If you’ve been following the recent spate of news on high-profile shootings lately, you may have seen somewhere that President Obama’s nomination of Dr. Vivek Murthy to the post of Surgeon General of the United States has been met with resistance by gun rights advocates, especially the National Rifle Association. Firearms advocates are suspicious of Dr. Murthy’s view of gun violence being a public health issue, primarily because it may lead to additional avenues of firearms regulations through other government agencies, in particular the U.S. Department of Health and Human Services.
I support Dr. Murthy’s view. Although I am (mostly) a gun rights supporter, I also hold a master’s degree in public health and have worked with and within public health authorities throughout my career. I have to agree with him that treating firearms violence as a public health issue is necessary, mainly because of the knowledge that public health’s structured science base can bring to our understanding of guns and gun violence.
Let’s consider gun violence in public health terms by comparing it to the world’s first great public health discovery: cleanliness prevents disease. Until the late 19th Century, we humans were usually filthy creatures simply because we did not understand what disease was. Until that time, if you were a physician educated in the best universities, you believed disease was caused by acts of the Divine upon sinners, an ethereal imbalance of the body, and “bad air.” (Or as literally translated into old Italian, “malaria” – does that term sound familiar?) The solution to most health issues was to pray to God, swallow concoctions that were often poisonous, or move to the coast or mountains for saltier or drier air.
Naturally, these things did nothing. Billions (yes, billions, with a “B”) still died from smallpox, plague, and influenza alone, to say nothing of deaths from cancers and infections and scores of other viruses and bacterium. Disease persisted because they had been focusing on causes that were thoroughly incomplete. Maybe God has something to do with disease, but that’s faith and not science. Viruses are certainly passed through the air, but they are passed through dozens of other channels as well. A century later we know disease can be caused by bacteria, viruses, faulty DNA in our own bodies, and even misfolded proteins (prions, which we’ve only recently discovered). I don’t need to mention to a group of social workers about all the secondary diseases that are caused by primary diseases, such as how mental illness can cause alcoholism and other addictions that ruin the body. I myself suffered through a primary genetic disease that caused a second disease, which in turn caused a third disease (Shameless plug: read about it in my hilariously traumatic upcoming book “The Spider and the Wasp,” to be published July 2014!).
How did we learn about disease? We learned through a structured, scientific approach to public health, which began that legendary day in 1854 when Dr. John Snow singlehandedly stopped London’s worst-ever cholera epidemic in only a few days. His first weapon was data collection and mapping, which pointed to a public water supply as being the source of infection. His second weapon was the wrench by which the handle of the Broad Street public water pump was removed. It was such a radical approach to disease prevention that the city leadership could not accept that God, imbalances, and bad air were not what caused cholera, and they reattached the pump handle right after the deaths stopped. It took years for people to disregard superstitions and begin believing in the germ theory of infection.
Likewise, solutions to gun violence can benefit from the new, radical approaches that the sciences of public health can lend it. Americans have been jumping to conclusions about how to stop gun violence in much the way our ancestors thought that penance could stop the Black Death and spiritualists could stop smallpox. (Hint: these don’t work.) Likewise, rigorously applying public health to gun violence can shed light on how well gun bans and magazine capacity limits and background checks function. Public health can help us understand how the possession of firearms might motivate crimes that otherwise may not have been committed in the first place. It may even help us ultimately learn whether violence is a disease condition of the human mind.
Just a warning, though: Like London’s city fathers in 1854, a reluctance to change our longstanding beliefs on gun violence will prevent it as effectively as cholera was prevented by putting the handle back on the Broad Street pump (It didn’t prevent the disease).
Written by Matt Haarington, MPH
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