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A public health approach to gun control

Dear Editor:

Columbine. Sandy Hook. Las Vegas. Pittsburg. Parkland. El Paso. Dayton. Odessa. Certainly not an all-inclusive list of high-profile mass-shooting tragedies. Mass shootings are becoming more frequent. During 2018 in the U.S., there were 340 mass shootings (defined as 4 or more shot) with 1346 people wounded and 373 killed. That’s just the tip of the iceberg. While mass shootings are horrific, the firearm death toll from homicides, accidents, and suicides is also of great concern. There are 80,000 injuries from firearms each year in the U.S. with 39,000 fatalities. Sixty percent of firearm deaths are from suicide.

Presidential candidates and gun-control activists have promoted various ideas to curb the violence. They include universal background checks, assault-like weapon and high capacity magazine bans, enhanced mental illness intervention, federal gun registration, safe gun storage, and “red flag” laws allowing the temporary confiscation of firearms from high-risk individuals until a court can rule.

I am a gun owner. I believe in the right to defend myself in my home, and that the American public should not be disarmed. It is a necessary defense to a tyrannical and demagogic government, if that should ever occur in America. But reasonable gun control is warranted. What is occurring in our country is outrageous. The vast majority of Americans support reasonable gun-control measures.

So, what can a physician add to this discussion? A public health approach. It has been successfully utilized for other public health issues. Take motor vehicle deaths. We didn’t do away with automobiles, but rather researched the issues that gave us answers to making motor vehicles safer. The public health approach has been used to battle tobacco use, obesity, the opioid epidemic, HIV/AIDS, and heart disease.

The approach recognizes that although behavioral change is important, it’s usually more effective to change the environment. It recognizes that garnering common ground between those with opposing perspectives is essential.

Public health professionals, joined by health-care providers, add the health perspective to what is ordinarily a criminal justice and legislative process. Indeed, seven physician and public health organizations just released a position statement regarding firearm-related injury and death published in the Annals of Internal Medicine. It endorses some of the measures listed above. It adds a call for systematic research on gun injury and violence as well as protection of confidential, unrestricted patient-physician communication regarding gun ownership and gun safety.

A public health approach offers a methodical, comprehensive, and scientific method for finding solutions to cultural, social, economic, and mental-health factors; and for researching the agents that deliver the injuries. It involves the entire community including government, law enforcement, public health and health-care organizations, and religious, educational, and business entities working together to find solutions.

The public health approach involves epidemiological research and the rigorous scientific evaluation of suggested constitutionally-consistent changes in regulations, policies, and laws; investigating perpetrator risk factors and factors that may protect against violence and injury; testing the effectiveness of proposed strategies; and implementing proven solutions and best practices. We are currently entertaining changes in policy that sound good or intuitive but not necessarily data-driven and evidenced-based.

But there is a serious lack of necessary federally-funded research on gun violence that may lead to gun control measures since a Congressional ban was enacted in 1996. Although there has been some Presidential and Congressional affirmation for the research of gun violence, the research has never recovered.

Inordinate gun violence is preventable and should not be considered acceptable collateral damage for the right of gun ownership.

– Richard Feldman, Former Indiana State Commissioner of Health