Today’s Health Issues: Gun violence as a public health problem

A recent article in the Journal of the American Medical Association from Jan. 7, 2013, was a strong motivator and the basis of the topic of this month’s column.

It seems that the present approach to the decrease of gun violence is misguided. We are mostly talking about gun control when we should be talking about gun violence.

Gun control or gun ownership is a very narrow aspect of this issue and triggers passionate reaction from many people. On the other hand, if we would treat gun violence as another type of public health problem, the approach would be based on solid data and it would involve a variety of approaches.

Gun violence should be approached by clearly researching and finding answers to social, cultural, educational, behavioral, mental health and product-safety issues involved in this matter. The solutions would be based on solid data. The tactic, so far, has been limited to legislative approaches affecting high-capacity magazines, rapid-fire weapons, a heterogeneous (state-by-state) approach to waiting periods before purchase of a firearm, background checks and registration of firearms just to name few.

The focus on car accidents was not on automobile ownership, although it seems reasonable to think that the fewer cars on the road, the fewer the opportunity for accidents. The focus was on making cars better prepared to tolerate impact, make the occupants safer by the use of seatbelts and airbags, safety glass, better outside lights, better design of highways including safer merge zones, better exit and access ramps and speed control.

Engineering improvements were not all of the dimensions to this issue. Educational approaches including the danger of drunk drivers and driving without seatbelts were addressed. Legislative approaches about permissible alcohol levels, more punitive penalties for drunk drivers and changes made by the Department of Motor Vehicles for licensing were also implemented.

Little has been done about the fear factor used by the gun industry and others to increase the number of guns sold. Although the murder rate in the U.S. is at the lowest it has been in more than 50 years, people consistently buy a large number of guns because of the risk of death or serious injury by assailants.

This is despite available data showing a decrease of risk and the fact that most homicides occur among people who know each other and not by strangers. Other than police officers and security personnel, concealed weapons are carried because of fear of an attack. Only four states in the U.S. in 1970 allowed people to carry a weapon without given a specific reason.

Liberal concealed weapons laws are now legal in 40 states, indicating that, with no data to support, people now live in more fear. This is an opportunity for an educational intervention.

Our youth read, play and constantly watch comic books, games and videos associated with graphic violence. It is ironic that one of the most antigun communities, Hollywood, constantly depicts gun-associated violence in films and television. It has been reported that the average child watches 8,000 televised murders and 100,000 acts of violence before finishing elementary school.

The typical attitude has been that all is well since the homicide rate is down. But, when we look further, the ratio of victims of homicide during the 1980s was 17.5 and 13.2 for the 18-24 and 35-49 age groups respectively. In 2005, the same ratios were 14.9 and 5.7 indicating that most of the decrease in the overall homicide rate was at the expense of the older group.

The critics of controlling explicit violence in the media claim definitive studies have not been done. But even assuming this is accurate, can a reasonable person see any societal benefit to exposing millions to graphic violence?

We do not use the same criteria for pornography. Although there are no large, long-term studies showing an association between exposures to pornography by children and antisocial behavior, common sense indicates that it cannot have a positive impact on children. Thus we attempt to control exposure by limiting at what time, on what channels, and have developed a parental guidance scoring system.

The fact that this column is endorsing wide public health approaches to gun violence should not be interpreted as a vote for not acting now on common-sense measures. For instance, if the major reason for gun ownership is protection, should we allow unrestricted purchase of firearms?

In Virginia, a 19-year-old law restricting the purchase of a handgun to one per month was recently rescinded. It is hard to make a case for purchasing multiple handguns on a weekly basis if the guns are used for protection.

This is an encouragement for secondary illegal sales and smuggling of guns to other states where more control exists. Arizona has no registration, no permit required and no waiting period on handgun purchases. Additionally there is no limit on the guns that can be purchased in one month. According to the Yellow Pages there are 111 gun dealers in the Phoenix area alone with a population of 1.5 million people.

This does not take into consideration online retailers, gun dealers without a land-based phone or national department store retailers who do not advertise themselves as “gun dealers.” It is not a stretch to think that many of these guns will find their way to undesirable hands, many of them in Mexico. For comparison purposes, Los Angeles, home for more than 4 million people, has 21 gun dealers.

Reasonable gun ownership is not the issue, gun violence is. As we have successfully done with car accidents and cigarette smoking, public health measures should be applied to this problem which is responsible for 30,000 yearly deaths in the U.S. Most of them young people.

We owe it to our youth to consider a multidimensional approach to this problem.