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We Must Treat Gun Violence as a Public Health Crisis. These 4 Steps Will Help Us Reduce Deaths

6 minute read
Ranney MD MPH, Professor of Emergency Medicine and Associate Dean of the School of Public Health, Brown University. Twitter: @meganranney

COVID-19 has taught us many deadly lessons, among them how dangerous it is to approach a health problem as a political problem. We have lost lives, jobs, hope, and an imagined future, all because scoring political points became more important than following the science.

This is not the first time that Americans have made this mistake of conflating politics and health. For decades, we have made the same error about firearm injuries. We have not approached gun deaths as an issue of public health. As a result, we have not just failed to contain gun injuries and deaths, we have seen them increase substantially in number and horror.

For most Americans “gun violence” surfaces only when there is a mass shooting. The fact is, gun-related injuries are far more common than we think. From 2014 to 2017, death rates from gunshot wounds in the United States increased by approximately 20%. In 2020, preliminary reports suggest that the overall rate of gun homicide and suicide increased 10%. More than 100 people died, and more than 200 were injured, by firearms every single day of 2020. Most of these deaths, as in every other year, were gun suicides.

The two public mass shootings in March—in the spas in Atlanta, Georgia, and at the supermarket in Boulder, Colorado—are horrific. But for gun violence in America, they are just the tip of the iceberg.

Each firearm-related injury and death leaves a trail of destruction, contagion, post-traumatic stress, future injury, and lost wages behind. We must meet this challenge by approaching firearm injury as a public health epidemic, rather than a debate about gun rights or control.

This is what we’ve done for COVID-19—we’ve tested, we’ve identified that being a frontline worker puts you at risk, we’ve proven that masks and vaccines make a difference, and now we’re (finally) spreading these small miracles across the country. We’re on the road to ending that pandemic.

History provides us with many other examples. For instance, in the 1970s, car crashes were thought of as inevitable. Since then, death rates have decreased by more than two-thirds—despite there being more and faster cars on the road, and millions of more miles traveled—thanks to the public health approach. Instead of trying to ban cars, we used good public health techniques. We improved car safety through engineering (installing airbags and 3-point seatbelts). We educated parents about the importance of child car seats. We passed laws about drunk driving. And we funded research on how to make us safer. We knew that policy was necessary, but not sufficient.

Now compare that to our approach to firearm injury. In 1996, the now infamous Dickey Amendment was passed. It ostensibly banned use of government funds to advocate for gun control (which, by the way, was already illegal). But after its passage, all money that our country’s research institutions had received for firearm injury prevention, dried up. As a result, government-funded research on the public health approach to firearm injury prevention has been 50-100 times smaller by dollars spent than for diseases and injuries that kill a similar number of people. And that means that we have had no reliable data on gun injuries, and minimal data on deaths. We have been relying on the goodness of philanthropy and non-profits to develop new ways to stem the tide. We have also been stuck in tired arguments between banning guns and arming everyone, thinking that policy debates alone were sufficient, instead of doing the hard work to reduce risk and improve safety. Considering the number of guns in private hands in America, we’re kidding ourselves if we think that laws alone will fix this problem.

To move forward requires that we really, finally, use a basic, four-step public health approach.

First, we need accurate data. The American people deserve to know who is hurt, and where, and why. We deserve to know what makes some firearm owners safe, and others not. We deserve to know which policies are effective, and which aren’t.

Second, this approach requires non-partisan money to create answers and drive change. Although a total of $25 million was appropriated to the NIH and CDC in 2020 for firearm injury prevention, this is a drop in the bucket compared to the decades during which this issue was sidelined. As we learned with COVID-19 vaccines, without funding—whether for Operation Warp Speed or for the logistics behind its distribution—there can be no progress. The solutions may involve effective policies, but they may also include changes in the ways that guns are engineered, changes in beliefs about risk, or changes in economic incentives for safety. We need the best and brightest minds in the country working on this problem.

Third, once we know what works, we need to scale it up, quickly. A few examples among many: Violence interruption programs like Advance Peace have effectively decreased gun homicides in cities in California; Innovative suicide prevention programs like Lock2Live.org can help ER doctors to counsel suicidal patients on safer storage of guns, and improve safe storage among the military; Turning vacant lots into gardens in high risk neighborhoods decreases crime, stress, and gunshot wounds in surrounding blocks; Physician counseling of parents and teens results in improved safe storage of firearms and reduces future violence. These programs, and others, deserve investment. And with proper research funding, there will be many, many more to come.

Finally, a successful public health approach to firearm injury requires that we stop pointing fingers, and instead work together. Some of the most promising approaches to firearm injury prevention (such as the work of AFFIRM Research, a non-profit that I’m affiliated with) are true partnerships between those who are experts in firearms, and those who are experts in health.

Because, honestly, both sides of the debate are right. Yes, we would have zero gun deaths if we had zero guns. But a gun does not go off on its own; there is always a person behind it. Ultimately, there are too many guns in the hands of people whose risk changes in an instant. The public health approach requires that we talk about both the object, and the person.

It’s time to flip the narrative. These mass shootings, and the 1000s of daily tragedies behind them, are not inevitable. We can reduce gun deaths, just like we did for cars, by acknowledging that firearm injury is, at its root, a health problem—and that solutions are within reach.

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