The public health solution to gun deaths

Last year, the National Rifle Association chided physicians to “stay in their lane” when it comes to gun violence.

Our lane.

We responded, sharing images on Twitter of bloody trauma bays and blood-soaked scrubs. Memories were stirred, like the night one of us spent in an emergency room, waiting for foster care to be arranged for an infant and toddler who were orphaned after the murder-suicide of their parents. Or the time we sat with a grieving mother whose only surviving son was murdered by a gun just two years after his brother was gunned down on the same block.

And now, just days after a string of mass shootings, we find ourselves again compelled to speak out.

To claim that gun violence is outside the scope of health professionals is bewildering and incendiary. Not only because it’s clinicians — not the NRA — who bear the responsibility of telling families of the nearly 40,000 gunshot victims each year that their loved ones aren’t coming home, but because providers have a unique role to play alongside communities, policymakers, and industry to reduce gun deaths in a nation with the highest rates of gun violence in the developed world.

As physicians who educate our colleagues on gun violence prevention, we think a lot about how providers can co-create policies that foster prevention, and look to past examples of these powerful partnerships to save lives. Like the automobile industry. When cars were getting bigger, faster, and deadlier, we didn’t exclude medical insight from the dialogue. We also didn’t ban automobiles, as President Trump recently suggested. Instead, we engaged health care professionals to stop the rising death toll. Through legislation, creative design, enhanced licensure requirements, and public awareness, countless lives were saved.

Or smoking. In 1965, 42 percent of U.S. adults were smokers; today, that number is closer to 17 percent. Smoking cessation counseling had some positive impact, but the real change came from policies like prohibiting smoking in public spaces, decreasing access to cigarettes, posting stronger warning labels, and disclosing internal documents detailing industry efforts to obscure scientific evidence. Where tobacco industry representatives once boasted of their untouchability, the steady march of lawsuits by states, health insurers, and individuals fundamentally changed public perception — and utilization.

And then there’s SIDS. When unexplained crib deaths reached epidemic numbers in the 1970s, Congress funded aggressive research that uncovered the link between sleep position and risk of fatality. The resulting “Back to Sleep” campaign was responsible for a steep decline in deaths.

Through decades of successes, failures, and research, we know that the most effective approach to behavior change is environmental change. That’s the essence of public health. Address the conditions in a community, and you have a far better shot at modifying behavior.

It’s time to take the public health approach to gun violence.

First, with data.

For the first time since the landmark 1996 Dickey Amendment barred federal dollars from research perceived as interfering with gun rights, the U.S. House of Representatives approved $50 million for the Centers for Disease Control and the National Institutes of Health to examine gun violence. More is needed, to be sure, including Senate approval of the funding, but we’re gaining ground.

Next, we need legislative action. By working together to repeal the 2005 Protection of Lawful Commerce in Arms Act, which shielded the firearms industry from civil liability, we can allow people affected by gun violence to hold accountable the gun industry. Not only is that the right thing to do; it’s the American thing to do. If our nation espouses the right to engage in fair and just commerce, then granting recourse for consumers harmed by an industry or product must also be guaranteed.

And lastly, it’s time for aggressive public outreach. Research shows that mere exposure to guns increases aggressive thoughts and hostile action — a phenomenon known as the “weapons effect.” So while it may be said that “an armed society is a polite society;” the data says otherwise. This is an area where successful public health approaches have had and continue to have a tremendous role to play by altering public perception. We’ve done it before; we can do it again.

Physicians, health care professionals, and public health specialists know the powerful impact of our involvement in mitigating risk and lowering deaths. We can save lives. Not because doing so is “in our lane,” but because in today’s America, gun violence is the whole interstate.