A public health response to gun violence in America
Public health workers try hard to balance individual and public rights - ensuring that someone who refuses treatment for infectious tuberculosis has access to due process before being quarantined and required to take medications. How do we apply this equation to guns?
A public health response to gun violence in America
Esther Chernak
Esther Chernak is a physician and director of the Center for Public Health Readiness and Communication at Drexel University School of Public Health, where she is an associate research professor.
By Esther Chernak
One of the fundamental challenges in the practice of public health – the work that keeps populations and communities healthy and safe – is balancing the rights of the individual with the rights of the public. We work hard to make sure that a person with active tuberculosis who refuses treatment has access to due process before they are deprived of their civil liberties and required to take medications and confined so they don’t infect others.
We are responsible for identifying restaurants that sell unsafe food and companies that sell unsafe medications. The public whose health we are committed to protecting expects that those businesses will be shut down until their products are no longer dangerous.
This week, we watched helplessly as innocent children and their teachers were slaughtered in an elementary school in Newtown, Connecticut, another tragedy arising from our failure to regulate access to firearms and to address serious mental illness. This is a tragedy that recurs too frequently now and, given the horrific events at Newtown, we are at a reckoning— we need to develop a clear sense of what our society should look like moving forward, we must quickly make decisions about what resources we will need to make the world safer for our children, their teachers, and just everyday citizens, and, finally, we need to confront the implications of such changes on how to balance the rights of individuals with the health and safety of our communities. The practice of public health has a great deal to teach us in these areas.
Not surprisingly, the first discussion we must have is about the easy access to guns in the United States. Anyone with a credit card or ready cash has seemingly unfettered access, the Irish Times reported, with a perspective that reflects much of the world’s disbelief with American right-to-carry culture, to hand guns, automatic weapons, and ammunition. This access has contributed to high profile tragedies across the United States – in Columbine and Aurora, Colo.; at Virginia Tech; in Oak Creek, Wisc.; in Tucson, Ariz., and now in Connecticut. A recent survey of 62 gun massacres in the United States shows that “of the 142 guns purchased by the killers, more than three-quarters were obtained legally.”
Weak gun laws also contribute – in lower profile, but with no less tragic consequences – to a plague of homicides by firearm in cities like Philadelphia, Chicago, Detroit, New Orleans, and Miami. Somehow, the slow, steady accumulation of casualties from daily gun violence has become, for many, too easy to ignore as our elected officials struggle not to head over the fiscal cliff, or manage the conflicts overseas that threaten our national security.
But the events in Newtown demand our attention, and we need to understand that after a steep decline in the 1990s, gun violence has increased in our nation, and threatens our safety no less than these other issues. Restricting access to guns through better enforcement of laws that are already on the books and through new legislation at the state and federal level will be important. We need to identify the gaps across systems and states that allow people access the types of firearms whose only appropriate use is in combat in Iraq or Afghanistan. And we need to have the willpower to restrict that access.
We must also acknowledge and deal with the fact that violence has become part of our popular culture. Acts of violence are glorified in movies, music, videos, and in the electronic games whose popularity has surged in recent years, particularly among adolescent boys. This culture of violence trivializes its actual impact. Do the young men who absorb images of macho, gun-toting characters, in the world of fiction and in real life, realize the permanent and fatal costs of gunshot wounds before it is too late?
The second conversation to have is about how we handle mental illness in this country. Fueled by a combination of good intentions and dwindling resources, we have slowly dismantled a public mental health system that has limited resources to deal with dangerous psychiatric illnesses. No longer do we hospitalize individuals with profound mental illness: the Byberry’s and state institutions shuttered their doors long ago. Instead, we rely on a fragmented, under-resourced system of outpatient providers, crisis mental health emergency rooms, and short-term psychiatric hospitalizations with uncertain follow-up of patients with critical problems. Families are on their own to manage major mental illness in their relatives and loved ones, a situation that can lead to deadly consequences.
The absence of an accessible, robust system to deal with mental illness is compounded by the shame of acknowledging that it exists. Earlier this year, in my own primary care medical practice in a community clinic, I had to involuntarily commit (obtaining a “302 warrant” in medical parlance) two different patients who threatened to commit suicide. The experience was brutal. Both had confided their intention to take their own lives, but did not want to seek care for that impulse. They were taken by police to the local psychiatric emergency room, in handcuffs. There are abundant reasons for this procedure, all good and designed to protect everyone involved, but that does not make the reality of it any easier. And this commitment, for 72 hours unless a ruling of a court extends it or the person elects to remain in care voluntarily (which both of my patients ultimately chose to do), is still insufficient for many with serious psychiatric illness. Upon discharge, they are on their own to seek further counseling, take or not take their medications, and hopefully not harm themselves or others.
Will my patients confide in me again if they feel those dangerous impulses? I am not sure.
As a society, we are often uncomfortable with illness in general, but there is significant stigma around mental illness for those who live with it and for their family members. We have to be able to talk about it without embarrassment if we are to come to grips with its impact on both individuals and society. This is an appropriate time to take a hard look at the mental healthcare system, the resources we devote to it, and the supports that we provide to providers, patients, and their families when it comes to recognizing and treating psychiatric disease. We need a system that offers something other than short-term and long-term incarceration for people who suffer from serious mental illness, but also protects us from people who might be dangerous – granted, a difficult judgment to make sometimes.
We are also uncomfortable, perhaps more so than residents of other countries, with depriving people of their rights – to live freely, to sell goods and services, to own guns. But we recognize that there is a limit to the exercise of those personal rights when they infringe upon the health and welfare of others. Even if it means restricting the rights of a few, for the benefit of the community.
Read more about The Public's Health.
The state isn't effective at preventing death and addressing problems from a public health perspective? That's hilarious. Besides starting with the completely obvious (e.g., water regulations, etc), let's look at traffic safety. The amount of per capita deaths via auto accidents in 2011 was 10.3 per 100,000. That compares to a high of 29.3 per 100,000 in 1937. Safety regulations and speed limitations have reduced auto fatalities by over 2/3 despite cars that go faster and are much heavier along with lots of large trucks on the road.— PhillyGuy77- I own guns but I am baffled by gunowners who think it is a good idea that wide segments of the population are armed at most times and/or support some of the current laws in place especially regarding gun sales & transfers. You can pretty much get any gun you want with no background check simply through private purchase which constituted more than 40% of the estimated gun purchases last year. If the diehard gun enthusiasts want largely unfettered access and carry privileges, then there is going to be a relatively large amount of gun-related crime. Let's also not minimize the amount of suicides committed annually with firearms. There were over 16k last year in the U.S. and guns are by far and away the way in which people successfully commit suicide.— PhillyGuy77
- It's not the guns that are the issue, it's all these video games and movies. Love the logic, if a cop pulls me over for speeding I'll tell him it's not my fault my car was going so fast, it's Nascar's!— jweis
- Reagan/Bush I did save a lot of money by defunding mental health care and replacing it with a thousand points of light. Aided and abetted by the left, which argued that forcing the mentally ill to get treatment violated their rights.
That's enough of blame to go around. The root of our problem is that now there is nothing that can be can be done about people who show obvious signs of being mentally ill until they shoot a person or twenty.
That was the case at VA Tech, in Colorado, and now in Connecticut. Address that problem, and we might actually get somewhere.— arturner - Any thoughts on the NBC news reports that the AR-15 was in the trunk of the car and NOT used in the school?— jimmymack
- I was at my local ammo supplier this afternoon to buy some .45 cal ammo. They were sold out!!! What does that tell you? The South will rise again.— dogman5
- "our failure to regulate access"
in newtown the firearms were stolden, the vehicle was stolden, he broke into the school. i guess the laws did not mean anything to the criminal. lets pass some more.
"An individual is not a militia. Your home is not a militia. This was not written with assault rifles in mind."
this means that the flintlock at the time was not an "assault" rifle??? maybe they should be banned also? during WWII the japanese were thinking about invading the west coast. they saw no problem with the "army" but the thought voiced was that the larger army they could not defeat were the armed citizens, hence no invasion of the west coast.
as our esteemed attorney general of the United States, eric holder, once said "never let a tragedy go to waste".— 41Mag - nice of the author to parrot the Irish Times claim that we have unfettered access to "automatic weapons".
saves me the trouble of reading the rest of the column.— ekw555 - http://ssristories.com/index.php?sort=what&p=school
Yes, lets talk about public health and gun violence— STEPHEN1988 - Nothing like jumping on the "bandwagon" Esther. How about addressing the mental health issue. or effect violent video games and killer rap artist condoning shooting cops. Didn't think so. Your agenda is obvious. Shame on you for calling yourself a "doctor" and writing this babble.— dogman5
- What are "public rights"? The only one I aware of is the right to public assembly. Otherwise, rights are individual rights. Read the Constitution.— kingnutter
- Public-health studies all jump on the gun as a cause of violence as if it were a germ causing a disease. The fact is that their mindset is for looking at a disease and identifying the germ that causes it. Their logical leap from germs to guns is understandable: When the only tool you have is a hammer, all problems begin to look like nails.
— DonQ
