Gun Violence and Public Health – An Intersection Designed for Impact

Gun violence is a present and growing issue in many communities across the country. The deadly impact of these types of incidents is widespread and the causes are highly complex, which means any strategies to address gun violence must take these complexities into consideration. Because the root causes are so complex, the conversations regarding appropriate interventions have expanded to not only include law enforcement response and social service involvement, but to apply a larger public health approach to gun violence. The public health approach is a model rooted in the scientific method, designed to evaluate problems and address systemic needs through collaboration. Understanding how the social determinants of health and current social circumstances impact gun violence is essential for grasping the scope of the problem. But to create lasting change, the focus must expand beyond reactive data collection to include actionable plans tied to systemic causes, a job the public health model is well equipped to do.

Here we will review the public health viewpoint on gun violence, how the public health model applies to gun violence, and how the public health model can assist local stakeholders with developing appropriate responses in their communities.

The public health model and how it applies to gun violence

Many are familiar with the public health approach to infectious disease prevention, such as with seasonal influenza and childhood vaccinations. But it has significant applications to other health issues that cause injury and death, such as violence prevention and car safety.

The public health approach is comprised of these four components:

Define and monitor the problem.
Identify risk and protective factors
Develop and test prevention strategies
Assure widespread adoption

The CDC’s approach to gun violence prevention

The CDC’s approach to gun injury prevention is an adaptation of the public health framework with three key elements: providing data, conducting research, and promoting collaboration. These elements use science to identify potential interventions and encourage meaningful action.

The recent return of federal funding for gun violence research renews the flow of data used in this approach. Multiple active research projects are guided by priorities identified by the Institute of Medicine (IOM) and the National Academies of Science, Engineering and Medicine (NASEM).

These priorities focus on the most critical needs with the greatest potential impact on public health and safety. They include understanding the characteristics, risk and protective factors, and effectiveness of preventative interventions.

Funded surveillance projects also provide insight into nonfatal firearm injuries in near-real-time. With this comprehensive data, collaborations can build prevention strategies and interventions from a solid scientific foundation.

Applying public health principles to public safety issues

While the lens of public health has not consistently been applied to public safety issues such as gun violence, this approach has been successfully applied under these circumstances – the most notable example being car safety. Between 1979 and 2011, auto-related fatalities decreased by 41% and have maintained a downward trend. The promotion of safety engineering and legislation was the key driver in this transformation, an effort driven by a public health approach.

These efforts required more than just public promotion to make an impact. Important pieces of legislation have changed the landscape of driving safety. Mandatory seatbelt use, age limits, and laws targeting driving under the influence have all played a role in reducing driving-related injury and death across the country. So while driving safety does not fit the typical disease management focus many associate with public health, the beneficial impact of its implementation is undeniable.

Public health strategies to address gun violence

The lack of federal research funding has made it more challenging to address gun violence beyond what social determinants of health reveal. Despite this barrier, a few communities have taken the public health model to address local gun violence issues.

Cure Violence is a gun violence prevention program designed with public health principles in mind. The approach resembles disease control management with a focus on three strategies.

Stop transmission directly by identifying and interrupting potentially violent conflicts.
Reduce transmission by addressing individuals most at risk to perpetuate violence.
Prevent transmission by changing social norms around violence.

Staff members involved with Cure Violence teams are carefully chosen for their skills and credibility among high-risk individuals. Many staff members engaging in conflict disruption are from communities struggling with gun violence , some of whom are former gang members. As staff members form relationships in the community, they build a foundation of trust. They influence individuals to think differently about gun violence and teach alternative methods for managing conflict.

Outcomes show some improvement with mixed results. Research studies have not clearly distinguished the impact of the Cure Violence program from concurrent crime reduction in some communities. However, this cost-effective program puts less strain on law enforcement and shows promise as a helpful intervention.

Prevention programs like Cure Violence have taken a page from the public health playbook to create what some may view as an unconventional approach. Initial research has clearly demonstrated that prevention offers promise for many communities impacted by gun violence.

A deeper conversation about gun violence: Moving from evaluation to action

As the impact of new research unfolds, so will the shape of interventions and strategies to address gun violence. A higher volume of recent research findings will add new insights to the conversation, and the public health approach is built to move problems forward with action.

Entities engaged in solving gun violence in their community will have a proven framework and solid research within which they can work. With this approach, conversations can advance beyond social determinants so larger systemic concerns can be more fully addressed.

Public health and the future of gun violence

Effective interventions are much needed to stem the tide of gun violence. Public health emphasizes strategic prevention methods, a perspective that is highly applicable to reducing gun violence. With a resurgence of research funding and urgency for change, public health interventions hold promise to reduce gun violence.