Gun-violence re­duc­tion must be treated like auto-safety move­ment

Modern Healthcare - - NEWS - By Steven Ross John­son and Shan­non Much­more

The U.S. pub­lic health com­mu­nity needed no wake-up call to re­al­ize that gun violence is deeply af­fect­ing the health and safety of Amer­i­cans. But never be­fore has the is­sue hit so close to home for them.

Last week’s mass shoot­ing in San Bernardino, Calif., which killed 14 peo­ple and wounded many oth­ers, occurred at an em­ployee hol­i­day party hosted by the San Bernardino County Depart­ment of Pub­lic Health.

Dr. Ge­orges Ben­jamin, ex­ec­u­tive di­rec­tor of the Amer­i­can Pub­lic Health As­so­ci­a­tion, said the shoot­ing was “deeply per­sonal” for him. He urged Congress, which has long been par­a­lyzed on the is­sue, to take ac­tion on “com­mon-sense mea­sures,” given that about 32,000 peo­ple in the U.S. are killed by guns an­nu­ally.

Achiev­ing mean­ing­ful so­lu­tions, Ben­jamin said, will re­quire a change in the na­tional con­ver­sa­tion to understand gun violence through a preven­tion-ori­ented pub­lic health lens. And that will re­quire up-to-date re­search data on gun violence, which the U.S. cur­rently lacks. “Right now we’re making emo­tional de­ci­sions, and peo­ple are just run­ning to their cor­ners when some­one pro­poses any­thing, with­out ac­tu­ally hav­ing the ev­i­dence to back up what they say,” he said.

But ev­i­dence that could help iden­tify so­lu­tions is scarce. The Cen­ters for Dis­ease Con­trol and Preven­tion’s last re­port on gun violence was re­leased in 1996. That year, the Repub­li­can-led Congress, con­cerned that the agency was pro­mot­ing gun con­trol, barred fed­eral fund­ing for gun-violence re­search. Since then, ef­forts to restart fed­eral re­search fund­ing have gone nowhere.

“Data and re­search help to show there really is a prob­lem,” said David He­men­way, di­rec­tor of the Har­vard In­jury Con­trol Re­search Cen­ter. Data also are cru­cial in eval­u­at­ing whether “what you’re do­ing is making a ben­e­fi­cial change,” he added.

Just hours be­fore the San Bernardino at­tack, rep­re­sen­ta­tives of the Amer­i­can Acad­emy of Pe­di­atrics and the ad­vo­cacy group Doc­tors for Amer­ica asked Congress to ex­am­ine how gun violence af­fects Amer­i­cans’ health. Dr. Alice Chen, ex­ec­u­tive di­rec­tor of Doc­tors for Amer­ica, likened gun-violence re­search to the auto-safety stud­ies that led to manda­tory seat belts, airbags, safer high­way de­sign and a sig­nif­i­cant re­duc­tion in deaths from car ac­ci­dents.

Pres­i­dent Barack Obama di­rected the CDC to con­duct re­search on guns af­ter the 2012 mas­sacre of stu­dents and school staff at Sandy Hook El­e­men­tary School in New­town, Conn. He in­cluded $10 mil­lion for such re­search in his two most re­cent bud­get pro­pos­als. But con­gres­sional Repub­li­cans op­posed to gun con­trol have blocked that fund­ing.

For­mer Arkansas GOP Rep. Jay Dickey, who spon­sored the 1996 law that ended fed­eral gun-violence re­search, now says cut­ting off that fund­ing was a mis­take. Ev­ery time he drives on the high­way and sees im­proved road safety fea­tures, he says he thinks about how sim­i­lar re­search could help re­duce gun-re­lated mor­tal­ity with­out in­ter­fer­ing with Amer­i­cans’ Sec­ond Amend­ment rights.

In Novem­ber, the CDC is­sued a 16-page re­port on the violence plagu­ing Wilm­ing­ton, Del. At the city’s re­quest, the agency ex­am­ined the 127 shoot­ings that killed 154 peo­ple in 2013. Those shoot­ings rep­re­sented a 45% hike in gun violence over the prior two years. CDC in­ves­ti­ga­tors combed through po­lice records for so­ci­o­log­i­cal in­for­ma­tion about whether those who had been ar­rested for vi­o­lent firearms crimes were em­ployed, had ex­pe­ri­enced child abuse or had dropped out of school.

One fac­tor that the CDC did not look at in Wilm­ing­ton, how­ever, is the one that ex­perts say could be most help­ful in de­sign­ing poli­cies to ef­fec­tively re­duce gun violence—how the shoot­ers got their guns. That in­for­ma­tion could help pol­i­cy­mak­ers fig­ure out how to limit ac­cess to the guns used in crimes. But out of po­lit­i­cal cau­tion, CDC of­fi­cials are leery of ven­tur­ing into such is­sues.

Chen sug­gested that gun violence re­searchers could edge into the pub­lic health realm by in­ves­ti­gat­ing the less po­lit­i­cally volatile is­sues of sui­cide preven­tion and safe firearms stor­age.

He­men­way said a pub­lic health ap­proach is pow­er­ful be­cause it fo­cuses on sys­tem change. “Al­most al­ways, real suc­cesses come not from chang­ing peo­ple, who are really hard to change, but from chang­ing the sys­tem,” he said. “You want to make sys­tems so that it’s hard to make mis­takes and hard to be­have in­ap­pro­pri­ately. And then when peo­ple do, no­body gets se­ri­ously hurt.”

Ben­jamin said the history of pub­lic health ini­tia­tives proves that mul­ti­dis­ci­plinary col­lab­o­ra­tion could re­duce the num­ber of Amer­i­cans in­jured or killed by guns. “It’s not about tak­ing firearms away, specif­i­cally,” he said. “It’s about look­ing at the data and find­ing ways to make firearms safer and to make the com­mu­nity safer for peo­ple with their firearms.”

Just as the na­tion re­duced deaths and in­juries from car crashes, he said, “we can do the ex­act same thing for firearms.”

A can­dle­light vigil in San Bernardino, Calif., hon­ored the 14 peo­ple killed dur­ing a hol­i­day party last week.

Source: Con­gres­sional Re­search Ser­vice

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