Guns Are Not Just a Public Health Problem

Public health is the lingua franca through which liberal America understands guns, and the traumas they engender.

When President Biden called for action after last October’s mass shooting in Maine, he did so by once again casting gun violence as an “epidemic”—a Hippocratic term taken from the study of the spread of infectious diseases.   

The notion that guns cause a public health crisis best addressed through harm reduction strategies like background checks, red flag laws, or safe storage guidelines courses through the language of experts, doctors, activists, and media commentators. 

That language reflects gains made by gun safety researchers like me. Our work promotes wellbeing within the armed petri dish that is America—a nation with more guns than people, and more mass shootings than calendar days.

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A health framework makes profound tactile sense: guns present unacceptable threats to American mortality, and the numbers only worsen. Faced with such trends, public health experts and physicians mobilize to try to save lives in the same ways we once did when excess mortality resulted from cigarettes, faulty seatbelts, or asbestos insulation.

But a limitation to our approach becomes increasingly significant in the leadup to the 2024 election: guns represent different kinds of pathogens than did cigarettes or cars. The ideologies driving expansive gun rights aspire, not just to sell specific products, but to gain power and wield influence in increasingly undemocratic ways. And a heath framework that emphasizes threats to human bodies offers little counter to threats to the American body politic as a result.

Background checks and red flag laws, for instance, offer little counter when expressly pro-gun judges and courts overturn firearm safety laws put in place by voters in places like New York, Maryland, and Oregon.

Gun politics bleed into realms of governance when pro-gun donors, politicians, and judges shape widening swaths of U.S. domestic and foreign policy about matters ranging from women’s reproductive choice to voting rights to free speech.

Guns also fan America’s deepest social divides when armed militias storm state capitals or intimidate voters at polling stations. Or when gun sellers play on fears and conspiracies about safety to foment white anxiety about Black violence and looting while at the same time marketing semiautomatic weapons to Black and Latino populations using concerns about police brutality.

These instances and others highlight how guns represent more than health problems: they are problems of race, of history, of plurality. As columnist Jamelle Bouie puts it, gun politics present “a challenge to the very possibility of an open, democratic society.”

Guns, in other words, are not just threats to public health; they are threats, as historian Ruth Ben-Ghiat writes, to the “strong civic culture and a public sphere conducive to social trust and altruism” that healthy democracies require. 

These dangers promise to grow even more intense should Donald Trump—who once called himself the “most pro-gun” president in history, and now ominously touts himself as the NRA’s “loyal friend”—win in 2024.

All of which highlights, I have come to believe, the need for a broader approach: Democrats need to tie gun safety to the defense of the American public square.

I am a physician, sociologist, gun policy scholar, and a longtime advocate for gun safety. Our interventions save lives.

Yet I’ve spent the past five years interviewing gun owners and gunshot victims across the U.S. South for a new book, What We’ve Become, that tells the story of the 2018 Nashville Waffle House mass shooting. My research showed me time and again how, while the health frame can be effective on clinical and moral levels, it is less so at political ones.

For instance, the Nashville shooting, like so many others, appeared to support the need for stronger gun laws. The shooter would have almost certainly been stopped by a red flag law before he killed anyone, had one been in effect; instead, he was easily able to buy and carry firearms.

But no such legislation passed in Tennessee in the months after the shooting. Instead of making GOP politicians pay for their inaction at the polls, the opposite scenario played out. In the gubernatorial election held months after the tragedy, Tennessee voters elected GOP businessman Bill Lee, who ran on a platform that championed eliminating most restrictions on gun owners and eliminating most permits and regulations governing public carry. Lee became arguably the most pro-gun governor in state history.

Public-health backed candidates for Governor and other state offices lost because health arguments failed to contest what journalist Patrick Blanchfield calls gunpower—power accrued and wielded under the mantra of gun rights to build reliable voting blocks and donor bases, elect loyal politicians, and seat sympathetic judges. 

I also came to appreciate how violence prevention efforts that emphasized government regulations could be problematic for many conservative gun owners—the very people who would be most impacted should these regulations become laws. 

A wide range of Southern gun owners, even ones who told me that they supported gun safety, voiced alarm about policies that required their personal identification entered into government databases, or expanded police authority through civil restraining orders. 

In their view, the government threatened individual autonomy.  As a man who lived on a farm in Tennessee and owned multiple AR-15’s put it to me, “people out here come to terms with the idea that the government isn’t going to save you from violence.  Each individual is their own most effective first responder.”  

Another red state gun owner contended that Southern conservatives remained skeptical of regulation because, “the majority of violent gun crime is committed in places with the strictest control on guns”—in other words, in this fraught formulation, in dense urban blue cities by persons of color.

These largely predictable responses pointed me toward a core challenge facing public health: a widening gap between what guns do and what they mean. 

Public-health based approaches developed methods for reducing the nearly fifty thousand American gun deaths per year, an unconscionable number. 

But a framework focused on injuries and deaths had relatively less to say about the social effects of the roughly 500 million guns bought and carried by more people in ever-more locales across the U.S. The vast majority of guns carried in parks, bars, airports, busses, and other public settings, were not involved in shootings or crimes.

I saw time and again how the space between seeing guns as health risks and as viable tools of American public life was eagerly filled by self-interested parties like gun manufacturers and the NRA who framed gun ownership as a trapping of white, male identity through themes of protection against liberals and racial others, superiority, and liberty. 

During the pandemic in particular, gun sellers played on fears about police violence and public health overreach to sell guns to new groups of owners.  By 2020, gun sales “soared,” headlines announced, “amid pandemic, social unrest, election fears.”  Black and Latino Americans, and “leftists…socialists, progressives,” rushed to buy guns after the police murder of George Floyd. 

Guns and not governments increasingly became the autonomic American responses to feelings of uncertainty. 

On a practical level, vast increases in public guns made it nearly impossible for safety experts like me to pick the mass shooters of the world out from the millions of people who own and carry firearms to no effect.

And at the level of ideology, buying guns during moments of peril bolstered a neoliberal belief long undergirding gun rights arguments—that your safety is your responsibility because the state won’t protect you.  

All of which rendered a central tenet of the public-health approach to gun safety seem increasingly illogical to many gun owners: the notion that equitable regulations and prevention policies yield trust among people, as if by herd immunity.

There are stirrings that new forms of activism might break though the roadblocks to reform long put in place by the NRA. Candidates backed by the grassroots group Moms Demand Action performed well in 2023 elections. Parkland survivor David Hogg heads a new organization that helps young, progressive lawmakers get elected to state legislatures and the U.S. Congress. The appalling GOP response to the Covenant School shooting mobilizes a new wave of reform-minded candidates in Tennessee.

These initiatives are exceedingly important. In our winner-take-all political system, winning is a requisite step for change. Winning lets you seat judges, allocate resources, and enforce regulations. Winning lets you strengthen democratic institutions.

But my research suggests that victory will remain elusive if the aim of political power is to enact more of the same gun laws without attending to the larger contexts and structural drivers of violence, unsafety, and democratic decline. 

I’ve come to believe that in the current moment, when democracy itself is at stake, gun safety needs to improve people’s lives in ways that they can see and feel, strengthen the concrete undergirding civil society, and allow blue and red state Americans to imagine broader coalitions based on shared interests rather than on shared anxieties.  

In the long run, gun laws by themselves will have relatively little effect in changing the contours of the American gun debate if they don’t go hand-in-hand with material investments that take seriously people’s safety concerns, and reward community cohesion over armed tribalism. 

Thankfully, a growing body of research combines the insights of public health with methods from urban planning, economics, business, criminology, and sociology to show how gun laws have the greatest effect if joined with investments in lived environment. Fixing streetlights, creating parks and green space, jobs programs, and rebuilding “civic infrastructure,” public safety, and community resiliency can reduce gun crime at rates that supersede those produced by gun laws alone.

While these types of interventions have been tested in blue cities, they are rarely attempted in rural parts of red states like Tennessee. People in these parts of the country often confront public health most visibly in moments of crisis, such as after mass shootings or during pandemics, when they are told to wear masks, get vaccines, or regulate gun sales. Public health can connote restricting freedoms or being forced to comply with mandates, but rarely represents prosperity in ways that are evident in the everyday.

That needs to change. Public health researchers and gun safety advocates could work together across Red-Blue divides to partner with builders, employers, developers, Internet providers, supermarkets, transit experts, and city planners to redefine and construct safe neighborhoods. They could align with local and national businesses to promote ways that gun safety can be pro-growth—such as working with AI developers to reimagine safe parks, workplaces, or schools. They could host grant-writing workshops and reward communities to improve public safety using reinforcement algorithms developed by health insurers.

Reformers could create economic benchmarks to aid mayors and governors based on the work of sociologist Patrick Sharkey, showing how investments in “place” reduce violent crime and enable formerly distressed neighborhoods to prosper.  

These kinds of interventions take at face value the core assumption of many gun-carry arguments—that public spaces should be safe for everyone—and intervene upstream to do so.  Few of these interventions involve trying to mandate individual-level behaviors, but instead aim to engage broader categories of shareholders to build what political theorists call “strategy influence” by creating long-term sustainable relationships that provide practical benefits.  Deeper attention to financial structures can also counter critiques that public health fails to pay enough attention to economic factors in its interventions.

Again, it’s a travesty that America does not have comprehensive national guns laws. But interventions long proposed by scholars like me are imperfect—in large part due to the narrow terrain on which we’ve been allowed to even research gun safety, let alone put the policies we propose into practice. Years of funding bans and outright resistance have left us promoting modest interventions to an overwhelmingly complex national scourge.

As we fight for adoption of even the most basic laws, it’s important to keep in mind that guns are issues into themselves, and they are also symbols, material objects, and lethal enforcers in a much larger fight about America, about who we are, and who we will become.

Leading up to the 2024 election and beyond, we are ultimately better off by combining biomedical expertise with sustained investment in structures that build and reinforce common knowledge, common cause, and common sense.