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Gun violence as a global health issue

Written by Allie Liss, Intern for the Gun Violence Initiative

As a global health student, I spend a lot of time learning about all of the current and historical health problems around the globe, but a surprisingly limited amount of time learning how to solve these problems. This is what attracts me to public health generally, and more specifically, to the idea of framing gun violence as a public health issue; it is a focus that emphasizes framing the problem in order to find a solution. But almost inevitably, the first thing discussed at our Global Health Conversation event was why we look at gun violence as a public health issue. Many in our audience remarked that they had never thought about gun violence from this perspective before. I don’t know why I still found this surprising.

As an intern with the Gun Violence Initiative, the first thing I always get asked is why the Gun Violence Initiative is housed in the Institute for Public Health. A public health perspective is a given when studying infectious diseases, malnutrition, or lack of sanitation. People would not question, or be surprised by, the use of a public health model to investigate cholera, tuberculosis, or HIV. With gun violence, however, you have to first justify investigation in the field of public health before conducting research and developing interventions based on a public health model.

In order to investigate gun violence, or any issue, as part of a public health model it is necessary to have adequate data and funding. A study conducted last year at Stanford that compared the top 30 causes of mortality in the United States determined that funding and the number of publications for gun violence were extremely low relative to the mortality rate.

One thing that was previously anecdotally blamed for the lack of funding and publications is the 1996 congressional appropriations bill that stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention [CDC] may be used to advocate or promote gun control.” This has not, however, prevented some innovative, and successful interventions.

In 2014, there were 32,963 deaths, and 78,816 injuries attributed to gun violence in the United States: 20,511 suicides, 3,853 attempted suicides, 11,184 murders, 58,210 attacks, 567 accidental death, 15,798 accidental shooting injuries. A public health approach dictates a methodical approach driven by a specific issue within the larger category of gun violence.

Interventions that work for suicides are not the same ones that will work for murders and accidental shootings; the presence of a firearm does not indicate a single solution.

For example, Cure Violence, Means Matter, and Lock it for Love are three very different public health based interventions that each tackle a specific subset of gun violence.

Cure Violence is aimed at reducing violence in inner city communities and is based on treating gun violence like an infectious disease. The basic premise is to interrupt transmission, identify and change the thinking of the highest potential transmitters, and change group norms. This model is similar to those used to target infectious diseases such as HIV and tuberculosis.

The Means Matter campaign was started at the Harvard TH Chan School of Public Health to be used as part of a comprehensive approach to suicide prevention. It is based of the idea that in addition to focusing on why people take their lives, it is important to recognize that how a person attempts suicide plays a significant role in whether or not people live or die. Intent is not the only determinant of fatality.

Lock it for Love is run by the organization, Women’s Voices Raised for Social Justice. They provide community education about death and injury prevention specifically related to guns in the home and distribute free gunlocks throughout the community. This program is based on public health data that shows that guns kept unlocked in the home drastically increase the risk of accidental shootings, especially those involving children.

These are just some of the examples of the many programs that exist throughout the world aimed at combatting gun violence using a public health model. While it is imperative to continue to recognize the devastating effects that gun violence has on an individual level, in order to begin making progress towards solving the problem, we need to see gun violence as simultaneously an interpersonal and societal problem. The best way to do so is by using a public health model.