Now is the time to fight leading cause of death for youth

When a child dies, a community’s only moral and rational response is to do all it can to reduce the chances of another child dying the same way.

When thousands of children and adolescents die from the same cause, the national moral imperative should be to invest any and all resources to save lives and prevent future harm, for the adults to devote whatever energy and effort it takes to prevent a leading cause of death for our kids.

There was a time in the United States when the death of a child wasn’t unexpected, a time before certain medical advances, before public health guided public policy.

In 1900, children 5 and younger accounted for 30 percent of all deaths in the United States. The leading causes were influenza, pneumonia, measles, rheumatic fever and diphtheria.

Government, medicine and science attacked these causes with sustained and vigorous public health actions. Local and federal governments used preventive policies to improve sanitation through water treatment, sewage disposal and public education campaigns on hygiene, including hand-washing and food-handling.

Vaccines were developed, all but eliminating many of the diseases that claimed the lives of so many children. They were vigorously promoted.

Regardless of the leading causes of death for American children — whether infectious diseases in the 20th century or, more recently, motor vehicle crashes, drowning, drug overdose and poisoning — the federal government has responded by treating each as a public health crisis. And the nation has rallied with moral urgency, reason and resolve.

Except when the leading cause of children’s death is firearms. Except when there has been another mass shooting.

After a mass shooting, the fierce urgency of now is reduced to “now is not the time” to address the epidemic of gun violence and the accessibility of weapons meant for war, or to take preventive measures to save lives, especially those of young people.

Now wasn’t the time after Columbine.

Now wasn’t the time after Sandy Hook.

Now wasn’t the time after Charleston.

Now wasn’t the time after the Pulse nightclub.

Now wasn’t the time after Las Vegas.

Now wasn’t the time after Sutherland Springs.

Now wasn’t the time after Parkland.

Now wasn’t the time after Santa Fe.

Now wasn’t the time after El Paso.

Now wasn’t the time after Buffalo.

Failing to respond to each tragedy only sets the stage for the next.

With the weight and full force of all of this history, we say: Now is the time after Uvalde.

After an 18-year-old armed with an AR-15-style weapon murdered 19 children and two teachers in Uvalde last month, now is when state and federal lawmakers must treat gun violence as the public health crisis it is. They must do what previous generations of lawmakers did to confront other leading causes of death for children: Pass legislation and reforms. Spur public health and marketing campaigns that will span a generation. Rally the nation to save children’s lives.

Firearms were the leading cause of death for American children and adolescents in 2020, according to data from the Centers for Disease Control and Prevention. That year, the most recent for which the CDC has data, firearms deaths accounted for more than 5 per 100,000 deaths of Americans 19 and younger.

Mass school shootings capture the media’s and public’s attention because of their scope, horror and arbitrariness — it could happen to any of us at any time — but they account for only a small percentage of firearm deaths.

Mass shootings concentrate the public’s outrage and fuel calls for lawmakers to “do something,” but that “something” must be multifaceted, not just a response to mass shootings but a plan to address suicides, accidental shootings, domestic violence, and change the popular culture and mythology around guns.

“What people don’t realize is that mass shootings are a very, very small part of firearm morbidity and mortality in the United States,” Katelyn Jetelina, author of the popular “Your Local Epidemiologist” newsletter and an expert on violence prevention, told us.

“While we can leverage mass shootings as a way to start educating people, we also need to not just wait for mass shootings but also educate in between them as well, to start moving this much quicker.”

Just imagine, Jetelina said, if we consistently discussed gun violence through the lens of public health — not solely in response to mass shootings.

And just imagine if that discussion occurred not through a political lens, but through the simple goal of reducing gun deaths.

Then we might emphasize and require gun safety storage the same way we emphasize and require car seats and seat belts. We might emphasize and require training and licensing, much as we do with driving, or we would implement age restrictions, much as we do with tobacco and alcohol use.

“A lot of people think we’re in this dichotomous world where you’re pro-gun or you’re anti-gun, but, really … there’s this spectrum,” she said. “When you start taking a health approach to this, you can get rid of those politics for a large part.”

And where are we in terms of having that national public health discussion? “I think we’re at the very beginning of this,” she said.

Writing in her newsletter shortly after the Uvalde massacre, Jetelina said “a 2017 study estimated that we need $1.4 billion to curb the firearm epidemic as a whole (mass shootings as well as suicides, homicides, and unintentional injuries).”

And here it does get political.

For decades Republican lawmakers have been unwilling to talk about the role guns play in shootings. Since the Uvalde massacre, many prominent Republicans have stuck with this playbook, offering “solutions” such as locked doors or a single door at schools, taller fences, bulletproof windows, armed teachers, more policemen on campus, better funding for mental health and stronger families. Everything but the gun used to kill. None of these would prevent an 18-year-old from purchasing an AR-15-style weapon tomorrow and storming into a classroom.

Imagine if the National Rifle Association were as committed to reducing child deaths by firearms as it has been to an unfettered access to a gun. There is no more of a contradiction between “well regulated” — as written in the Second Amendment — private gun ownership and reforms than there is a contradiction between owning a car and requiring a license or the use of seat belts.

Motor vehicle safety is an excellent example of how deaths can be reduced when an issue is treated as a public health crisis. Motor vehicle crashes were the leading cause of death for American children and adolescents until firearms overtook them in 2020. A dramatic reduction in motor vehicle deaths of those 19 and younger — from about 10 per 100,000 in 2002 to about 5 per 100,000 in 2020 — is a remarkable achievement.

Dominic Sisti, associate professor of medical ethics and health policy at the University of Pennsylvania, cites it as an example of the life-saving effect of good public health outreach.

“Public health campaigns had to do with public policy,” he said. “Getting seat belts in cars was one way, and then mandating seat belt use became another way, and then mandating that children be placed in an age-appropriate car seat or booster seat.”

But for whatever reason, we do not talk about reducing gun deaths in this way. Dr. Esteban López, a pediatrician and owner of Hopscotch Health Children’s Urgent Care, said just bringing up gun safety with parents can be a challenge.

Parents will be open to medical guidance on all kinds of health topics. “But with regards to guns, we will get upset at pediatricians or physicians who give anticipatory guidance, just talking about gun safety,” he said. “It’s not talking about removing guns, it’s just talking about keeping guns safe around children. And that is controversial.”

Now is the time for change — recognizing that change will be frustratingly incremental.

In the aftermath of Uvalde, Senate Democrats and Republicans have tentatively agreed on a framework of narrow gun safety legislation that would enhance background checks to include reviews of the juvenile and mental health records of prospective gun buyers younger than 21; include dating partners in the prohibition on domestic abusers from gun ownership; incentivize states to adopt red flag laws; and provide funding for mental health resources, and for strengthening safety and mental health services in schools.

To be clear, enhanced background checks are not universal background checks. Reviewing juvenile and mental health records for gun buyers younger than 21 is not raising the purchase age for a weapon. Incentivizing red flag laws is not a mandate. This package is far from what we want or what gun safety reformers have been advocating.

Nevertheless, this would be the most substantial federal legislation enacted in decades. We will take any progress over no progress — and then push for more. And perhaps if these laws had been passed earlier, 21 Uvalde families would be celebrating, not suffering, this Father’s Day.

Instead, next weekend will be the last of the 21 funerals for the children and women murdered in Robb Elementary.

The service Saturday in San Angelo will be for Uziyah Garcia, 10.

Thursday was Layla Salazar’s funeral. She will forever be 11. She and her father used to sing Guns N’ Roses’ “Sweet Child of Mine” on their way to school. Now, there is no music to be sung.

As we approach the onemonth anniversary of this shooting, this tragedy has shaken our Editorial Board. Four of our Editorial Board members are parents. Two of our households own guns. We have visited Uvalde many times, and stood at the shrines at Town Square and outside Robb Elementary School.

We have seen how the flowers at these memorials have withered because time marches forward, even as time has frozen for the victims and their grieving families.

Remember Uvalde. Stand with Uvalde. Uvalde Strong.

These are not just slogans to be placed on signs or in shop windows — they are lifetime promises to the victims and their families. Implied in that promise is a commitment to prevent future gun violence — in any form. Are we capable of honoring these children and their teachers by preventing other gun deaths? Can we one day celebrate that firearms are no longer the leading cause of death of American children and adolescents? Can we commit to ending this nightmare of repeated mass shootings? Can we look beyond mass shootings to see the other horrors of gun violence?

Now is the time for change. Let our actions be the truest measure of how we honor Nevaeh, Jose, Jacklyn, Annabell, Jayce, Makenna, Jailah, Lexi, Tess, Xavier, Amerie, Maranda, Eliahna, Rojelio, Layla, Alithia, Maite, Uziyah, Ellie, Irma and Eva.

Getty Images file photo From disease to car crashes and drownings, when the lives of children are threatened, the nation has responded with public health and safety campaigns — until now.

Wong Maye-E/Associated Press This is not simply a slogan. It’s a promise to the victims and their families.

Staff file photo