Applying a Public Health Approach to Gun Violence Prevention
Infectious disease is currently dominating the news. The COVID-19 pandemic has affected countries across the world, with the virus spreading quickly between individuals. The disease has altered our way of life, decimating communities, burdening our healthcare systems, and forcing people to shelter in place.
While COVID-19 remains a public health emergency, there is another ongoing public health crisis in the United States: gun violence. Though these two crises may initially seem unrelated, the two share several common threads — and the same framework for a solution.
Gun violence has many analogs to infectious disease. Like COVID-19, gun violence can affect anyone, yet it disproportionately affects communities of color, exacerbating existing inequities in these communities. And similar to infectious disease, those who are exposed to gun violence are often at increased risk for becoming victims or perpetrators. Gun violence is also similar to a disease in that it burdens our healthcare system. Between 2006–2014, emergency departments treated approximately 700,000 gunshot victims, costing hospitals around $2.8 billion annually. The total estimated economic cost of gun violence in the U.S. is $229 billion each year.
To adequately address gun violence as the public health problem it is, we need to apply a public health approach. The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) describe a public health approach to violence prevention based on four steps. The steps, outlined below, include examples related to firearm suicide, but these steps be applied to any type of gun violence, including community violence, domestic violence, unintentional injuries, and more.
Step 1 — Define and monitor the problem
We cannot address a problem until we identify exactly what the problem is and who it is affecting. Collecting and distributing reliable data on firearm injuries and deaths is essential to combating gun violence using a public health approach. The data collected in this first step defines the scope of the problem.
For example, when studying firearm suicide, the CDC collects data to understand who is dying by firearm suicide, where they are located, how old are they are, etc. This allows us to know which communities and groups are at greatest risk and tailor our solutions accordingly.
Step 2 — Identify risk and protective factors
The public health approach focuses on prevention, and identifying population-level risk and protective factors is an important part of any prevention strategy. As the term itself suggests, identifying risk factors helps to further define who is at risk and why. With this information, we can begin to develop solutions that take these factors into account.
For suicide, risk factors include easy access to lethal means, family history of suicide, previous suicide attempt(s), a history of mental illness, a history of risky alcohol or substance use, feelings of hopelessness or isolation, and others. By identifying these risk factors and thus further defining who is at risk, we can more effectively develop strategies to address these risk factors and prevent firearm suicide.
Step 3 — Develop and evaluate prevention strategies
Based on the information gathered in the first two steps, public health professionals, policymakers, and others create data-driven interventions. These include policies and programs that address the risk factors and root causes of gun violence and target solutions to best serve at-risk populations.
For instance, extreme risk laws have proven to be an effective suicide prevention tool. These evidence-based laws take risk factors for harm to self or others into account and allow family members and/or law enforcement to petition a court to temporarily remove firearms until the period of heightened risk has passed.
Step 4 — Ensure widespread adoption of effective strategies
The work does not end after a prevention strategy is developed. Strong gun violence prevention policies like extreme risk laws are only effective if they are properly implemented and people understand how to use them. Implementation and evaluation of these initiatives should be conducted at the federal, state, and local levels as applicable.
For firearm suicide prevention, this means training the proper stakeholders, such as law enforcement and judges, and ensuring that new policies and programs to prevent firearm suicide — like extreme risk laws — are being properly adopted.
The four steps that comprise the public health approach promote healthy behaviors, control the spread of outbreaks, and address the underlying causes of a disease or injury. Now more than ever, it is critical that we utilize these four steps to address all issues that impact our health and well-being — including COVID-19, gun violence, and the intersection of the two.
The public health approach has saved millions of lives — public health professionals, policymakers, and advocates have used this model to promote widespread usage of vaccines, reduce smoking-related deaths, and decrease motor vehicle crashes, among other interventions. As National Public Health Week concludes, we will continue using and promoting this critical approach as an evidence-based framework to stop gun violence in all its forms.