POV: Waking Up to Another Preventable Tragedy

Public health providers must be “a clear voice against” gun violence

Umpqua Community College shooting

Photo by Mike Sullivan/Roseburg News-Review via AP

October 5, 2015
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The mass shooting at Umpqua Community College in Oregon last Thursday is heartbreaking, especially for the students and families directly affected. But it is tragic in a different way for those of us in public health who have followed the trajectory of gun violence in the United States and tried to sound a call for change.

Firearm deaths are a preventable epidemic.

There is no other cause of death that we know how to prevent so readily—and that, time and time again, we do nothing about. And so we wake up to the latest of more than 40 school shootings this year, the headlines so familiar to us, even as the geography and the faces of grief change.

The extraordinary prevalence of firearm-related violence in the United States stands in harsh contrast to our peer nations. In 2003, the United States had the highest rate of firearm homicide (6.9 times higher than others) and firearm suicide (5.8 times higher) among 23 populous, high-income nations. There have been 142 school shootings just since the massacre at Sandy Hook Elementary School in Newtown, Conn., which claimed the lives of 20 children and 6 educators in December 2012.

The United States clearly has a long and complicated relationship with firearms, and constitutional rights aside, there are abundant organizations and high-profile arguments on the side of unfettered firearm availability. But while the arguments around the rights to gun ownership often center around self-protection from other firearms, the evidence is overwhelmingly clear that this claim is not supported by data.

Studies on the risks of firearm availability on mortality have provided strong evidence of an increased risk of both homicide and suicide. A recent meta-analysis of 16 observational studies, conducted mostly in this country, estimated that firearm accessibility was associated with an odds ratio of 3.24 for suicide and 2.0 for homicide, with women at particularly high risk of homicide. In the case of firearm suicide, adolescents appear to be at particularly high risk.

A 2013 study led by researcher Michael Siegel, a School of Public Health professor of community health sciences, found that US states with higher estimated rates of gun ownership experienced a higher number of firearms-related homicides. Another recent study, examining the association between firearm legislation and US firearm deaths by state between 2007 and 2010, found that stronger legislative restrictions were associated with lower gun mortality.

But despite the clear evidence that guns pose a threat, the public health community has been unable to get traction on this issue. Unfortunately, instead of quality scholarship and policy efforts to map and respond to the risks of guns, we have seen the silencing of gun researchers, health practitioners, and policy makers intent on addressing these problems.

Actions by Congress, fueled by the National Rifle Association in 1996, effectively defunded federal gun research, a still extant legacy, and to date, the Centers for Disease Control and Prevention website lacks materials on prevention of gun-related injury or violence. While translatable lessons from successful public campaigns on smoking, unintentional poisonings, and car safety abound, the political will necessary to implement and test those lessons has been absent and under unremitting attack.

Would we tolerate such lapses in our response to other prevalent health challenges? Imagine for a moment that because of emphatically articulated, rights-based arguments, the United States remained alone among peer countries in not having seat-belt laws, and that our automobile death rate was sevenfold greater than that of Canada. Would that be tolerated?

While acknowledging the broader issues around the balance of rights and privileges, it seems to me that it falls to public health to be a clear voice against the legal widespread availability of a pathogen—guns—that peer nations conquered long ago.

I worry that the voice of academic public health has been far too quiet on this issue, simply because the typical mechanisms that support our scholarship, extramural funding chief among them, have not been conducive to this work. But it is on us to organize our efforts in a way that will allow us to be a compelling voice on the issue, by translating scholarship and joining the public conversation.

The ultimate solution to the firearm epidemic does not lie with the doctors who treat victims or with the community providers who try to keep youths away from guns. It lies rather with policy makers and legislators. An activist public health community needs to play a central role in engaging this constituency through data-driven research and scholarship.

It is only then that we have any hope of turning the tide on what is truly a preventable epidemic.

Sandro Galea, dean of the School of Public Health and an SPH professor, can be reached at sgalea@bu.edu.

This column originally appeared on the Huffington Post.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.

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POV: Waking Up to Another Preventable Tragedy

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  • Sandro Galea

    Sandro Galea is the Robert A. Knox Professor and dean of the BU School of Public Health. He can be reached at sgalea@bu.edu. Follow him on Twitter: @sandrogalea. Profile

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There are 31 comments on POV: Waking Up to Another Preventable Tragedy

  1. Any firearm related death is traject. Criminals do not care for or follow laws. No matter how strict gun laws criminals will find away to cause harm to innocent .

    There are about 319 million people in the United States, so that means there are about 118 million gun owners in this nation.

    The “Mass Shooting Tracker” counts any incident where four or more people are shot, whether fatally or not, as a mass shooting. For 2015 so far, this tracker counts 294 incidents — of those, there are names for only 45 of the shooters, which leads us to believe the others are gang or crime related. But let’s assume for a moment all 294 shooters were actually law-abiding, legal gun owners.

    That means, out of 118 million gun owners, 249 or .00025 percent of the gun-owning population are potential mass shooters.

    But some perspective is needed.

    According to the Mass Shooting Tracker, 375 individuals have been killed during a mass shooting in 2015.

    Now compare that number to 10,076. According to MADD, that’s the number of people killed during drunk driving crashes in 2013 alone. In fact, every day in America, another 28 people die in drunk driving crashes. Every. Single. Day.

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    2. Dave, you’ve kind of missed the point of Prof. Galea’s post – we do a LOT to prevent deaths from drunk driving. Roadblocks, initiatives at bars, publicity to take the keys away from your drunk buddy, etc etc. The point is that as public health professionals, our hands are completely TIED by Congress and the NRA. Our public health agency, the CDC, is prohibited from keeping track of the shootings and deaths, or from doing research on the topic.

      That is the point – on gun violence, we are doing NOTHING because we are NOT ALLOWED to do anything. The comparison with drunk driving doesn’t make much sense in this context.

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      1. Hi Susie,

        I agree that the NRA & its enablers in Congress have substantially tied the hands of health providers. The ban on CDC tracking shootings is only the most outrageous aspect of this. But your hands are not completely tied, as you say. Like all citizens, you can still vote, lobby, support candidates who favor gun control, & gain access to a range of forums to express your views. We have more power than we know — but it’s crucial to develop the habit of using it.

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  2. Well said, Dean Galea. As a parent of an elementary school child, I was sure that Sandy Hook would be a wake up call to our country and that action would finally be taken on gun control. To my astonishment, not so. How can a society apparently indifferent to both data and catastrophic incidents be moved? If the public health field can be a voice for a way forward, it could inspire some to join the field.

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    1. I agree Sandy Hook should have been a wake up call and yet sadly most schools still do not have an armed guard or armed teachers forcing the unarmed victims to cower in fear until the police arrive. After Sept 11 we began allowing our pilots to carry guns. But we still do not trust law abiding teachers who pass multiple background checks to get a concealed carry permit to bring that gun on campus so they can defend our children in the event of an emergency.

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        1. Bad guys will not stop being bad because you disarm their victims. Bad guys are inherently cowards which is why they attack defenseless victims and often commit suicide by cop.

          I suppose based on your comment that you would prefer we live in a dream world instead of having people take responsibility for their own self-defense?

          Or perhaps, we should psycho-analize the poor perpetrator of this heinous crime and paint him to be a victim of easy access to guns?

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          1. Missy, your argument proceeds from a disorganized set of assumptions. Assumption #1 being that if a “bad guy” is even mildly aware that teachers may be armed, he is not going to commit the crime. (I say “he” because the perpetrators in these cases are overwhelmingly male) Are you forgetting that in most of these horrific cases, the perp commits suicide, showing disregard for his own life? Knowing that a teacher is likely to be be armed, what’s to stop him from bursting through the door, offing the teacher first, then spraying as many children as possible? Your second disorganized assumption is that because a teacher is armed, he/she is suddenly Wyatt Earp. Target practice is one thing; grabbing a gun in an instant out of a drawer in a terrifying moment and trying to aim w/o hurting even more children……….is there more risk of harm than good? Perhaps you will counter with arming the teachers with shoulder holsters. This is what we want to expose the children to on a daily basis?

            No one here is painting a perp to be a victim of easy access to gun laws. We ARE painting the children and other innocents to be victims of such laws.

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      2. Sorry to say, Missy, your approach to school shootings is thoroughly wrongheaded. Schools will not be safer with more guns around, any more than society is. Teachers’ primary task is to teach, not provide armed security. To the extent that they do the latter, it interferes with the former.

        Background checks do not provide training for use of force in dangerous situations, & without training (a diversion from teachers’ primary function) schools simply are more dangerous. Guns also fall into the wrong hands, esp. in places where young people can come across them (that includes private homes too).

        Your emphasis on “bad guys” is telling & no more helpful than public discussions of terrorists or rogue states as more “bad guys.” In the US the majority of shootings occur between people who know each other, particularly household members. They mostly are not “bad,” instead they lose control & make wrong decisions, which then are compounded by ready access to firearms.

        And what about the mentally ill — disproportionately blamed due to isolated but well-publicized shooting incidents? Are they “bad” people too? If you say yes, your view runs strongly counter to trends in mental health treatment & evolving public perception of mental illness. You should read the article “You Speak: Mental Health Matters” in this same issue of BU Today.

        In short, your poorly-conceived arguments serve as little more than a smokescreen for promoting widespread acceptance of guns throughout American society. Reduce the number of guns & we’ll see gun violence reduced. That’s not too hard to understand.

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        1. Also cf. Nathaniel’s point below. Attempted & successful suicides are more common where guns are available to those in extreme despair. They should not be considered “bad guys” either.

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          1. Well said, NOLA Dad. Your dose of good sense is also a breath of fresh air. Unfortunately common sense, like common courtesy, isn’t all that common.

            BTW, I have lots of (favorite) relatives in NOLA, mostly around Tulane. Nice coincidence!

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        2. If your argument is correct then why bother calling the police when all that will do is bring a bunch of gun toting LEOs running onto the the scene?

          In fact, why bother having armed guards at banks and why not get rid of the armed secret service agents too? In fact, let’s just do away with anything that could ever possibly be used as a weapon by either law enforcement, a victim trying to defend herself and/or the potential perpetrators of violent crimes as this would likely bring about the end of all violent crime and the dawn of the long awaited utopia.

          Or, perhaps the potential victims of future violent crime could instead be instructed on how to perform curbside psychoanalysis of the perpetrators just in case they are innocent deranged mentally ill persons in need of counseling?

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  3. Gun control is working out just fine Australia in fact 4 out 5 would be terrorists recommend gun control for the citizens they seek to terrorize. Just look at the most recent report of a young man of Iraqi-Kurdish background born in Iran, who shot Mr. Cheng in the back of the head. It was the “armed” police who finally shot and killed this maniac.

    The logic that a good person is not what stops a bad guy with gun is fundamentally skewed by the fact that none of the good people who were victims in any of these mass shootings that occurred in gun free zones ever had the option of fighting back with the only truly effective means of self defense (ie a gun).

    The other fundamentally flawed argument we keep hearing is that there are fewer homicides in areas with more strict gun control. But researchers doing this work seem to always conveniently fail to control for proximity of the victim to a major medical center or trauma ward. Anyone who is intellectually honest knows that Boston, Chicago and DC which all have strict gun laws also have more gun crime that than say Maine, Vermont or NH which all have limited gun laws yet you are more likely to die of a gun shot wound in a rural area simply because you will not get to a trauma center before you bleed out.

    Gun crime is most closely tied with drug trafficking so if the public health professionals in the USA really want to help reduce gun violence they should work to legalize and tax all recreational drugs as this would come with additional benefits of solving another public health with the same dime.

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    1. I think the issue when we all start talking about guns is that turns into a yelling match on all sides. I don’t think the mainstream is happy with extremist solutions (“arm everyone to the teeth” versus “ban guns completely”). So, why can’t we use the data we have, and the knowledge we have, and technology, to create a solution that is palatable to both sides? What’s wrong with “regulation” of guns? If the owners are so-called “good people,” then why do they care if their weapon is regulated? Regulation doesn’t affect firearm use in situations of self-defense, or in hunting, does it?

      How is the general public safer with more people carrying loaded guns around? A self-described “good person” is not something I trust. Lots of murderers were “good people, kept to themselves, were always polite.” Lots of good people crack under pressure and act in the heat of the moment. Right? Surely the deep levels of anxiety, stress, fear, disenfranchisement, alienation, and isolation that exist in our society should be a concern to those who advocate for more guns and less regulation.

      One more issue, for me at least: does a person’s unfettered right to bear arms interfere with someone else’s right to free speech? What if I say something that is not acceptable to someone who is a hothead with a gun? What if I have a gun too? Are we gonna have a shootout? Does gun ownership create a society of intimidation, effectively putting a chill on the freedom to speak one’s thoughts? The right-wing argument that gun ownership is a balance against unchecked government tyranny is flawed, because those who end up pointing to their guns just intimidate the rest of the population into fear-based silence.

      Finally: there have been more than 10,000 deaths each year in the past decade due to gun violence, including suicides. There have been about 3,000 terrorism-related deaths in that entire period. The terrorism argument isn’t really supported by the numbers.

      Unless there is an argument that mass shootings, gun homicide, and suicides are somehow a civic necessity for the U.S., then we have to solve the problem by meeting in the middle and having discourse in the name of the common good for all citizens.

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      1. Well put, Nathaniel. I do not have a problem with owning guns, but it is high time for some regulation. NO ONE needs semi-automatic weapons for instance. Gun ownership is a right. If someone commits a crime beyond a traffic violation, take the gun away. Somehow the idea of earning responsibility has totally escaped the NRA.

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        1. Well, Dad, I think you do have a problem. First off, you might imagine a semi -automatic is the exception these days. It’s not. It’s the standard issue which only fires one round at a time. When someone is attacking your daughter, and the police (who are under no legal responsibility to respond)are minutes away , she might have to fire several rounds for effective defense. Usually police do not fire one round and leave it at that.
          The concept of the Right to Keep and Bear is from the founding father’s , not the NRA. The NRA is a very active in protecting that Right, and fostering safe and responsible firearm usage.

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    2. Not to detract from your comment, but you could have said “…most recent report of a young man who shot a NSW police employee in the back…”

      Identifiers not needed

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    3. Myth of the “good guy with a gun.” Except in the case of the Oregon shooting, plenty of good guys were on campus at the time because this was not a gun free zone. Even though the college had the option to make it so, they chose to allow concealed carry. And in fact one of those good guys who was interviewed said he chose not to act because authorities were on the scene and he feared being mistaken for the bad guy.

      http://thinkprogress.org/justice/2015/10/02/3708410/good-guy-with-gun-was-on-ucc-campus-at-time-of-massacre/

      There is no proof that mass shootings targets have been targeted specifically because they are gun free zones, and there is no proof that allowing “good guys” carry guns “just in case” makes any sort of impact.

      Funny you mention Australia too because the US and our lack of gun control is making us a laughing stock over there.

      http://thinkprogress.org/justice/2015/10/03/3708876/australians-are-disgusted-at-the-american-response-to-the-oregon-gun-massacre/

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      1. You seem to rely quite a bit on this “think progress” site, authors of such other notable works as “Jeb Bush Chooses Worst Possible Argument Against Gun Control” and “The Feminist ‘Slutwalk’ Movement Just Landed The Perfect Celebrity Spokesperson.” Oh, and who could forget the enthralling article, “Obama On UCC Shooting: ‘This Is Something We Should Politicize’.”

        My point in bringing this up is that your source is ridiculously biased against gun-rights supporters, and republicans in general, to start out with. Furthermore, if you actually read the article, you note that the people mentioned by it aren’t political leaders, or people of really any autority whatsoever, but newspaper writers and editorial writers, but the article tries to paint them as AUSTRALIA’S VOICE or something like that. In fact, they even went as low as to take the interview of some guy who happened to be Australian as representative of what Australia thinks.

        tl;dr don’t just link drop. Actually examine your sources and their biases, and then look at your sources sources and see if those are trustworthy. In this case, it is clearly unfairly biased, and they are clearly not.

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        1. Quite right about this. In the old days , with limited outlets, we were at the mercy of the press. The CIA even had a program called “Mockingbird” in which they controlled the content of books, periodicals, papers, radio, television. It was finally stopped in 1975 by the Church Committee. Now it’s back, and even worse.
          They own some of the media, but that is not enough. Instead of controlling the media, they are controlling the content. Of course then they must have a damn good motive for that. So we have a crisis, and the people are expected to demand a solution. And it just so happens the government is ready to step in with that solution. So they just keep repeating the same game, but upping the anti. So now it’s all about race, religion, gender, and innocent kids dying. At some point they figure you guys will break.

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  4. This country chooses to place limits on a number of activities that, if not pursued responsibly, legally, and with proper training, can lead to traumatic injury and death — both to self and others. These include obtaining a driver’s license and drinking alcohol, but, apparently, and unbelievably, not firearm ownership. Indeed, there are now more rules around who has to sit out a football game due to a concussion than there are around who can purchase and use a firearm. Why the fear of mandatory background checks with a reasonable waiting period in order to purchase a firearm? Why the fear of training to ensure that those who purchase them know how to use and care for them them safely and responsibly?

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    1. We have numerous limits and what you can do with a gun ranging from not discharging one in city limits to not using one to commit murder yet these laws never stop the bad guys.

      Ownership of a gun is not a crime per se. In fact. the Mass Supreme judicial court has ruled that ownership of a gun without a permit is a victimless crime. So regulating gun ownership would one be akin to regulating your right to have a mouth before you open it up to exercise your right to free speech. Many anti gun people like to compare yelling fire in a crowded theater to the right to keep and bear arms but this is an irrational argument some owning a gun per se has about as much to do with discharging one in the wrong place at the wrong time as owning a mouth has to do with yelling fire in a crowded theater.

      I have never heard of a gun owner who objects to additional training so long as it does not cost them any additional money. In fact most gun owners enjoying the shooting sports so asking them to do more of what they inherent like to do will be unlikely to meet with much opposition.

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      1. Unfortunately, Missy, your thinking is part of the problem here. As Einstein defined insanity as doing the same thing and expecting different results, you keep wanting to defend unfettered gun ownership to your death and seem to think there is some magical Disney-like solution besides putting ANY limits on the precious guns. You are steeped in your belief; so be it then. I do hope and pray you do not have a loved one whose life is taken by the very premise you so steadfastly espouse.

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  5. Nothing is going to change. The politicians don’t want it. Gabby Giffords got shot but before she got shot Giffords opposed Washington D.C. prohibitions on possession of handguns in the home and having usable firearms there, signing an amicus brief with the U.S. Supreme Court to support its overturn. I think she changed her mind a bit after she got shot. Does it take getting shot or having a relative getting shot to change an opinion? Sandro have you written your congressman or even your mayor?

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  6. No evidence to suggest anyone was killed or injured. Similar story on Sandy Hook. Closed site, wounded/deceased never properly triaged according to SOP. Wounded hero with injuries inconsistent to multiple gunshots.
    It’s use to be just about the guns. Remember ‘Fast and Furious”? Then it was about the mental illness and children. Now it’s also about race and religion…

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    1. “firearm deaths that could be accidental or suicide. These are not violent crimes.”

      Oh yes they are. Whatever definition you use, it’s not a good working one. Your other remarks suggest that you are a Sandy Hook denier. Are you also a Birther & a 9/11 denier? These are not credible groups to be associated with.

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      1. Per the FBI: violent crime is composed of four offenses: murder and nonnegligent manslaughter, rape, robbery, and aggravated assault. Violent crimes are defined in the UCR ( Uniform Crime Prevention) Program, as those offenses which involve force or threat of force. The author of the article fails to explain that most violent homicides are in Democratically control urban areas such as Chicago, DC, NYC, Philadelphia etc.

        As far as this alleged shooting. I believe in credible evidence.
        No crime scene, no bodies, injuries inconsistent with what should be severe trauma. No armed security, intervention by armed citizenry dis-allowed, perpetrator is deceased as is often the case, and we have no evidence to support that he even existed other than some hokey web pages and testimony by some very poor actors who will be made rich by go-fund-it

        I might also say I am not associated with any of organizations you mention.

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        1. Peter, you associate yourself with extreme, irrational people by sharing & disseminating very similar views. Espousing such extreme & unprovable claims about these tragedies is inexcusably heartless to the victimized families & communities. BTW, you’re not escaping on a technicality by asserting that you don’t belong to certain “organizations,” unnamed by either you or me.

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