The Disease Approach: A Public Health Intervention for US Gun Violence?

June 13, 2016; WBUR

Five thousand people have been killed with guns so far this year, with over 10,000 injured, according to the Gun Violence Archive. In just two weeks, there have been three headlining stories of horrific gun violence, with the most recent incident in Orlando being among the worst in U.S. history. News of gun violence should not be just another day in American life, yet sadly it is. 

Given these extraordinarily high numbers, gun violence has been referenced in public health terms. Major news sources, including the New York Times and U.S. News and World Report, have been using words like “disease” and “epidemic” to describe gun violence. As with other public health crises, it would seem that the appropriate next step would be to design an intervention to stop the spread of this disease. The problem is that the lead public health agency, the Centers for Disease Control and Prevention (CDC), has not released recent data regarding gun control. In fact, sources seem to report mixed messages as to whether or not the CDC is even able to research firearm-related deaths.

Doctors for Responsible Gun Ownership’s Dr. Timothy Wheeler in his report, Public Health Gun Control: A Brief History, claims that the CDC was blatantly opposed to gun ownership during the 1980s and early ’90s. As such, any research produced by the agency was deemed biased. In 1996, the National Rifle Association (NRA) lobbied heavily and effectively passed legislation that prohibited the CDC from using funds to “advocate and promote gun control.” The key words here, of course, are “advocate” and “promote.” Based purely on semantics, it does not seem as if this legislation banned any and all research related to firearms, but Dr. Garen Wintemute, emergency room physician and leader on gun violence research, says, “The message was really clear.”

After a $2.6 million cut from the CDC’s budget, the exact amount spent on gun violence research, the CDC was threatened with more cuts if the research continued. In 2003, the language was expanded to include the phrase “in whole or in part,” and in 2012, this ban was further expanded to encompass all Health and Human Services agencies. During 2012, in the aftermath of the Sandy Hook shooting in Newtown, Connecticut, President Obama attempted to lift the ban on gun violence research. Unfortunately, after 16 years with no federal funding, the top researchers in the field moved on to different projects, and very few students were encouraged to pursue research in this area.

Fast-forward to 2016. Massachusetts Attorney General Maura Healey, along with twelve other state attorneys general, wrote a letter to Congress urging its leaders to “address the nationwide public health and safety crisis created by gun violence.” The letter goes on to ask for funding directed toward the CDC specifically for the purpose of studying “gun-related injuries and deaths” and to remove the language prohibiting the CDC from advocating or promoting gun control. They wrote, “Analysis of prevention measures, such as intervention and counseling by healthcare providers and gun safety improvements, as well as research into the root causes and psychology of gun violence are needed to inform our response.”—the “response” being, if this is a public health issue, an appropriate intervention.

Some argue that a gun violence intervention could be modeled after the highly successful “Click it or Ticket” campaign used to promote seatbelt usage. In 1984, only 15 percent of Americans used a seatbelt. After the “Click it or Ticket” campaign, this increased to 82 percent. A major flaw in this comparison is that a PSA encouraging seatbelt use can tap in to one’s instinct for self-preservation. In terms of firearm-related injury and deaths, aside from preventing accidental use, gun violence appears to be rooted in many different causes. Of course, the catch-22 is that we can’t know what the root causes truly are to design interventions until research has been completed.— Sheela Nimishakavi