Report from the 2018 APHA Meeting, Part 2: Approaches to Reducing Gun Violence

In part two of a two-part series from the 2018 meeting of the American Public Health Association, PLOS Medicine Chief Editor Larry Peiperl reports from sessions that discussed strategies for reducing gun violence

Among high-income countries, the US is a dramatic outlier in gun violence. High prevalence in the US is sustained by societal factors not seen in other countries, in particular the widespread presence and availability of guns.  Presentations at the 2018 meeting of the American Public Health Association covered a variety of approaches to reduce the impact of gun violence. (Research specifically on reducing racial disparities in gun violence are discussed in Part 1.)

The meeting’s opening session, which took place just a few days after the mass shooting in Thousand Oaks, California, included Eden Hebron, a 15-year old survivor of the Marjory Stoneman Douglas High School shooting in Parkland, Florida, and Tatiana Washington, a 17-year old Wisconsin activist against gun violence, who reminded the audience that political debate is not the goal; the goal is to arrive at plan to make our communities safer.

A number of strategies appear to be making headway. David Hemenway of the Harvard TH Chan School of Public Health described programs in several states (session 3016), including:

• Strong data systems in California, helping to prevent people with a history of violent misdemeanors from possessing guns
• Inclusion of a suicide prevention module in Utah firearm classes for concealed-carry permits (More people in the US die of gun suicides than gun homicides, and having a gun in the home multiplies the risk of a suicide by 3.)
• Required security measures for gun shops in Massachusetts, required reporting of gun loss or theft, and a ban on residential dealers.

Framing also surfaced as a key consideration (session 3016).  Pamela Mejia of the Berkeley Media Studies Group noted that the reporting of firearm injuries as isolated events involving specific individuals under particular circumstances can limit broader action by absolving governments and institutions of accountability. Rather than portraying shootings as evidence that that bad things happen to people who make bad choices, Linda Degutis of the Avielle Foundation recommended placing gun violence in the context of individual stories in a way that enriches dialogue with community members and leaders who may not be receptive to epidemiological arguments; while not replacing data, stories can helpfully illuminate its implications.  She also recommended framing the issue in terms of “gun violence” or “gun safety” rather than in the potentially confrontational language of “gun control.” One participant suggested that appropriate framing can avert unconstructive debates about the Second Amendment: “Let’s not argue about the Constitution—can we agree that people should be safe?”

Discussions in several sessions focused on the myth of a sharp division between gun-owner and non-gun owner. Claire Boine of Boston University (session 3161) sought to identify different gun subcultures through a principal-component analysis of 10 variables related to gun culture, and then examined the association between the identified components and firearm homicide rates at the state level. This analysis identified 3 kinds of gun culture: “general” (collecting, hunting, target shooting), “self-defense”, and “guns as freedom”) and found these to vary among states and in their association with gun homicide rates. Discussants further questioned the portrayal of gun owners as a uniform group in light of a 2018 survey finding that a majority of gun owners (even those who belong to the NRA) support background checks.

In a presentation on gun violence prevention advocacy in “red” states, Beth Joslin Roth of the Safe Tennessee Project (session 4235) reported that support for gun law reform has increased substantially in that state between 2016 and 2018 and identified policies that show promise as legislative priorities with bipartisan support, including  gun-violence restraining orders in cases of extreme risk, strengthening firearm dispossession practices (so that a trusted holder of firearms does not simply return them to an owner at risk of misuse), safer storage practices to prevent child access, and expanding background checks.

Ari Freilich of the Giffords Law Center to Prevent Gun Violence summarized legislative responses to gun violence (session 4235).  US gun deaths increased in 2016 for the second consecutive year, driven mostly by firearm homicides, which increased by 30% (versus 0.6% for non-gun homicides) from 2014 to 2016.  While Congress has refused to open debate on proposed federal legislation, some 280 new gun safety laws have passed in 45 states and DC since 2013. Among these, 13 states have enacted extreme risk protection orders (8 of these in 2018 alone, of which 5 were signed by Republican governors).  Laws requiring background checks to buy at least some kinds of guns have been passed by 20 states. In 2018, ten states enacted laws to help keep guns away from domestic abusers.  The gun lobby appears to be on the defensive in 2018, with 44 gun-lobby–backed bills in 31 states defeated so far this year (for example, bills to repeal permit requirements for concealed carry of firearms failed in 11 states).

Presentations at the 2018 APHA provide cause for optimism that the grave burden of gun violence in the US is neither monolithic nor irremediable.  The recognition of gun violence as a public health issue represents an important step towards understanding and addressing its causes.  Research can inform, and shared stories can solidify, alliances to lessen the danger of gun violence. The challenge is to minimize that danger through approaches that overcome political and ideological divides.

Image Credit: Brett_Hondow, Pixabay