Taking a Public Health Approach to Gun Violence Prevention

Lessons from Motor Vehicle Traffic Safety.

By: Linda C. Degutis, DrPH, MSN

There is widespread acknowledgement and agreement that gun violence and its impact on people in the U.S. is a public health issue that requires a public health approach to prevention and mitigation. This is clearly stated as the third agreement in the Denver accord.

Yet there has yet to be a true effort at taking this approach in a manner that engages diverse stakeholders, as well as engagement of public health leaders, agencies, and their colleagues in implementing evidence-based and evidence informed policies and practices to prevent deaths, injuries, and disabilities resulting from gun violence. Even a recently published paper on the future of firearm violence does not propose any changes in approach, and is a reiteration of what has been tried in the past without success.

We continue to hear arguments focused on banning all guns opposed by arguments to increase options for access to, and possession of, various types of firearms and ammunition. The impasse of the debate continues while we witness one hundred or more deaths from gun violence every single day.

We ignore the lessons that we might learn from the successes in taking a public health approach to other public health problems, such as motor vehicle traffic safety. While there is still a need for more progress in motor vehicle traffic safety, much has been accomplished. How do we change the dialogue and move from an impasse to a breakthrough concerning gun violence?

Since 2017 deaths in the U.S. from firearm violence have exceeded the number of deaths due to motor vehicle crashes. Starting in 2020, firearm related violence became the leading cause of death for children and youth ages 1-18 years.

If we examine what happened to decrease fatalities, injuries, and disabilities due to motor vehicle traffic crashes, we find that the effective strategies have included policy change, technology improvements, and environmental/road modifications.

Specific examples are helpful in understanding what happened and why, and provide guidance for taking a similar public health approach to preventing and mitigating gun violence.

In the early 1980s, most states in the U.S. set a minimum legal alcohol drinking age (MLDA) of 18 years. Alcohol-related motor vehicle crashes were a leading cause of motor vehicle crash deaths in teens, including teens who were younger than 18 years, but old enough to obtain a driver’s license in their state. The U.S. Congress passed legislation that required that states increase their MLDA to 21 years by a specific deadline or face the loss of a portion of their Federal highway funding. All states raised their MLDA to 21 years, and the alcohol-related motor vehicle crash death rate fell in the mid-late teen age group.

The National Highway Traffic Safety Administration (NHTSA) is responsible for requirements for motor vehicle safety features such as seatbelts, airbags, and vehicle design safety features such as steering wheel energy absorption.

NHTSA overcame the objections of motor vehicle manufacturers using data on fatalities and crash data, as well as information from testing sites such as the Insurance Institute for Highway Safety (IIHS) to identify the need for technological improvements. They created safety interventions that allowed for crumple zones that would cause a car engine to drop to the floor rather than intrude into the passenger compartment, and improved the energy absorption of the steering column to prevent energy transmission to passengers in the vehicle.

These interventions took place with input from public health, the insurance industry, the automobile industry, consumers, emergency medicine physicians and trauma surgeons, pediatricians, Mothers Against Drunk Driving (MADD), Advocates for Highway Safety, the American Public Health Association (APHA), Federal and state governmental agencies, and others.

The changes that took place impacted both Federal and state policy as well as technology, and decreased motor vehicle related traffic fatalities despite increases in the number of vehicles on the road and miles traveled.

The question remains: given that there are examples of a successful public health approach to decreasing automobile fatalities, why is there reluctance to take such an approach to gun violence prevention?

Why are so many governmental public health agencies silent on what needs to be done to decrease gun violence? They’re willing to report increases in gun-related fatalities each year, but not to ensure that there is awareness of the data on the part of policymakers and the public? What are the biases and fears that exist around engaging gun owners, gun sellers, the gun industry, and the public at large in the dialogue?

When there is a public mass shooting, do we hear something from public health about the long term impact on the community? Do we hear about the fact that public mass shootings are just the tip of the iceberg with respect to fatalities? Does public health dispel the myths and disinformation that arise and spread with respect to statements about gun violence being a mental health issue; or that if there are restrictions on access to specific types of firearms, only criminals will have firearms? Does public health highlight the need for gun safety as opposed to gun control?

There are more questions than there are answers, but there are three key questions that we need to address:

If we continue to do the same thing that we have always done in order to prevent gun violence, why do we expect different results?

When will public health accept its responsibility for addressing public health issues and change the dialogue around preventing gun violence?

And the ultimate question: How do we keep people safe, given that there are guns in our environment, like it or not?

Linda C. Degutis is a lecturer at Yale School of Public Health, and former Director, National Center for Injury Prevention and Control, CDC.

Car crash image by Marcel Langthim from Pixabay