Gun Violence Is ‘A Problem We Don’t Need to Have’ – The Public Health Approach

Just as smoking, vehicle accidents and drunk driving are public health issues, so is gun violence – and it will respond just as effectively to public health preventive solutions, prominent gun violence experts recently told a Public Health Institute (PHI) Web Forum.

For this to happen, public health will need to advance a comprehensive set of strategies that includes: much more data and studies on gun violence as well as policy change, design modifications to guns, and convenings of a wide range of collaborators, the speakers said. It will take time, but just as with smoking, cultural norms around firearms will change, said Deborah Prothrow-Stith, MD, an adjunct professor at the Harvard School of Public Health.

“We have a problem in the United States we don’t have to have,” said Prothrow-Stith, who was the first woman public health commissioner of Massachusetts. “It is in fact a preventable problem. There are many things we can do about this problem.”

An audience of more than 360 attended the Web Forum, “Exploring the Link Between Violence and Guns,” the first in a two-part series on guns and violence.  Georges Benjamin, MD, executive director of the American Public Health Association (APHA), moderated the event, which was sponsored by PHI, APHA and The Jacob & Valeria Langeloth Foundation.

Powerful evidence demonstrates the public health impacts of guns and violence. In 2010, 31,672 Americans died from firearms, and the regularity of mass shootings keeps the public on edge. (2010 is the last year for which the Centers for Disease Control and Prevention has released data.) Of that total, 11,078 were homicides, 19,392 were suicides and 606 were unintentional deaths.  On an average day, more than 250 people are shot, suffering serious damage such as spinal cord and traumatic injuries, and more than 85 of them die.

Guns are used in gang violence, school shootings, assassinations, intimate partner violence and burglaries. Death by guns is the number one cause of death for certain population groups, including young African American men, said Stephen Teret, HD, MPH, director of the Johns Hopkins Center for Law and the Public’s Health and founding director of the Center for Gun Policy and Research.

A look at guns in other industrialized countries, including Japan, France, the United Kingdom and Australia, is telling, said David Hemenway, PhD, director of Harvard’s Injury Control Research Center, who has reviewed data on gun violence worldwide. The U.S. has rates of crime, violence, bullying and depression among schoolchildren similar to these other countries, but American gun laws are much weaker and more permissive than theirs, and more Americans own handguns, he said.  A United Nations survey of 14 developed nations found that all require gun licensing and all but one have gun storage laws, while the U.S. has neither. As a result, he said, our gun-related death rates are strikingly higher:

• The American firearm homicide rate is three to four times that of the other English-speaking developed countries.
• American children 5 to 14 years of age are 13 times more likely to be murdered with a gun and eight times more likely to commit suicide with a gun than children in other developed countries. But when a gun isn’t present, American children’s murder and suicide rates are on a par with those of these developed nations.
• 85 percent of all children murdered in the 14 nations are American children.

Other industrialized nations have responded to mass killings by tightening their gun laws and regulations, he said. “We are really an outlier country,” Hemenway said. “Other industrialized countries don’t understand why we allow this.”

Even within the U.S., fewer children living in states with lower gun ownership died from homicides or suicides with a gun. For example, between 2001 and 2007, 117 children committed suicide using a gun in states with a lot of guns (like Alabama, South Carolina and Wyoming) while just 10 children – still too many – used a gun in their suicide deaths in low-gun states like Massachusetts, New York and Hawaii, he said .

Hemenway decried the lack of data and research being done on guns, particularly by national data systems. “There has been so little money compared to the size of the problem from the federal government or even from foundations,” he said.

Continuing to push for a better background check system and other public policy changes will be important prevention efforts, but the “most fruitful area” to pursue could well be designing guns so that they can only be operated by an authorized person, Teret said. These “smart guns” or “personalized guns” would reduce gun accidents by children and teenage suicides; the technology to produce these guns already exists, he said.

Another advantage of smart guns: If the more than 500,000 guns stolen in home burglaries annually were smart guns, it wouldn’t be worth a person’s while to obtain these guns illicitly to use in crime because the guns wouldn’t be usable, Teret said.

With public concern and political will higher than ever, and so many public health strategies available, Teret said he is “optimistic” about reducing gun deaths. “By focusing on guns as a public health issue and as a consumer product, as public health people tend to do, I think we’re ultimately going to reduce the incidence of gun deaths in the United States and turn this trend around.”