Op-Ed

Health officials can attack gun-violence epidemic the way they attacked HIV/AIDS

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With the dust settling after the familiar uproar immediately following another mass shooting, let’s assess where these tragedies, and subsequent discussions, leave the gun debate in America.

The daily threat of gun violence is unique in our society. As the violence pervades our public spaces, the need for a public-health approach is often pondered, but rarely discussed carefully — and even when it does receive deeper discussion, it’s never fully explicit as to what this approach might mean for an epidemic already framed within a criminal justice and mental-health paradigm.

Often, this approach includes preventive efforts that can mitigate the harm caused by the misuse of firearms — universal background checks, increased education on handling guns safely, etc. However, this fails to address the scientific nature of epidemics and, therefore, disregards the foundation upon which the public-health framework is built. This incomplete appraisal leaves rhetorical gaps in an argument that should be able to support itself with extensive data and proven studies.

To understand gun violence within a public-health framework, we need to emphasize public health as a prevention science, a multidisciplinary field that has emerged at the intersection of science and practice. By studying the origin, distribution and transmission of a disease, public-health professionals are able to predict where an outbreak may occur next and identify the most effective interventions to disrupt the practices that contribute to this spread.

The HIV/AIDS epidemic provides a practical example of how public-health professionals can work to limit a disease by identifying a number of factors, including how it spreads and which individuals are at higher risk of infection. While it originated as an infection that was primarily passed between men who have sex with men, it has evolved to incorporate multiple other transmission pathways. We now know that individuals most at risk for the infection engage in various risky social behaviors, such as having unprotected sex or needle-sharing with injection drug use. Interventions aimed at slowing the spread of HIV/AIDS target these populations and specific behaviors. They, and emphasize best practices such as consistent condom use or disinfecting of injection equipment.

As this portrays, epidemics can function as behavioral interactions that, with the proper knowledge, have the ability to be traced, predicted, and slowed based off characteristics of the high-risk population. Such research is paramount when it comes to understanding gun violence as a public-health epidemic. Preliminary research shows that gun violence concentrates within social networks similar to a contagion, and much in the same way as HIV/AIDS, has adapted a way to be spread through behavioral interactions.

A recent study from Yale follows a specific social network of individuals located in Chicago, Illinois over an eight-year period. The study analyzed gun violence using mathematical models based on both demographics and social contagion to predict the next potential victims of gun violence (fatal or non-fatal) in the vicinity.

They viewed the individual responsible for infecting others as the person within the social network most accountable for exposing the next victim of gun violence and identified high-risk individuals as those who had “co-offended” — or been arrested together for the same offense. Results showed that 63 percent of the identified gunshot violence incidents were due to social infection and that on average the subjects of violence were shot 125 days after their infector.

This analysis highlights the social dynamics of gun violence that make it analogous to the spread of epidemics such as HIV/AIDS. Co-offending, like other risky social behaviors such as needle sharing, was found to promote the spread of gun violence. By detailing gun violence through this public-health lens, professionals have the ability to track outbreaks to determine where future cases might occur, identify high-risk individuals and, subsequently, enact targeted interventions to efficiently disrupt behavioral risk factors and mitigate further transmission of the disease.

The entirety of public health is based upon preventing harmful behaviors. Gun violence is a preventable behavior. It is time now that a contagion-based approach to such violence is adopted to prevent further mass trauma in our communities.

Roderick King, MD, MPH, is the CEO of the Florida Public Health Institute and assistant dean for public health education at the University of Miami Miller School of Medicine. Katelyn McGlynn is a recent MPH graduate from the University of Miami.

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