatment for people at risk of suicide could have been covered in the mental health care expenditure, but there is not data on how much of the mental health care budget goes to preventing suicides.
Lessen harms and prevent future risk
The CDC recommends that to lessen harm and prevent future risk, a community integrate postvention or helping people cope after a suicide of a community member. They also recommed safe reporting and messaging about suicide. This is determined by how a recent suicide is communicated to the public. If a suicide is reported without coping resources, risk/protective factors, stories of hope/resilience, and suicide prevention messages, then there is a likelihood of suicide contagion. The CDC explained, “exposure to sensationalized or otherwise uninformed reporting on suicide may heighten the risk of suicide among vulnerable invidiuals.”
The act of postvention is usually done by smaller communities (cities, towns, not countries) or school districts, so there is no specific data. The safe reporting and messaging also has no specific data, but in the future, could be helped by an analysis of suicide reports in different countries. It is recommended that governments ensure that safe reporting and messaging is required in a community and ensure effective postvention as soon as possible after a reported suicide in the community.