Treat gun violence as a public health crisis and let's get to work | Opinion

LeBron Hill, Nashville Tennessean
·5 min read
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The current spate of gun violence is not isolated to Memphis and the Midsouth. It is an epidemic throughout the United States. Bickering about needing more guns or fewer guns has not proven fruitful to reduce the increasing number of shooting deaths. A different approach is needed. Perhaps we should treat this epidemic like we have treated other epidemics – as a public health problem.

In February 2018, the American Association for the Surgery of Trauma (America’s premier academic trauma surgical organization) published a Statement on Firearm Injuries (J Trauma Acute Care Surg 85; 2:426).

This was in response to yet another mass shooting, and was a challenge to all branches of government to address the following:

  • Substantially strengthen the National Instant Criminal Background Check System and require a background check on all firearm sales;

  • Standardize a waiting period for firearm sales;

  • Promote responsible firearm ownership, including training of new firearm owners, use of safe storage devices, and application of practical technologic safety strategies;

  • Strictly regulate the sale of high capacity magazine-fed semiautomatic rifles (including but not limited to the AR15, M-1A, AK-47, and MAC10);

  • Strictly regulate the sale of bump stocks and trigger actuators;

  • Strictly regulate high volume ammunition sales;

  • Require reporting of all firearm sales – both public and private – to the appropriate agency;

  • Require firearm owners to report lost or stolen weapons to law enforcement;

  • Remove firearms from accused perpetrators of intimate partner violence and those threatening violence to others until the case is adjudicated;

  • Encourage and train physicians to counsel their patients about firearm safety and health risks associated with firearm ownership;

  • Improve access to quality medical care for all patients, including behavioral health services to reduce suicide and gun-related violence;

  • Mandate new federal funding from the NIH and CDC for research on firearm injuries and injury prevention strategies commensurate with the burden of the disease;

  • Create a National Trauma Care System;

  • Support bleeding control training for the public and public access to bleeding control kits.

That was about 2700 mass shootings ago. That was about 91,400 shooting deaths ago. To date, elected officials have done little to adopt these practical, common-sense measures. Such measures are supported by a majority of Americans – across party lines.

Why has so little been done? Reasonable people on both sides of the issue – do guns kill people or do people kill people? – are missing the most critical point.

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Seeing gun violence as a public health issue

Any debate should revolve around a single concept:

The primary goal is to reduce the number of bullet holes in people.

How, then, should we approach this epidemic of gun violence? By treating it as what it is – a public health problem (J Trauma Acute Care Surg 85; 2:247-8). All the rhetoric, accusations, and partisan politics are counterproductive. The standard principles of a systematic public health approach include modifying the host, agent, vehicle, and environment. These principles which include research, education, engineering and enactment have been effective for a wide range of adverse events, including AIDS, smallpox, cancer, and motor vehicle deaths to name a few. For example, automobile manufacturers were not thrilled when they were required to add seat belts to their cars. But research, education, engineering, and enactment led to fewer deaths from car crashes. Further research saw the addition of airbags and safer automobile construction which led to even fewer deaths.

Using the public health model to approach gun violence should yield similar results as long as we continue to recognize the most important thing:

The primary goal is to reduce the number of bullet holes in people.

Reducing gun violence is not as simple as legislating guns, however. Those in need of behavioral health care are usually left behind. Behavioral health should be managed similarly to people with hypertension, cancer, or heart disease with the emphasis on early diagnosis and treatment. This would require restructuring components of our health care system – so be it. Increasing poverty, substandard early education, diminishing nuclear family unit, and societal tolerance of aggressive behavior are critical issues that must be addressed. These social determinants can all be addressed with a comprehensive public health approach. There is no quick fix. Kicking the can down the road hasn’t worked yet.

Perhaps implementation of the measures offered by the AAST and treating gun violence as a public health problem would have prevented the abhorrent murder of a colleague, Dr. Benjamin Mauck. Perhaps not. But doing nothing has not, and will not, make everyone safer. Maybe earlier intervention would have kept the killer from abusing the doctor-patient relationship and we wouldn’t be mourning the murder of a gifted surgeon and dedicated family man. If his senseless death can stimulate action to address all issues surrounding gun violence, then his death will not simply be a statistic. He was one of the good guys who cared. He will be missed.

Martin A. Croce
Martin A. Croce

In the interest of full disclosure, I do not own, nor have I ever owned a gun. I am a surgeon who has cared for thousands of gunshot victims. Gun violence is a public health epidemic that will require everyone to work together to solve it. The debate must be removed from the political arena. Focus must remain on addressing gun violence as a public health problem.

Whenever the discourse strays from this and into politics, rights, bans, or other circular arguments, the mantra bears repeating:

The primary goal is to reduce the number of bullet holes in people.

Martin A. Croce, MD, FACS is the senior vice president and chief medical officer of Regional One Health and professor of surgery at the University of Tennessee Health Science Center

This article originally appeared on Nashville Tennessean: We must see gun violence as a public health crisis to get solutions