Treat gun violence as a health problem

April 18, 2005|By David Hemenway

CITIZENS AND public officials in Baltimore face the perennial and politically contentious question of how to reduce a serious gun violence problem. At times it appears to be an insurmountable challenge to reduce the deaths and injuries caused by gunfire.

Politics is always at play when it comes to the gun issue - and the debate over solutions represents an emotional flashpoint that most elected officials would like to avoid.

There is, in fact, a different way to address gun violence: by approaching it is as the problem it is - a public health problem.

Compared with other high-income countries, the United States has similar levels of crime and violence (assault, robbery, burglary, bullying), but far higher rates of homicide, particularly firearm homicide. We have more private guns per capita, particularly handguns, than any other high-income nation and more-permissive firearm regulations.

What America needs is a scientific, sensible and comprehensive approach - a public health approach - to preventing firearm violence.

Gun violence in America is not only a criminal issue. The majority of gun fatalities, for example, are suicides, and a sizable minority of nonfatal gun injuries are due to accidents.

Fortunately, most of our firearm injuries are preventable. We need better parenting, better mental health care, better schools and a host of other things that would reduce the problem. We also need a systematic approach to reducing gun-related injuries that should include reasonable regulations concerning the production and distribution of firearms.

A systematic public health approach has been successful in ameliorating many of our nation's problems, including motor vehicle injuries. The United States has reduced motor vehicle fatalities, without banning most cars, by making the roads and vehicles safer (collapsible steering columns, air bags). Traffic fatalities per mile driven have fallen 80 percent since the 1950s, even though motorists do not seem to be driving any better.

Public health is about prevention - let's make things better. We can do more than focus only on the gun user. We should also have reasonable policies directed toward gun manufacturers, gun sellers and the environment in which guns are used.

Most motor vehicle deaths are the direct result of the willful and unlawful actions of motorists. But we have done much more than just increase the likelihood and severity of penalties for drunken driving, speeding, running red lights, etc. We also have made cars and roads safer.

Currently, we effectively ban certain motor vehicles, such as cars without seat belts or all-terrain vehicles with only three wheels. Such bans have been politically feasible because of the existence of established regulatory agencies concerned with promoting safety (such as the National Highway Traffic Safety Administration and the Consumer Product Safety Commission) and because the issues were discussed more on their merits than as attempts to take away the rights of vehicle owners.

A large number of sensible policies reduced motor vehicle fatalities; similarly, many sensible policies can begin to reduce the death toll from firearms. These include policies directed at manufacturers, such as safety standards for firearms and serial numbers that are difficult to obliterate; policies directed at the distribution system, such as background checks for all sales and one-gun-per-month laws to reduce gun-running; and policies directed at owners, such as training requirements.

A key to successful motor vehicle safety was a federal regulatory agency that could mandate that cars include passive restraints and collapsible steering columns and a comprehensive data system on motor vehicle injuries that has enabled us to determine which policies are effective.

Guns, like cars, will undoubtedly continue to be common consumer products in American society. Similar to the way we have successfully reduced motor vehicle injury, we should be considering a more comprehensive rather than a piecemeal approach to reducing firearm violence, an approach based more on science than partisanship or ideology.

It is as true for Baltimore and Maryland as it is for the rest of the nation.

David Hemenway, a professor of health policy at the Harvard School of Public Health, is the author of Private Guns, Public Health.

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