We need a public health approach to gun violence

In his address to the nation after the Oct. 1 mass shooting at Umpqua Community College in Roseburg, Oregon, President Barack Obama asked the media to compare the number of gun deaths in the U.S. to the number of deaths caused by terrorism. While edifying, his comparison didn’t go far enough. Each year guns kill more Americans (including deaths by suicide) than Parkinson’s disease and hypertension, and they kill nearly as many as liver disease and cirrhosis, which would rank guns as the 13th leading cause of death nationwide. Even more disturbing, researchers believe mass shootings, like the one in Roseburg, are contagious, and many in the media have begun to refer to an epidemic of mass shootings.

Gun violence is a public health crisis. Consequently, it’s time to address these shootings and gun violence as a whole using public health tools. The best tool we have is to reduce the number of people exposed to gun violence, and the best example of how to do that comes from the automobile safety movement of the 1960s.

After the publication of “Unsafe at Any Speed” by Ralph Nader in 1965, automakers and the U.S. government were forced to face the fact that, at the time, driving was more dangerous than it had any right to be. In response, Congress passed the National Traffic and Motor Vehicle Safety Act (1966) and the Highway Safety Act (1970), which mandated many safety features we take for granted today, such as centerlines on roads and seatbelts in cars. These reforms made cars safer to drive and roads safer to drive on, improving not only the cars that caused so many deaths but also the driving environment in which these deaths occurred. Driving got safer immediately. By 1970, motor vehicle deaths per 100 million miles traveled were on the decline, and by 1997, they had decreased by more than a third.

We need to take a similar approach if we want to make guns safer. Changing the types of guns available, by restricting, for example, the sale of assault rifles or high-capacity magazines is a good start, but it’s only one part of the picture. Such a change would be analogous to adding seatbelts to cars: They don’t prevent disasters from happening, but they make disasters less deadly.

A public health approach to gun deaths would also require making the environment safer so mass shootings would be less likely to occur. This could entail a variety of measures, including making guns harder to buy, restricting where guns may be carried and who may own guns, on the basis of their mental health history, and even mandating gun-safety training for people who live in the same household as a gun owner. Improving background checks so they cover all gun sales (including theestimated 40 percent of firearms sold by unlicensed dealers, who are not required to perform these checks) and a federal waiting period for gun purchases, similar to those already in place in various states, would help make this possible. Also, mandating that prospective gun owners complete a minimum amount of training and pass a test of basic gun safety and knowledge before they buy a gun and being retested periodically, similar to taking driver’s ed and passing a road test, would help.

Those who fret over the influence of the gun lobby should note: Public health has a long history of taking on entrenched interest groups and winning. Take the fight for smoking regulations despite intense pushback from the tobacco industry or restrictions on lead paint despite resistance from the paint industry, including marketing lead paint directly to children. While public health initiatives don’t have a perfect record in these sorts of fights (for example, New York City’s failure in 2010 to pass a tax on sugar-sweetened sodas), they have frequently found success even when the odds seemed impossibly long. With this track record in its corner, the public health approach might just have what it takes to tackle the National Rifle Association and other gun lobbyists.

One of reasons public health campaigns have been able to beat such long odds is that they used sound research. Public health scientists have been able to prove that many of these products were bad for our collective health. After that, no amount of lobbying or politicking really mattered, as the public had made up its mind. Unfortunately, funding for this kind of research on gun violence has been banned by Congress since 1996, when a Centers for Disease Control and Prevention study produced findings that reflected so poorly on gun ownership that the NRA felt compelled to lobby Congress to prohibit federal funding for research into gun violence. This ban would have to be reversed if we want to tackle gun violence through public health.

With that said, it’s time for a new approach to curbing gun violence. Right now, we make the argument for gun reform from a standpoint of moral outrage. That outrage is completely justified, but at the same time, that outrage gets us nowhere. It ebbs and flows without meaningful policy changes. If instead we take a public health approach, first by providing grants for gun violence research and then expanding into improving guns and the environment they exist in, we might finally be able to solve America’s gun problem.