It is a map of misery and death – a grimly fascinating overview of Hong Kong that offers a neighbourhood-by-neighbourhood breakdown of thousands of lives lost to suicide. Bright red patches mark the hotspots where suicide rates are the highest, while deep blue colours show the areas where rates are the lowest. Lighter shades of red and blue mark the areas that fall between the high and low rates.
A team of academics and psychiatrists from Hong Kong and Taiwan spent two years studying 5,754 suicides across the city from 2005 to 2010 to create the map, believed to be the first detailed small-area analysis of suicide in an Asian city. Previously, suicides have only been broken down according to Hong Kong’s 18 districts, and geographical clusters of suicides only identified by exceptional circumstances – such as the spate of suicides a decade ago that led Tin Shui Wai to be nicknamed City of Sorrows. By contrast, the new “suicide map” breaks down the deaths by neighbourhood – there are more than 1,000, each of around 5,000 people – giving the most detailed insight into the spatial patterning of something that still claims two to three lives a day. “It is like a microscope,” says Professor Paul Yip Siu-fai, director of the Hong Kong Jockey Club Centre for Suicide Prevention and Research at the University of Hong Kong and one of the report’s co-authors. By looking at this data, we can really see where things go wrong and try to understand things better. The idea is that by identifying the communities where suicide rates are the highest, resources can be channelled to tackle the sometimes unique factors causing those deaths. “By looking at this data, we can really see where things go wrong and try to understand things better. It will help us to do suicide prevention work more effectively.” The ‘suicide map’ and accompanying report, entitled “Geography of suicide in Hong Kong”, will be published this week in the journal Social Science & Medicine. Its findings will be shared with NGOs and the Hong Kong government, which funded the research with the Jockey Club. “District councils can look at this and if an area has a high suicide rate and is deprived, they can channel resources to improve the wellbeing of the district,” Yip says. Although the study is the first of its kind in Asia, similar research has been conducted in Western cities, including Chicago, Edinburgh, Sydney and London, where high suicide rates were found to be clustered in inner city areas. The patterns in Hong Kong are similar, although district variations are starker: the highest rates (more than double the average) were found in some densely populated, deprived areas of Kowloon such as Sham Shui Po and Kowloon City, while affluent Central on Hong Kong Island showed mostly average rates.
In general, suicides rates were higher in areas with higher levels of social fragmentation and deprivation, the authors found, and areas with more households in public housing and higher population density had higher suicide rates. As well as giving a detailed geography of death, researchers were able to identify the demography of the people who took their own lives by studying coroner’s court reports. Researchers noted distinct trends at an almost a neighbourhood level, with clusters of high suicide rates among elderly men aged 65 plus in Tsuen Wan and Kwai Tsing, for instance, and clusters of high elderly female suicide rates near North Point and Wong Tai Sin. One significant difference from Western cities is that in Hong Kong, there is a stronger connection between suicide and money problems, particularly among men – something authors attributed in part to the growing rich-poor divide and the city’s relatively weak social welfare system. “Working-age men are more likely to be the main earner in the family and thus may be more susceptible to economic hardship or more likely to become isolated in poor socioeconomic circumstances, which may contribute to a high suicide risk,” the report noted. Yip elaborates: “What we see in Hong Kong is that a lot of our mental wellness is related to our financial situation. It is partly because of the high cost of living and the high cost of finding a place to live. “Western countries have better social support systems. If someone doesn’t have a job or gets divorced or becomes a single parent, the support networks are there. I’m not saying Hong Kong doesn’t have good social support but there is still room for improvement.” The report concluded that young and middle-aged men living in deprived areas were at a particularly high risk of suicide. “Community-based programmes that offer support for education and work opportunities in this group could be considered,” it said, adding that it was important to strengthen social and health care services in high-risk districts. Yip concedes there were some concerns their suicide map could lead to areas being stigmatised as Tin Shui Wai was. “There were some people who said if you put this map out, property prices of the place could be affected,” he said. “But the whole idea of doing this is to highlight the needs so that hopefully more attention and support can be put into those areas. What we are trying to do is understand the social demographic at a community level so we can channel resources there and make it more focussed. Deprivation comes in different forms. Some areas have more single parents. Some have high unemployment. Some have high levels of single housing. Based on each area, you can tailor-make programmes to meet the challenges within that area.” Yip added: “Stigmatisation comes from ignorance and prejudice. Hopefully, by raising this sort of knowledge, we can remove the stigma from these disadvantaged groups of people and at the same time channel facilities and services to that area.”
The map is being released at a time when the overall suicide rate has fallen by about a quarter from more than 1,250 in 2003 to about 900 a year currently – or 11 deaths per 100,000 people. This decline has been credited in part to initiatives by the suicide prevention centre; publishing helpline numbers on charcoal packets, for instance, has helped cut annual charcoal-burning deaths from a peak of 320 to about 140 now. Despite this encouraging reduction, Yip sees a need to do more. “We are now seeing a slight increase in youth suicide, so we want to identify the areas and see if youth services can be improved. This spatial mapping can help guide policy formulation.”
This article first appeared SCMP, 9 March 2015.