What Can Public Health Do to Curb Gun Violence?

In the days since the mass shooting at the Stoneman Douglas High School in Parkland, Florida, the country has reckoned with the urgent need to prevent future bloodshed. On March 6, Mailman School students, staff, and faculty assembled to consider the scope of the problem and the appropriate role for public health in finding solutions. 

"Understandably, mass shootings elicit a strong public response," said Epidemiology Chair Charles Branas, who led the schoolwide discussion with a panel of gun violence researchers, "but they are only one part of the larger problem of gun violence." In the days since the Parkland shooting, there have been approximately 5,000 more such incidents in the United States, nearly all suicides and small-scale homicides.

“We often focus on the most high-profile shootings,” said Branas. “Mass shootings, however, are only the tip of the iceberg of shootings in our country.”

Once the sole domain of criminal justice, gun violence is increasingly being understood as a public health concern, with growing interest in learning how the issue affects populations, not just individuals, as well attention paid to how to prevent it—whether through policies like a ban on assault rifles or guidance such as how best to talk to your children about protecting themselves.

“There is very little data to go on to answer these questions,” said panelist Magdalena Cerda, a researcher at the University of California, Davis, and former faculty member at the Mailman School, adding that she is one of a very small group of scholars in the country who study the issue.  

One reason for this gap is the Dickey Amendment, passed by Congress in 1996 to ban federal research on gun violence by the Centers for Disease Control and Prevention. Despite this impediment, some researchers forge ahead—among them, Branas, Cerda, and fellow panelists Julian Santaella-Tenorio, a postdoc in Epidemiology, and Ted Alcorn, a journalist and researcher consulting with the New York City Mayor's Office of Criminal Justice.

In a 2016 paper in Epidemiologic Reviews, Santaella-Tenorio, Cerda, and collaborators helped answer the most basic question of whether gun laws can reduce gun injuries: In fact, they do. This February, Branas, who has studied gun violence for 20 years, was the first author of a paper in the journal PNAS reporting on a simple and uncontroversial intervention to clean up vacant lots in low-income neighborhoods that lead to reductions in gun violence.

Despite this evidence and increasingly common high-profile shootings, Washington has so far refused to take up gun control. Some states, however, are helping take up the slack. For example, California, which funds research on gun violence and whose lawmakers consult with researchers, has implemented tight controls on the ability to purchase and carry firearms, and most recently, enacted a ban on the sale of assault rifles.

Timely action of this sort is critical, Cerda said. Policymakers shouldn’t wait on science for definitive answers. Even so, researchers play an important role too. “Based on the limited information we have, we need to figure out ways to respond right now,” she said. “At the same time, we need to evaluate those responses to figure out what is most effective.”

Panelists contemplated a range of policy options, including several that home in on high-risk groups—for example, restricting access to firearms for individuals with a history of violence or drunk driving.  Other approaches were modeled on public health successes to curb smoking by taxing ammunition and restricting sales based on age or place. As mayor of Cali, Colombia, Rodrigo Guerrero, an epidemiologist, drastically reduced gun violence, in part by targeting alcohol, banning its sale after 2 a.m.

Several audience members encouraged the researchers to be sensitive to the communities their interventions target. In rural areas, a faculty member observed, it’s important to keep in mind that firearms, which are passed down generation to generation, have an emotional meaning for families. In cities, researchers should take care that interventions don’t have unintended consequences, a student averred. Some law enforcement practices, for example, have contributed to mass incarceration, disproportionately affecting communities of color.

Looking ahead to the future, the panel expressed cautious optimism. Most Americans, even most members of the National Rifle Association, support common-sense legislation to restrict gun violence. And Washington may finally be listening. Pushed to action by the Parkland students and growing activism nationally, Florida Congressman Marco Rubio, a staunch ally of the National Rifle Association, now supports restraining orders to remove firearms from potentially violent individuals (on the other hand, another proposal to arm teachers is less likely to help).

On the research front, the outlook is also less cloudy. In recent years, the National Institutes of Health has joined private foundations in funding studies of gun violence, opening the way for a new generation of researchers to examine the issue. “There is a lot of research for students to do,” said Santella. “These are real opportunities to get better outcomes.” Added Cerda, “We should have a lot of hope.”

Following the discussion, a group of Mailman students walked to the steps of the Hammer Health Sciences Building where they joined with their counterparts at Physicians & Surgeons, Nursing, and Dental to advocate for preventing future shootings. A large banner made their intentions clear: “Gun Violence = Public Health Crisis.”