The mass shooting?at Umpqua Community College in Oregon last Thursday is heartbreaking, especially for the students and families directly affected. But it is tragic in a different way for those of us in public health who have followed the trajectory of gun violence in the United States and tried to sound a call for change.
Firearm deaths are a preventable epidemic.
There is no other cause of death that we know how to prevent so readily—and that, time and time again, we do nothing about. And so we wake up to the latest of more than 40 school shootings this year, the headlines so familiar to us, even as the geography and the faces of grief change.
The extraordinary prevalence of firearm-related violence in the United States stands in harsh contrast to our peer nations. In 2003, the United States had the highest rate of firearm homicide (6.9 times higher than others) and firearm suicide (5.8 times higher) among 23 populous, high-income nations. There have been 142 school shootings just since the massacre at Sandy Hook Elementary School in Newtown, Conn., which claimed the lives of 20 children and 6 educators in December 2012.
The United States clearly has a long and complicated relationship with firearms, and constitutional rights aside, there are abundant organizations and high-profile arguments on the side of unfettered firearm availability. But while the arguments around the rights to gun ownership often center around self-protection from other firearms, the evidence is overwhelmingly clear that this claim is not supported by data.
Studies on the risks of firearm availability on mortality have provided strong evidence of an increased risk of both homicide and suicide. A recent meta-analysis of 16 observational studies, conducted mostly in this country, estimated that firearm accessibility was associated with an odds ratio of 3.24 for suicide and 2.0 for homicide, with women at particularly high risk of homicide. In the case of firearm suicide, adolescents appear to be at particularly high risk.
A 2013 study led by researcher Michael Siegel, a School of Public Health professor of community health sciences, found that US states with higher estimated rates of gun ownership experienced a higher number of firearms-related homicides. Another recent study, examining the association between firearm legislation and US firearm deaths by state between 2007 and 2010, found that stronger legislative restrictions were associated with lower gun mortality.
But despite the clear evidence that guns pose a threat, the public health community has been unable to get traction on this issue. Unfortunately, instead of quality scholarship and policy efforts to map and respond to the risks of guns, we have seen the silencing of gun researchers, health practitioners, and policy makers intent on addressing these problems.
Actions by Congress, fueled by the National Rifle Association in 1996, effectively defunded federal gun research, a still extant legacy, and to date, the Centers for Disease Control and Prevention website lacks materials on prevention of gun-related injury or violence. While translatable lessons from successful public campaigns on smoking, unintentional poisonings, and car safety abound, the political will necessary to implement and test those lessons has been absent and under unremitting attack.
Would we tolerate such lapses in our response to other prevalent health challenges? Imagine for a moment that because of emphatically articulated, rights-based arguments, the United States remained alone among peer countries in not having seat-belt laws, and that our automobile death rate was sevenfold greater than that of Canada. Would that be tolerated?
While acknowledging the broader issues around the balance of rights and privileges, it seems to me that it falls to public health to be a clear voice against the legal widespread availability of a pathogen—guns—that peer nations conquered long ago.
I worry that the voice of academic public health has been far too quiet on this issue, simply because the typical mechanisms that support our scholarship, extramural funding chief among them, have not been conducive to this work. But it is on us to organize our efforts in a way that will allow us to be a compelling voice on the issue, by translating scholarship and joining the public conversation.
The ultimate solution to the firearm epidemic does not lie with the doctors who treat victims or with the community providers who try to keep youths away from guns. It lies rather with policy makers and legislators. An activist public health community needs to play a central role in engaging this constituency through data-driven research and scholarship.
It is only then that we have any hope of turning the tide on what is truly a preventable epidemic.
Sandro Galea, dean of the School of Public Health and an SPH professor, can be reached at firstname.lastname@example.org.
This column originally appeared on the Huffington Post.
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