Gun Violence: Shifting from a Political Issue to a Public Health Movement

By Jennifer Larson, contributor

January 30, 2013 - In the wake of the massacre at Sandy Hook Elementary School in Newtown, Conn., people across the country began calling for action. Some are demanding more stringent gun control laws, while others call for a renewed commitment to funding mental health services.

Now, a growing number of scientists, researchers and healthcare professionals  are calling for more funding for research into gun violence--both causes and prevention.  Many feel the public health aspect of gun violence has been downplayed for years but is now getting the closer look it deserves, including the American Public Health Association, which calls the current situation “a public health crisis.”

More than 100 researchers in the areas of crime, medicine, public health, economics and public policy sent a letter to Vice President Joe Biden and the other members of the president’s newly-appointed task force on gun violence on January 10, urging change.

The authors wrote that little progress has been made in understanding and addressing the problem of firearm-related injuries because “the usual methods for addressing a public health and safety threat of this magnitude--collection of basic data, scientific inquiry, policy formation, policy analysis and rigorous evaluation--are, because of politically-motivated constraints, extremely difficult in the area of firearm research.” 

“This is the time,” said David Hemenway, PhD, director of the Harvard Injury Control Research Center and author of Private Guns, Public Health, who signed the letter.

Research is needed

After convening the task force in early January, the Obama administration released an executive order on gun violence on January 16. The detailed set of proposals ranged from closing the background check loophole to banning military-style assault weapons and high-capacity magazines to improving mental health services to ending the freeze on gun violence research.

Although the set of proposals drew immediate fire from the National Rifle Association (NRA), the call for more research drew praise from a number of medical and health associations, including scientists who study violence and injury prevention and have referred to the dearth of federal funding in recent years.

For example, according to the letter to Biden and the task force, firearms may account for more than 4 million injuries per year, but the issue has only received three research awards from the National Institutes of Health (NIH) during the past 40 years.

In 1996, certain lawmakers acted to strip federal funding from the Centers for Disease Control and Prevention (CDC) for firearm injury research. Although the $2.6 million was eventually restored, it was earmarked for traumatic brain injury, effectively preventing its usage for its original intent.

“The effect was sharply reduced support for firearm injury research,” wrote Arthur Kellerman, MD, MPH, and Frederick Rivara, MD, MPH, in a recent column for the Journal of the American Medical Association (JAMA).

Many researchers have also shied away from taking on projects to study anything related to firearms or gun-related issues, unwilling to risk the political backlash that often followed.

“It’s been a taboo subject,” said Susan Gallagher, MPH, co-chair of the Society for the Advancement of Violence and Injury Research’s policy and advocacy committee.

But good research is imperative, Gallagher continued. It allows scientists to collect and analyze data for patterns, which would then lead to proposals for prevention strategies.

“You need to do these evaluations and research to see what’s working and what’s not working,” she said. “You want to improve the science behind the decision-making.”

Howard Pollack, a professor with the University of Chicago’s Center for Health Administration Studies, emphasized that the purpose is to conduct “judicious research.”

“We want to approach this with an open mind, where we are ready to be surprised and not viewing research questions through an ideological lens,” he said.

“And it should be done in a scientific manner and published in a peer-reviewed journal,” noted Gallagher.

Hemenway noted that there are almost endless possibilities for public health research related to guns and firearm violence, including links to suicide, the best ways to reduce illegal gun trafficking, and the benefits and risks of carrying a gun.

Educating patients to prevent gun-related injuries

Another provision in Obama’s executive orders that has drawn praise from many in the healthcare community is the call to prevent any restrictions being placed on healthcare providers when it comes to discussing gun safety.  Until now, some jurisdictions have taken steps to limit or forbid providers from discussing firearms in the home with patients; these are sometimes referred to as “gag rules.”

Nurses, physicians and other healthcare professionals have the opportunity to educate people about potential dangers that might create more risky situations. There can’t be a prohibition on that opportunity to educate and counsel, said Karen Daley, PhD, MPH, RN, president of the American Nurses Association (ANA).

“The fact is, all providers, nurses included, have to have the freedom to talk with patients about safety issues in the home,” she said.

“What kills children is injury,” said Hemenway. “So you have to talk about it.”

The American Academy of Pediatrics also released a statement commending the federal policy recommendations and the clarification that “the Affordable Care Act does not prohibit doctors from asking their patients about guns in the home.”

Changing technology, changing social norms

Another public health challenge that lies ahead is exploring the possibilities offered by advances in technology. Hemenway, Pollack and others noted that technology has advanced that can make guns safer to use--or at least, harder for someone to misuse them.

Hemenway notes that an analogous situation is car safety. The highway fatality rate has dropped dramatically in the last 50 years. That’s not because drivers today are any better than they were 50 years ago, but, with advances in technology and research, the cars themselves are much safer--and so are the roadways.

“It’s hard to change people. It’s much easier to change systems,” he said. “You can have great success even if people don’t change very much.”

The public health community also advocates for efforts to change social norms to promote safety. For example, smoking was once an arena that was considered nearly untouchable. The tobacco industry had powerful allies in Congress, and even doctors once promoted smoking. But as research showed the dangers of smoking, the public’s perception of smoking began to change, and eventually the laws followed suit.

“You can see there’s been a tremendous change in social norms,” said Pollack. “When social norms change, all of a sudden, the legislative landscape can move in a way that would have seemed quite implausible.”

Pollack added, “The medical community is in a good position to [promote a shift in social norms], especially in a way that is not partisan, not in a political way.”

Now is the time

With the spotlight shining on firearm violence and injuries, many believe this is a watershed moment.

“This is the time,” Hemenway said again. “Everybody has to step up, though. People cannot sit and watch and wait and be cynical. This is the time--right now. And it’s everybody.”

Daley said the American Nurses Association will continue to put pressure on lawmakers to take action on a number of issues related to gun safety.

“It’s not an easy fight to win,” she acknowledged. “It is going to be an uphill battle.”

But she continued, “It’s about doing the right thing for the public health.”

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