Elizabeth Joy: We need a public health approach to firearm violence

(David Goldman | AP file photo) The federal headquarters for the Centers for Disease Control and Prevention are in Atlanta.

The deadly firearm events over the past month are a stain on America.

Events such as this will not be prevented through legislation alone. It will take the collective will and efforts of many stakeholders, both public and private, to prevent future tragedies.

The World Health Organization’s Violence Prevention Alliance describes a public health approach to addressing firearm violence and firearm deaths. This approach includes four steps:

  1. Define the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences of violence;

  2. Establish why violence occurs using research to determine the causes and correlates of violence, the factors that increase or decrease the risk for violence, and the factors that could be modified through interventions;

  3. Find out what works to prevent violence by designing, implementing and evaluating interventions; and

  4. Implement effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and the target outcome should be monitored, and their impact and cost-effectiveness should be evaluated.

To succeed in stemming the deaths from firearm violence, accidents and suicide, we must bring together diverse stakeholders from the many sides of the firearm debate. Everyone wants to be and feel safe. No one wants to see their loved ones gunned down.

There are multiple examples in recent history where a multi-stakeholder public health approach has addressed and solved problems affecting the health of Americans. Adult cigarette smoking has declined from 45% in the mid 1950s to 14% in 2017. This only happened because the scientific community studied the impact of tobacco on health, and later the impact of second hand smoke on the health of non-smokers. States enacted clean air legislation, and insurance companies charged smokers more money to insure their cars and their health.

The seatbelts we take for granted in our cars serve as another example where a multi-stakeholder public health approach lead to a universal change in how cars are designed to protect our loved ones. While vaccines remain a controversial topic in the public forum, their efficacy in preventing fatal disease is unquestioned, and their widespread use was achieved only through a massive public health effort.

Our nation’s public health agency, the Centers for Disease Control and Prevention (CDC), has been hampered in its ability to study gun violence due to the 1996 Dickey Amendment. During which time deaths from gun violence have steadily increased from 10 per 100,000 in 12 per 100,000 in 2017, or more than 39,000 lives lost.

We must call on leaders in science, public health and health care to design rigorous studies to inform interventions to reduce the firearm deaths of neighbors, friends and family members.

We need leaders in faith-based organizations, employers, the insurance industry, and policy makers to come together with a goal of protecting our citizens from harm. And we must do so now!

Elizabeth Joy, M.D.

Elizabeth Joy, M.D., MPH, is medical director of community health at Intermountain Healthcare.