A Public Health Approach to Gun Violence

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The United States sees more gun violence than any other developed nation. More than 33,000 people die every year as a result of firearms—roughly the same as car crashes—yet United States officials don't approach gun violence in the same way they do other health and safety issues, like infectious diseases or drownings. Why not? And what if we did?

Through a process known as the "public health approach," public health officials have been able to improve the health and safety of American citizens due to a wide range of issues, from smoking to obesity. This same multi-step, research-based approach could be leveraged to reduce the number of firearm-related injuries, too. Here's what would need to happen.

Pinpoint the Problem

A public health approach is a data-driven one. The first step in preventing firearms-related injuries—or any health or safety issue—in a given community is figuring out what is going on, who is involved, and how, when, and where it’s happening. To find out this kind of information, public health officials look at data from a range of sources, including police reports, hospital records, and surveys. This information is then analyzed to see if there are any trends or particular areas where programs or policy changes could be most effective.

This is exactly what was done with seat belts. When researchers found that seat belts decreased the risk of fatalities, public health officials began recommending their use, and states enacted laws requiring them. The result was safer cars, safer drivers, and fewer deaths from car crashes.

In order to figure out how to reduce gun violence in the United States, you first have to lay out what's happening and who's involved. Without this step, it's difficult to know where resources should be allocated, who should be targeted, or what interventions might be most effective.

Figure Out Key Risk and Protective Factors

After the problem has been outlined, researchers take a deeper dive into the data to figure out what might make the problem better or worse. They do this by identifying risk factors and protective factors.

Risk factors are things that might make someone more likely to have a negative outcome, such as becoming a victim or perpetrator of gun violence. As an example, smoking is a known risk factor for cancer because studies have shown smokers have a higher incidence of cancer than non-smokers. Health officials leveraged this information to shape recommendations, policies, and programs to help reduce the number of people who smoked and, consequently, reduce the rate of cancer.

Protective factors, on the other hand, are things that appear to reduce the risk of negative outcomes—in essence, what we should be doing more of or trying to expand. For example, exercise is a protective factor against cancer because research has shown that people who have a healthy range of physical activity have lower rates of cancer. Medical and public health experts used that information to encourage people to increase the amount of time they spend exercising every week.

In the case of death or injuries related to firearms, risk and protective factors could vary widely, depending on the type of outcome being studied. While mass shootings often get the most media attention, there are many ways using firearms could result in injury; some of which aren't intentional. In addition to firearms being used for intentional harm—as in the case of homicides, mass shootings, and suicides—gun violence can also encompass events like accidental discharges. Researching risk or protective factors associated with these types of unintentional shootings could, for example, help identify things that might make guns less likely to unexpectedly fire—like user training or gun safety features—whereas studying what makes homicides more or less likely might reveal entirely different factors to focus on.

It is important to note that while certain things might increase your risk of getting hurt by firearms, the presence of a risk factor doesn't mean that violence is inevitable or that victims are to blame when they are hurt.

Test Possible Solutions

Once key factors have been identified, public health professionals begin the work of developing and—most importantly—testing possible strategies to address the issue. Public health interventions can take many different forms. Some involve educational initiatives, where key individuals are taught how to manage or reduce their risk of getting hurt. Others might involve issuing recommendations to professionals in a given sector, such as physicians, social workers, or manufacturers, or proposing policy changes like laws or rules issued by regulatory bodies.

These initiatives are based on available data and research literature and are often shaped by what has worked in other environments or communities. They are then fine-tuned and tested using even more research like focus groups or surveys, to make sure they are appropriate and feasible for the population you want to reach. This whole process is known as evidence-based programming, and it's an important way program planners help ensure that resources are allocated as efficiently and effectively as possible.

Implement Proven Programs

After these initiatives have proven themselves to be effective in smaller settings, others are trained on how to adopt these programs or policies for implementation in their own communities. Typically in the United States, the role of "disseminator" is taken on by the Centers for Disease Control and Prevention (CDC), the federal agency responsible for protecting the public's health at a national level. If, for example, a particular educational program were shown to be effective at teaching parents of young children how to store their guns safely in the home, the CDC could train local health departments to conduct these classes in their own communities.

In each of these four steps of the public health approach, continued research is key, and the data collection never ends. A public health approach to gun violence would mean continuing to monitor the problem for any changes or improvements, as well as to evaluate the impact of the wheels already in motion. If the problem shifts or new risk factors arise, it would be important to adjust or redirect initiatives so that they continue to be effective.

Similarly, other countries or communities might launch new or innovative strategies that prove wildly successful in curbing firearm-related injuries. Without continued monitoring, the United States might miss out on employing a strategy that could be more effective.

Hurdles to Employing a Public Health Approach

Currently, the United States as a whole is hindered from using a public health approach to prevent gun violence due to a significant lack of data. This is because the primary government agency tasked with conducting public health investigations—the CDC—isn’t effectively allowed to study gun violence. The agency researches a wide range of public health issues, from vaccines to vehicular crashes, but it stopped virtually all research into gun violence in 1996.

The move has political roots. The CDC had funded a study published in 1993 that found having a gun in the home was a risk factor for homicide. In response, the National Rifle Association (NRA) began lobbying Congress to eliminate the agency completely. The agency stayed, but congressional members sympathetic to the NRA put language in a key appropriations bill stipulating that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” The section, known as the Dickey Amendment, continues to be included in the appropriations bill year after year, and rather than risk losing funding, the CDC stopped researching gun violence altogether.

In the wake of the Newtown school shooting in 2012—when more than 20 children and teachers were killed by a gunman—President Obama issued a directive to the Secretary of Health and Human Services and Director of the Centers for Disease Control and Prevention to resume studying gun violence in order to identify root causes and possible prevention strategies. The research, however, never really resumed to the same level as prior to the 1996 decision.

The CDC is not the only agency that could be tasked with studying the issue of gun violence—the National Institute of Justice, for example, conducted research after the Dickey Amendment was put in place—but it is a major funding source for local governments and other institutions looking into public health issues. Because of this, very few smaller organizations have the means to look into gun violence without the support of grants from the federal government.

Because of the deep political undertones of the topic, many public health entities have also chosen to avoid the area entirely rather than risk giving the appearance of taking a political stance and losing funding elsewhere. As a result, much of the data available on gun violence currently available is incomplete and outdated.

The impact of this can’t be overstated. Without sufficient data on what is happening with regards to firearm-related injuries and who is being impacted and why, public health agencies can’t develop or propose effective initiatives to reduce gun violence, let alone implement them. In short, without data, a public health approach is virtually impossible to employ at the national level until the federal government lifts its effective ban on this type of research.

A Word From Verywell 

Calling for a public health approach to gun violence is not the same as advocating for gun control. It is simply a process of figuring out the extent of the problem, what can be done, and what has shown to be effective to address the issue and make communities healthier and safer. While it's possible that the results of this approach could indicate that certain legislation might be effective at curbing firearm-related injuries and deaths, any recommendations made would be based on a systematic review of evidence and data—not any partisan affiliation or political agenda.

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