A Public Health Approach to Gun Violence

We have written earlier on this blog about how to look at insurance through a medical risk management model. The medical risk management model is one basically developed out of public-health. It is the product of people who have responsibility for looking at entire populations and drawing that down to an individual level.

Many people have suggested changes to gun laws to limit access to certain types of weapons, accessories or ammunition; other people have suggested that increased emphasis on mental health may make a difference. A lot of this pits second amendment rights to bear arms against rights to privacy both for people who are concerned about registering guns with the government and people who are concerned about the rights of people with mental health problems. Virtually everyone agrees that it is a complex problem without a single obvious solution. Following the tragedy in Newtown, Connecticut, three public-health physicians from Harvard have suggested a different approach to curbing gun violence.

In an editorial article in the Journal of the American Medical Association, these doctors suggest approaching the problem of gun violence in ways similar to those we have used in reducing the risks from smoking and motor vehicle accidents.  They point out that, as a society, we have reduced cigarette smoking from over 40% of the population to less than 20% of the population in about 40 years. This is had a great impact on diseases that are associated with cigarette smoking such as lung cancer and heart disease.  The story with motor vehicle this is even more dramatic vehicle deaths per mile of driving have dropped by 90% over time. 

Both these reductions have come from a combination of public health efforts that included public education, efforts to change perception, establishing safety standards and enforcing laws. It was popular 50 years ago to say “you can’t change human nature” or “you can’t legislate morality” but these don’t seem to be so true anymore as we realize how much our cultural outlook contributes to the way we see things. There was a time when smoking was “cool;” today it is as likely to be viewed as “gross.” Once, leaving a party or a bar “a little under the weather” might not have been a cause for concern but as the public has grown increasingly aware of the possible consequences of this behavior there is a real reduction in drinking and driving and a greater willingness to prosecute offenders.

There are even corresponding notions developing today in the law enforcement community where police strategies are shifting from reactive to proactive. Although these ideas are just beginning, the notion that violence can be reduced by focusing “efforts targeted on high risk places, behaviors, and actors” is pretty similar in concept to alcohol enforcement programs that set up checkpoints near drinking establishments.

It seems at least possible that it is not necessary to challenge the second amendment to the Constitution by making significant changes to gun laws or to expose people with mental health issues to increased government scrutiny if we worked at strategies that change the public perception of gun violence. A lot of patience is required for this kind of strategy, but getting a start on it could at least get us going in the right direction. After all, who among us who saw Paul Newman with a cigarette hanging from his lip in the 60s could have predicted what the reaction to that same vision might be today.

Leave a Reply

Your email address will not be published. Required fields are marked *