The Rise of Gun Violence as a Public Health Issue, US News

Should Gun Violence Be Treated Like Car Accidents?

By Kimberly Leonard, Staff Writer | July 7, 2015, at 12:01 a.m.

Smith and Wesson handguns are displayed during the two thousand fifteen NRA Annual Meeting & Exhibits on April ten in Nashville, Tenn. Justin Sullivan/Getty Pictures

The gun-control debate in the aftermath of a mass shooting is a stark reminder of the deeply held beliefs in the U.S. about firearms and access to them. Some members of the medical community, however, have been attempting for years to broaden those conversations to include, not just arguments about the Constitution or political ideologies, but a discussion about the toll gun violence takes on public health. Their objective: to work to reduce incidents of gun violence in the same way as campaigns that targeted polio, smoking-related cancer or car accidents.

It’s a controversial treatment. Opponents, among them the gun lobby and many Republicans, believe the budge is a thinly veiled effort to further restrict gun ownership and to provide fresh grounds for seizing firearms. But supporters, including doctors and medical associations, say that designating gun violence – which they define to include homicides, suicides and injuries – as a public health issue will save lives. Doctors already counsel patients about a range of safety issues, including avoiding lead paint, wearing seatbelts, getting vaccinated and dealing with the dangers of backyard pools. If the designation were to switch, they could more often ask patients about whether they keep a gun in the home and, if so, how it is secured.

“We’re not debating the constitutionality of firearms – that exists,” says Dr. Georges Benjamin, executive director for the American Public Health Association. “Firearms exist and people get hurt and die from firearms. There are ways for us in a nonpolitical manner to make people safer with their firearms in a society.”


A Tipping Point on Guns

The CDC and the World Health Organization already consider violence a public health threat, whether a firearm is involved or not. The American College of Physicians has been calling gun violence an epidemic since 1995, and tho’ homicide incidences have decreased dramatically since the early 1990s, the medical community still remains deeply worried, as more than 478,000 fatal and nonfatal violent crimes were committed with a firearm in 2011, according to the most latest data from the Department of Justice.

In February, several leading health associations issued a call to activity asking Congress to develop policies that would reduce the incidences of gun violence. Many of the recommendations look similar to those proposed by gun-control advocates – including limiting the availability of onslaught weapons and closing loopholes that exist in background checks for those who buy guns at gun shows or from dealers – and they are expected to build up little traction in the GOP-controlled Congress after also languishing under Democrats.

In fact, the proposed public health label has been so controversial that it held up Dr. Vivek Murthy’s nomination to be surgeon general for more than eighteen months after he tweeted about the issue. In a January two thousand thirteen letter, he urged Congress to enact public health measures including improving background checks and collecting more government data on the prevalence of gun violence – the latter a proposal that would require federal funding.

Illustration by Ethan Rosenberg for USN&WR/Photo by George Frey for Getty Pics

For a time, CDC was banned from conducting such studies. After its last probe in 1996, wording was inserted into the agency’s appropriations bill that stated, “None of the funds made available for injury prevention and control at the [CDC] may be used to advocate or promote gun control.”

Through executive order, Obama lifted the ban two years ago, but the funding still has not been made available. Last month, the House Appropriations Committee rejected an amendment that would permit the CDC to examine the causes of gun violence.

Rather than explore the broader implications of guns on public health, some Republicans in latest years have focused on the idea of limiting the availability of weapons to people who have a mental illness.

After mass shootings in Newtown, Connecticut; Aurora, Colorado; and at Virginia Tech University in Blacksburg, Virginia, questions about the gunmen’s mental health surfaced almost instantly. It was mentioned in conjunction with last month’s killing of nine black church members in Charleston, South Carolina, as well, however authorities found evidence that the attack was racially motivated and the alleged shooter, Dylann Roof, had purchased the gun legally in spite of previous arrests and a charge of felony possession.


A Very American Tragedy

Benjamin says focusing only on mental health in relation to gun violence is a mistake. “Most people with mental illness aren’t violent, and while it’s an significant issue – particularly around suicides – doing it through that lens is the wrong way.”

He points out that tackling the mental health issue won’t prevent a child from coming across an unsecured gun at home, and won’t make a difference in incidents like bar fights, in which someone shoots another person in anger.

“Even if we solved all the issues around mental illness, the problem of gun violence doesn’t go away,” he says.

Andrew Arulanandam, spokesman for the National Rifle Association, says gun violence should be viewed as a crime, not a public health issue.

The NRA has said that it is not making a statement on the Charleston case until all the facts come in, but Arulanandam spoke about gun violence in general.

“Attempting to framework it as a public health issue diminishes the seriousness of a crime that has been committed,” he says. “It provides criminals with a cover, and that’s wrong. … There seems to be an unwillingness by gun control activists to attempt to rightfully place the blame on the criminal. They are attempting to find all of these excuses and issues to blame rather than on the criminal.”

In an earlier interview with U.S. News, Arulanandam was critical of a providing doctors a greater role in the gun debate.

Illustration by Ethan Rosenberg for USN&WR/Photo by Karen Bleier for AFP/Getty Pictures

“Given that they are neither gun safety nor firearm storage experts, doctors ought to concentrate the limited time they spend with their patients focusing on their health and well-being instead of nosing around on private matters that do not concern them or engaging in political debate of a fundamental constitutional right,” he said.

The Brady Campaign to Prevent Gun Violence, however, says it favors a more-comprehensive look at gun violence.

“We look to enact policy switches that would make it more difficult for guns to get into the wrong palms,” says Rebecca Adeskavitz, the group’s senior program manager.

Some doctors say the question about gun ownership can be significant not only in homes where children are present, but also in cases where the patient may be depressed. More than 21,000 people kill themselves with a gun each year – a number that represents more than half of all suicide deaths.

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“Many people before they make a suicide attempt have visited a health care professional, and that’s a real point of intervention – for people to talk about the risks not only about guns in the home with adolescents but also to talk to middle-aged and older adults, where suicides are high,” Adeskavitz says.

But some medical providers say doctors should stay out of the debate. Dr. Paul Hsieh, co-founder of Freedom and Individual Rights in Medicine, says he views gun crime and violence as predominantly about criminal justice and individual rights.

“I remain deeply skeptical of any attempts to framework significant public policy debates as also ‘public health’ issues, especially when it concerns a long-running political controversy,” says Hsieh, who writes on health care policy from a free-market perspective for “Pretty much any public policy issue will ultimately have some sort of effects on the lives and well-being of Americans – but that doesn’t mean they should all be considered topics of ‘public health.'”

People are worried that sharing information about gun ownership with doctors may not remain private, he wrote in a Forbes lump. “In brief, I believe this undermines the critical doctor-patient trust necessary for the good practice of medicine,” he says.

But public health advocates insist that they could make gun safety as successful as other public safety campaigns.

“You go after the evidence,” Benjamin says. “We did it for car accidents. We made cars safer, we made people safer driving their cars and we made the environment safer.”

Clarified on July 7, 2015: This article has been updated to better reflect Department of Justice data on crimes committed with a firearm.

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