Act Now Before It’s Too Late: Gun Violence is a Public Health Crisis
The American Nurses Association (ANA) recently called on policymakers to ban assault weapons and restore access to mental health services for families and individuals. Moreover, the American Medical Association (AMA) voted almost unanimously that gun violence is indeed a public health issue. These organizations are not the only one’s reacting in the wake of the tragedy in Orlando. The American Public Health Association (APHA), Doctors of America, and numerous other healthcare associations have taken similar stances.
Guns are a public health crisis. Each day people are killed by guns and about as many die from guns as motor vehicle accidents (Blackwell & Clarke, 2014). Gun violence is the leading cause of premature death in the United States. Each year gun’s kill about 30,000 people and cause 60,000 injuries (Whitlock, 2005).
How do experts address public health issues? If you are a clinician you might think it is important to ask a family or patient whether they keep guns in their home. Similar to asking about seatbelts and car seats, a clinician may attempt to prevent deaths by inquiring about proper use. In states like Florida, however, clinicians cannot ask about the presence of guns, and if they do, they may lose their license. Studies show that a majority of Americans do not keep their firearms locked away (Conner, 2005). Given this information alone it is important to have these vital conversations.
Even if a clinician is able to talk freely about this public safety crisis, more wide-sweeping forms of investigation are still against the law within the United States. Currently research must be conducted into the causes of gun violence. The Centers for Disease Control and Prevention (CDC) has had a de facto ban on gun violence since 1996. During this time, the National Rifle Association (NRA) claimed that the CDC was attempting to limit the Second Amendment of the United States which reads:
“A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.”
After this accusation was lobbied against the CDC, the Republican-controlled Congress threatened to defund the CDC (Frankel, 2015). After the recent Newtown shooting President Barack Obama, via executive order, reversed the ban, however the CDC has still not resumed any research regarding gun control. Despite these attempts, the CDC has not resumed any research on gun control, and some scholars have attributed this to the fact that the CDC is funded by Congress, not the White House. Moreover, Congress has not funded gun violence research since 1996, while bills have been proposed to reinstate funding, none have been passed.
It is often said that good ethics is informed by good facts. In this case, we need ethical-decision making to guide our politics and this can only be done through accurate and valid science. The United States is a nation built upon free thought and this includes the freedom to research what one chooses, so long as the research complies with current ethical codes and recommendations. Science in particular must never be influenced in the name of politics, instead, politics must be guided by science. The CDC is an organization dedicated to utilizing epidemiological data to inform policy, no exceptions.
We also need more support for our vulnerable populations. Epidemiological studies over the past thirty years have shown that persons diagnosed with severe mental illnesses, such as schizophrenia, bipolar disorder, or severe depression, are never violent toward others (Stuart, 2003). This then begs the question, if mental health issues don’t correlate strongly with violence, why did the ANA call for mental health treatment? Suicide.
When examining epidemiological data from the CDC it becomes clear that mental illness is an area of concern. Suicides accounted for 61% of all firearm fatalities in the United States in 2014, or 21,384 of 33,599 gun deaths recorded by the CDC. Therefore, there is good reason to restrict access to firearms for people who have vocalized suicidal intent or have attempted suicide. However, the restrictions will do little to curb suicidal impulses, we need sweeping interdisciplinary treatment. If we were to see such a high correlation between washing hands and infant mortality, we would urge anyone who touches a baby to wash their hands. When we see such a strong correlation with gun deaths we must ask, can we do more?
Across all populations, suicide risk is correlated with incidence of mental illness (Cavanagh, Carson, Sharpe, & Lawrie, 2003). Moreover, recent research has illustrated that keeping a gun in the household can increase the risk for suicide (Miller, Barber, White, & Azrael, 2013). Proper mental health treatment can reduce such risk factors while keeping guns away from the home can alleviate risk factors for many struggling with suicide.
Most of the research which currently exists is based on epidemiological data. A study from 2011 showed that gun permit and licensing requirements in the United States lowered the rate of suicides amongst males (Andrés & Hempstead 2011). These more recent findings support previous findings indicating gun background checks and waiting periods significantly reduced suicide in the older population (Ludwig and Cook, 2000). Similar studies conducted on the effects of handgun bans correlated significantly with immediate reduction in gun-related suicides. In this study specifically, no reduction in suicides was observed by any other mechanism or in any adjacent territory not subject to the law (Loftin, McDowall, Wiersema, & Cottey 1991).
Clinicians have good reason to have crucial conversations, researchers have good reason to continue gun-related research, and policymakers have good reason to advocate for more restrictions, especially for at-risk populations. We can choose to act now, or we can choose to wait until the next tragedy strikes.
Allen, G. (2011, May 7). Florida Bill Could Muzzle Doctors On Gun Safety. Retrieved June 18, 2016, from http://www.npr.org/2011/05/07/136063523/florida-bill-could-muzzle-doctors-on-gun-safety
Andrés, A. R., & Hempstead, K. (2011). Gun control and suicide: The impact of state firearm regulations in the United States, 1995–2004. Health Policy,101(1), 95-103.
Blackwell, D. L., Lucas, J. W., & Clarke, T. C. (2014). Summary health statistics for US adults: national health interview survey, 2012. Vital and Health Statistics. Series 10, Data from the National Health Survey, (260), 1-161.
Cavanagh, J. T., Carson, A. J., Sharpe, M., & Lawrie, S. M. (2003). Psychological autopsy studies of suicide: a systematic review. Psychological medicine, 33(03), 395-405.
Connor, S. M. (2005). The association between presence of children in the home and firearm-ownership and-storage practices. Pediatrics, 115(1), e38-e43.
Frankel, T. (2015, January 14). Why the CDC still isn't researching gun violence, despite the ban being lifted two years ago. Retrieved June 18, 2016, from https://www.washingtonpost.com/news/storyline/wp/2015/01/14/why-the-cdc-still-isnt-researching-gun-violence-despite-the-ban-being-lifted-two-years-ago/
Loftin, C., McDowall, D., Wiersema, B., & Cottey, T. J. (1991). Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. New England Journal of Medicine, 325(23), 1615-1620.
Ludwig, J., & Cook, P. J. (2000). Homicide and suicide rates associated with implementation of the Brady Handgun Violence Prevention Act. Jama, 284(5), 585-591.
Miller, M., Barber, C., White, R. A., & Azrael, D. (2013). Firearms and suicide in the United States: is risk independent of underlying suicidal behavior? American journal of epidemiology, kwt197.
Whitlock, D. R. (2005). Bioterror killed five in US; guns kill 30,000 a year. Nature, 436(7050), 460-460.