Opinion: Violence is a treatable public health ill

From expert members of Atlanta’s public health community



Gun violence has reached frightening levels in Atlanta and many experts predict that it will get worse in the coming months.

We want to avoid something even worse, the fatalism and hopelessness that affects all of us -- including mayors, legislators and journalists — when we can’t understand the problem and can’t even imagine how we can solve it.

For many years, people thought that violence was just the result of evil forces in this world. It had always been present and it would always go on.

But 30 years ago, scientists at CDC published “Violence in America: A Public Health Approach,” which made the case that violence is something we can understand and prevent -- if we base our response on science, focus our efforts on prevention and work collaboratively.

The public health approach to gun violence prevention is based on science because this is a cause-and-effect world. Things happen for a reason and if we can understand the reason or cause, we can change the effect.

And by “science,” we mean that we ask four simple questions:

1.) What is the problem? Who is getting shot, how many people, where, when, and with what kind of weapon? What is the relationship between the shooter and the victim? Are these incidents increasing or decreasing?

2.) What is the cause? What is the role of alcohol, drugs, mental illness, gangs, robberies, domestic violence, poverty, easy access to guns, homelessness, and unemployment?

3.) What works to prevent these shootings? And how can we know what works?

4) How can we implement and scale-up those interventions and policies that work? What are the institutions and organizations that have roles to play and how can they be mobilized?

Public health looks at not just single cases, it uses epidemiology to find patterns of gun violence that appear only when looking at large numbers of cases among the population as a whole.

Public health focuses on prevention, finding ways to prevent gun violence from happening in the first place. It is also concerned with providing acute care and long-term care and support for victims of violence. The victims of a gun homicide and non-fatal gun injuries include the victim’s whole families and communities and also the perpetrators, whose lives may be spent in prison, shattering their families as well. Prevention programs may address early child development, mentoring programs, job training skills, poverty, discrimination, racism, and unemployment; or limiting access to guns by those who are not legally permitted to have them.

Credit: contributed

Credit: contributed

The public health approach is collaborative, recognizing that no one institution or sector can solve the problem on its own. Public Health has been defined as “the collective efforts of a community and society to create the conditions in which people can be healthy.” Rev. Martin Luther King Jr. would say that we should work to create the “Beloved Community” – a community where people care about each other and work together to foster and maintain good health.

But calling this a public health approach does not mean that public health “owns” the problem or its solutions. An effective solution must bring together police, the courts, schools, hospitals and healthcare organizations; social workers, counselors, employers, teachers, the business community and the faith community. It will require funders, legislators, government and reporters compiling data and sharing information.

Credit: contributed

Credit: contributed

And it will require all of us working closely with the most heavily affected communities.

For too many years, legislators, journalists and citizens assumed that the subject of guns and gun violence was too hot to handle. The NRA argued that the goal of those who did research on gun violence prevention was to take away the rights of law-abiding citizens to own guns. This was untrue, it was misinformation and it had deadly consequences. They were successful in shutting down federal funding for gun violence research for 20 years, and as a result, we know much less than we need to about reducing gun violence.

But two years ago, Congress recognized that there are solutions that can both reduce gun violence and protect the rights of law-abiding citizens, and restarted the funding. This research will take time because there is no magical and immediate cure, but there is much we already know and can do now.

Rates of gun violence have been increasing dramatically and the costs of gun violence -- in terms of injuries and deaths, financial costs, and social and emotional costs to families and communities -- are soaring.

This is a burden that is not distributed equitably across society. The rate of gun homicides among young Black men ages15 to 24 is some 12 to 15 times higher than for young white men. These are unacceptably high racial disparities that should drive us to look at the social and economic determinants behind them. We can make equity as important a value as effectiveness.

We can vigorously enforce effective gun laws at the same time that we protect the rights of law-abiding gun owners, and stop the overpolicing and mass incarceration of young men of color.

It is both urgent and important to get together behind a clear framework, develop a multi-pronged approach and implement a plan.

This scientific approach based on evidence has been used to tackle some of the most challenging problems of our time — saving millions of lives from smallpox, cancer, heart disease and motor vehicle crashes — and it can give us good reason to be optimistic about reducing gun violence and to not give in to fatalism.

This framework will help residents, legislators and journalists ask the right questions and seek productive answers and effective responses. It will also help citizens and journalists hold their politicians and leaders accountable as they look for both immediate relief and long-lasting changes.

In Atlanta, there is strong support for this type of systemic, multi-disciplinary work, with more than 110 organizations supporting cross-sector innovations through the Atlanta Regional Collaborative for Health Improvement (ARCHI).

So, what does this mean for Atlanta?

It means that we begin by analyzing the problem, compiling data on victims and perpetrators, locations and weapons: what kind of guns are being used, where do they come from, how were they acquired? Where were people shot, what were the circumstances, what was the time of day? We need to compile data on the causes: were these shootings gang-related? Retaliation? Drug- or alcohol-related, robbery-related? What was the role of mental illness?

And we need to continue to support research at CDC and other institutions that can not only help to define the problem and its causes, but can tell us what interventions and programs actually work to both reduce gun violence and protect gun rights.

Finally, we need to implement the policies and programs that work, mobilizing informed politicians and citizenry.

We envision this column as one in a series of articles on gun violence that will fit into the simple framework of what is the problem, what are the causes, what works and how do we do it?

We hope this will help to mobilize, organize and give hope to a successful response to this problem in Atlanta.

Gun violence is not something we have to live with.

We live in the city where the public health approach was born. It is now 30 years old, and it can guide our efforts to reduce shootings and create safer homes, streets, schools and safer communities for everyone, regardless of race or ethnicity.

And when we get there, we’ll all be able to breathe better -- and longer.

Mark Rosenberg is president emeritus of The Task Force for Global Health, was the founding director of CDC’s National Center for Injury Prevention and Control and former assistant surgeon general.

Kathryn Lawler is the executive director of ARCHI.

David Satcher is a former director of CDC, former assistant secretary for health and the 16th surgeon general of the United States.