A Public Health Perspective on Gun Violence

In recent years, gun violence has quickly become one of the most fiercely debated topics across the nation. Understandably, the topic is deeply personal for many. As heartbreaking acts of violence have taken their tolls worldwide, people are desperate for solutions. Gun violence touches many lives, both directly and indirectly. In 2011, the National Crime Victimization Survey found that 467,321 people were victims of unique crimes committed with firearms, meaning gun crimes made up 8% of all violent crimes committed that year. Even more harrowing, an estimated 100 people are killed by guns in the United States every day, with suicides accounting for two-thirds of those deaths a year. These statistics proportionately affect minorities and people of color, with Black Americans 500 times more likely to die due to gun violence. 

The damage associated with gun violence has a large public health impact that has only increased every year. The American Journal of Public Health recognizes gun violence as the leading cause of premature death in the U.S., resulting in over 38,000 deaths and 85,000 injuries a year. Those who witness acts of gun violence are found to have an increased risk of PTSD, depression, anxiety, criminal activity, and substance abuse. Furthermore, the communities faced with high rates of gun violence face businesses more likely to fail, a depreciating housing market, and great financial burden. As a whole, gun violence costs the U.S. $229 billion every year, with about 96% of this amount an indirect cost. This indirect cost includes medical bills, cost of treatment, insurance costs, and mental healthcare. Direct healthcare costs only constitute about $2.8 billion. The rest of the $229 billion is a burden that falls on the shoulders of affected communities. More startling is the cost of an individual firearm case. Each homicide costs a minimum of $1 million in healthcare, trauma, and more.  

A variety of attempts have been made and many strategies used to mitigate the effects of gun violence, but ultimately no approach has succeeded in addressing the issue directly. As public health communities have started to accept this issue as a major public health concern, many have suggested a new approach. Advocates of the budding public health approach to gun violence praise it for being comprehensive, utilizing the broad resources of those in the field. This approach leans heavily on preventive measures, as most public health strategies do. It is important to identify the risk factors and situations that create environments prone to gun violence. However, this is not a unique suggestion. Preventative measures have been the basis of most gun policies across the board. This approach dictates the utilization of preventive measures, such as analyzing hospital records and police files, and the subsequent enacting of laws from those findings. Simply knowing what the issues are is not enough to be a solution; action has to be taken and enforced. 

One example of a city where public health-driven strategies have managed to make a dent in gun violence statistics is Oakland. Oakland has been known as one of the most dangerous cities in America and has abnormally high gun violence rates, with a crime index 4 times the national average. However, through implementation of a program called Ceasefire, the armed robbery rate fell 65% and fatal and nonfatal shootings fell 51%. Furthermore, gang-involved shootings fell 43%. Ceasefire consisted of five core components: data collection, communication, community support, enforcement, and structure. In general, these five components all emphasized capitalizing on existing resources to integrate into gun violence reduction, such as mental health resources, and strengthening communication between authorities and citizens. 

DeVone Boggan, CEO and founder of Advance Peace in Richmond and former director of Richmond’s Office of Neighborhood Safety, offers a different point of view. Advance Peace is an organization dedicated to ending the cyclical nature of gun violence, using a variety of programs. He argues that some of the major drawbacks of Ceasefire, and of other attempts to reduce gun violence, is a major reliance on law enforcement and a promise of “better opportunities.” An emphasis on law enforcement creates a “stick” situation, in which the people meant to be benefitting from these programs are motivated by punishment and strict actions. The other major limitation, promises of opportunities, highlights the drawbacks of a heavy “carrot” approach. Many programs offer those vulnerable to gun violence opportunities to improve their lives, whether it be employment or other social services. The problem with this, Boggan explains, is that many of those vulnerable to gun violence or susceptible to it are simply not ready for these opportunities. He vouches for a fellowship program at Advance Peace, with 7 steps that ensure those vulnerable or susceptible to gun violence are trained in life skills and gain control over their situations. The 7 steps include strict daily meetings with a life coach, referrals to qualified social service opportunities, internships, and more. 77% of participants are not involved in any new gun violence cases. The underlying values of the program are human compassion, love, respect, and most importantly- humanization. 

But not every city can afford programs like Advance Peace. These programs are extremely resource intensive, often costing $24,000 per participant. Cities like Oakland cannot afford to spend that much on a single person, which is why programs like Ceasefire are often more viable. That being said, neither type of program can reach full effectiveness without the support of local, state, and federal public health departments. The successes of Advance Peace and Ceasefire highlight how preventative measures are valuable, which begs the question: why are public health departments and agencies not involved in the fight against gun violence? The dangers are clear, but the public health field’s reaction as a whole has been lackluster. The programs that have had the most success in bringing down gun violence rates are not even part of most cities’ public health departments. Experience tells us that success is achieved is when everyone comes together in full cooperation. But the blame doesn’t lie with public health departments alone. Many departments do not have enough to fund even the most barebone programs, and their sparse budgets are under further attack. President Trump’s latest budget proposal cuts the Department of Health and Human Services budget by 12% and completely defunds the mandatory Prevention and Public Health fund, which many departments rely on for funding. The administration has also taken it upon itself to loosen the country’s already lax gun laws. 

The tone that has been set doesn’t bode well for anyone looking to combat gun violence. Many are frustrated by the administration’s inaction and unraveling of protections, especially as other countries take quick and effective action. It took New Zealand’s parliament only 26 days to ban most semiautomatic guns after a horrific mass shooting that claimed 50 lives. The United States has suffered mass shooting after mass shooting, at concerts and schools and movie theaters and churches, and nothing has changed. Outrage and prayers don’t reduce gun violence; action does. Prevention programs need funding, gun laws need tightening, public health needs protecting. In the current political climate, elections are more important than ever. People have to use their vote to good use and make their voices heard. If not for the injustices of gun violence and the impact on people’s lives, do it for the cost upon society and for the fear that one day, this will be an issue that touches everyone directly.