Do green spaces lower suicide rates? A new study suggests that for European city dwellers, the answer is yes, but when it comes to indigenous peoples the question opens a web of complexity that highlights the urgent need for action and education on issues related to transitional justice in Taiwan.

In a study released earlier this year in The Lancet Planetary Health, researchers attempted to explore the relationship between green space and suicide. Findings showed a reduced suicide risk for people in the Netherlands who live in municipalities with a large proportion of green space.

In response to the study, however, a comment article appeared in the August 2018 issue of The Lancet Planetary Health, in which authors and argue that connections between suicide and green space should include the perspective and situation of indigenous people, such as the population of more than half a million who live in Taiwan.

For these indigenous populations, the authors propose, exposure to natural environments doesn’t necessarily contribute to a lower suicide risk, and city folks' desires for green space may have negative impacts on the indigenous communities impacted by an urbanite exodus to the hills.

In a 2014 study, the World Health Organization (WHO) called preventing suicide a global health imperative. Every year nearly 800,000 people die by suicide – one person every 40 seconds, and evidence exists that for every adult suicide death, perhaps 20 or more attempt suicide, according to the WHO.

In the same study, the WHO identifies indigenous peoples as a vulnerable group with a higher risk of suicide. This is partially due to the stresses of dislocation and cultural adaptation – problems the field known as “transitional justice” investigates and attempts to rectify. The most effective suicide interventions for indigenous people, according to the WHO, are those with high levels of local control and indigenous community involvement to establish culturally relevant interventions.

For Taiwan, studies confirm a clustering of the highest suicide rates in the mountainous rural areas of East Taiwan, notably a 2011 study in the journal Health and Place. The four major cities – Taipei, Taichung, Tainan, and Kaohsiung – showed average or lower suicide rates for all age ranges.


Credit: Geography of suicide in Taiwan: Spatial patterning andsocioeconomic correlates$

. Maps of standardised mortality ratios (SMRs) for suicide across 358 districts in Taiwan, 1999–2007: (A) raw (unsmoothed) map and (B) smoothed map. Smoothed SMRs were estimated using Bayesian hierarchical models. Deaths certified as suicide, undetermined death or accidental pesticide poisoning/suffocation were all included.

As an example of the complicated relationship between the natural environment and suicide, the authors of the August 2018 comment article in The Lancet Planetary Health describe an incident from their fieldwork in Wufeng District, an indigenous township near Taichung home to Atayal people.

In March 2018, a 63-year-old Atayal farmer committed suicide by swallowing pesticide. Under the Soil and Water Conservation Act, he was fined in 2017 for illegally digging in his land. Illiterate, not acquainted with the law and unable to pay the fine, he chose death.

The farmer’s story touches on other environmental pressures affecting indigenous Atayal. The Atayal previously lived in the mountains of Wufeng, where the state now regulates land, and illegal logging persists.

The farmer's case may seem like an isolated one-off, but mountain campsite density is growing to accommodate increasing numbers of visitors from urban areas such as Hsinchu.

“Urbanites should be aware of the ethical issues of outdoor leisure activity,” says Yi-Cheng Wu, regarding camping. Wu is a PhD student in Medical Anthropology at Durham University, and co-authored the comment article. According to Wu, public education is necessary to enhance awareness of indigenous culture and the situation of indigenous people as part of Taiwan's transitional justice aims.

In addition, Wu says the government should establish detailed guidance for running private campsites to avoid unethical land trade or forest exploitation – and empowering local people to embed these issues in local tourism is essential.

Over 1,700 public and private campsites exist throughout Taiwan more than double from five years ago – however, 84 campsites are endorsed by the Taiwan Tourism Bureau. In January 2018, the Tourism Bureau published an online camping guide. The guide informs campers about which sites are legal and not in conservation areas – which along with safety and accessibility, created challenges for campers in the past.

In Taiwan, the 24-hour suicide prevention hotline can be reached at 0800-788-995. Foreigners in Taiwan can call the 24-hour toll-free 1955 telephone counseling hotline. Other international suicide helplines can be found at

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Editor David Green (@DavidPeterGreen)

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