Auto safety efforts show the way for gun violence reduction

The U.S. public health community needed no wake-up call to realize that gun violence is deeply affecting the health and safety of Americans. But never before has the issue hit so close to home for them.

Last week's mass shooting in San Bernardino, Calif., which killed 14 people and wounded many others, occurred at an employee holiday party hosted by the San Bernardino County Department of Public Health.

Dr. Georges Benjamin, executive director of the American Public Health Association, said the shooting was “deeply personal” for him. He urged Congress, which has long been paralyzed on the issue, to take action on “common-sense measures,” given that about 32,000 people in the U.S. are killed by guns annually.

Achieving meaningful solutions, Benjamin said, will require a change in the national conversation to understand gun violence through a prevention-oriented public health lens. And that will require up-to-date research data on gun violence, which the U.S. currently lacks. “Right now we're making emotional decisions, and people are just running to their corners when someone proposes anything, without actually having the evidence to back up what they say,” he said.

But evidence that could help identify solutions is scarce. The Centers for Disease Control and Prevention's last report on gun violence was released in 1996. That year, the Republican-led Congress, concerned that the agency was promoting gun control, barred federal funding for gun-violence research. Since then, efforts to restart federal research funding have gone nowhere.

“Data and research help to show there really is a problem,” said David Hemenway, director of the Harvard Injury Control Research Center. Data also are crucial in evaluating whether “what you're doing is making a beneficial change,” he added.

Just hours before the San Bernardino attack, representatives of the American Academy of Pediatrics and the advocacy group Doctors for America asked Congress to examine how gun violence affects Americans' health. Dr. Alice Chen, executive director of Doctors for America, likened gun-violence research to the auto-safety studies that led to mandatory seat belts, airbags, safer highway design and a significant reduction in deaths from car accidents.

President Barack Obama directed the CDC to conduct research on guns after the 2012 massacre of students and school staff at Sandy Hook Elementary School in Newtown, Conn. He included $10 million for such research in his two most recent budget proposals. But congressional Republicans opposed to gun control have blocked that funding.

Former Arkansas GOP Rep. Jay Dickey, who sponsored the 1996 law that ended federal gun-violence research, now says cutting off that funding was a mistake. Every time he drives on the highway and sees improved road safety features, he says he thinks about how similar research could help reduce gun-related mortality without interfering with Americans' Second Amendment rights.

In November, the CDC issued a 16-page report on the violence plaguing Wilmington, Del. At the city's request, the agency examined the 127 shootings that killed 154 people in 2013. Those shootings represented a 45% hike in gun violence over the prior two years. CDC investigators combed through police records for sociological information about whether those who had been arrested for violent firearms crimes were employed, had experienced child abuse or had dropped out of school.

One factor that the CDC did not look at in Wilmington, however, is the one that experts say could be most helpful in designing policies to effectively reduce gun violence—how the shooters got their guns. That information could help policymakers figure out how to limit access to the guns used in crimes. But out of political caution, CDC officials are leery of venturing into such issues.

Chen suggested that gun violence researchers could edge into the public health realm by investigating the less politically volatile issues of suicide prevention and safe firearms storage.

Hemenway said a public health approach is powerful because it focuses on system change. “Almost always, real successes come not from changing people, who are really hard to change, but from changing the system,” he said. “You want to make systems so that it's hard to make mistakes and hard to behave inappropriately. And then when people do, nobody gets seriously hurt.”

Benjamin said the history of public health initiatives proves that multidisciplinary collaboration could reduce the number of Americans injured or killed by guns. “It's not about taking firearms away, specifically,” he said. “It's about looking at the data and finding ways to make firearms safer and to make the community safer for people with their firearms.”

Just as the nation reduced deaths and injuries from car crashes, he said, “we can do the exact same thing for firearms.”