What a Public Health Approach to Gun Violence Would Look Like

FILE - In this Monday, July 7, 2014, file photo, Chicago police display some of the nearly 3,400 illegal firearms the have co
FILE - In this Monday, July 7, 2014, file photo, Chicago police display some of the nearly 3,400 illegal firearms the have confiscated so far this year in their battle against gun violence during a news conference in Chicago. During the news conference, police Superintendent Garry McCarthy spoke about the more than 50 people were shot in the city, including multiple deaths, during the long Fourth of July weekend. (AP Photo/M. Spencer Green, File))

Guns are this country's second most deadly preventable public health menace (second only to car accidents). Firearm injuries and death have caused untold suffering, pain and death in the U.S. We have the democratic and political means to eliminate gun violence, and, based on supremely effective, well-established methods, we can. It is time that our country took the necessary steps.

Using centuries-old techniques to improve health outcomes, physicians and health professionals have lowered the rates of many deadly infectious diseases by instituting careful, data-driven, broadly-instituted approaches like hand-washing, universal vaccination, and food and drug quality laws. Some illnesses which have killed billions of people and changed the course of wars, like smallpox, have been completely eliminated. Similarly, automobile injuries have been vastly decreased by the use of seatbelts, falls from windows decreased by the use of window guards, lower lung cancer rates by regulations on smoking and taxation of tobacco products.

We need to consider firearms and bullets as pathogens, similar to the smallpox virus and its disease, smallpox. Gun injuries fall into three categories, intentional (criminal), accidental, and self-inflicted. All are at intolerable levels in this country, vastly higher than those in any other economically advanced country in the world. All are preventable through steps which parallel the medical advances mentioned above, but it will take a serious, nation-wide program to eliminate injuries from firearms and ammunition.

This could be started in a stepwise, local, data-driven, democratic process, led by those communities that are most pro-active. In medicine, we use tools called SCAMPS ("Standardized Clinical Assessment and Management Plans") which treat groups of people, like those living in communities across the country, and through a process of stepwise interventions, evaluation of results, and successive changes in the details of approach, create impressive improvements in outcome.

Using a similar approach for gun violence, communities around this country could vote to establish site-specific, enforceable local ordinances, such as firearm-free blocks, zip-codes, towns or cities. If, after a year, for instance, the firearm-related injuries and deaths dropped, other regions could be incorporated, through the electoral process, to institute similar ordinances. In order to gather accurate data, all health departments, through their police, physicians, ambulances and emergency rooms, would be required to gather and publicize such information. Communities could choose the strictness of their bans and the size and description of their zones, but a continuous voting cycle, informed by the data collected, would be scheduled yearly or whatever was chosen. Through this process, if one method of decreasing gun-related violence was shown to be superior to others, the zones would steadily increase in size and new techniques could be tried and added.

Such a consistent, progressive process has shown itself powerful enough to eliminate worldwide plagues and pestilence, and it can work to eliminate firearm violence. But it has to be instituted on a large enough scale to work. There are many communities in this country that are devastated, having lost children or other family members from gun-violence. If only one household chooses to ban guns, but their neighbors do not, or the community does not enforce the ban, no progress is made. This method works when put in place and enforced on a continuous, ever-enlarging community-wide basis.

Some gun owners believe that local gun bans would place their non-gun-carrying members at greater risk. The only way to know is to study it this way. Current gun-owners would be allowed to keep their guns in gun shops, armories, or police stations for use in agreed-upon areas outside of the gun-free zones. A community could vote to try variations on any theme they felt worth studying, such as keeping guns locked in homes with no ammunition in a community, or keeping only guns with personally identified triggering mechanisms, but the goal is to steadily apply all approaches that decreased the rate of gun violence. In this way, public health can react to gun violence not by attaching itself to general, society-wide legislative responses, but through instituting and managing a public health strategy itself.