Op-Ed

Gun violence has become an issue of public health

A student takes part in a protest against gun violence at Marjory Stoneman Douglas High School in Parkland, where 17 people were killed in February.
A student takes part in a protest against gun violence at Marjory Stoneman Douglas High School in Parkland, where 17 people were killed in February. Getty Images

I have been a pediatrician for 40 years. Over those decades, science and society have changed pretty drastically. We now understand how stressful life experiences, especially when frequent and pervasive, get embedded into the biology, chemistry and physiology of the growing child’s body and brain, affecting health and behavior over the lifespan.

Children are increasingly exposed to physical and psychological dangers from sources and circumstances that they can neither prevent nor fully overcome. When I started practicing pediatrics, the most common threats to children’s health and development came from infectious organisms, genetic diseases and commonplace accidents around the schoolyard or playground. Today, more are sickened, hurt or incapacitated by all-too-frequent contact with stressful life experiences. One of the most terribly adverse childhood experiences, direct or indirect exposure to violence, threatens the healthy development of every American child. And it does so now at epidemic levels. Today, the likely vectors for disease, disability and death are not germs but firearms, and we have no effective antibiotics to help children recover.

On Nov. 7, when 12 college students and a police officer were gunned down in a popular club in Southern California, America suffered the worst mass killing in almost 11 days. Yes, that’s right. In fact, in the first 311 days of 2018, there have been 307 mass murders committed by people using firearms — nearly every day of the year. The killings have occurred in every region of our country. Most of the perpetrators were U.S. citizens. Victims were usually unknown to the killers, tragically caught in the wrong place at the worst time. People have been gunned down in schools, places of worship, music festivals, theaters, bars, even grocery stores.

I called this an American epidemic because it is not a worldwide pandemic. In the last two years, more Americans have died from firearm violence in their homes and communities than died in combat or from terrorism. More, in fact, than were killed in the decade-long Vietnam War. In 2016 alone (the most recent year of reported data), 37,000 people were killed in the United States by firearms. (In 2017, there were more gun deaths by suicide than by homicide in the United States. The numbers have grown steadily over the past quarter century.

Only Brazil suffered more firearm-related deaths than the United States. This represents a striking contrast with every other industrialized nation. For example, over the same time span, Japan (population 127 million) has consistently averaged 10 or fewer firearm deaths a year, roughly the number who are killed in major cities in the United States each day. And the United States has six times the population of Great Britain yet 160 times the number of annual gun-related deaths. Surely, we do not have 160 times more people with mental illness.

What we do have is more and easier access to guns and other lethal firearms than other economically advanced democracies. Government gun policies help explain our pervasive national suffering. In the United States, there are 89 guns owned for every 100 residents — practically one firearm for every man, woman and child. Other Western societies specifically limit access to firearms by civilians. Statistically, you are more likely to die from firearms if you own one. Many nations deploy effective strategies to curb gun access. They enjoy far lower rates of gun-related death and injury than does the United States.

Again, to compare nations, to purchase a gun in Japan, you must first undergo an in-depth interview with law enforcement, a day-long intensive training on gun use and safety (offered only three times a year), a mental-health evaluation and a background check. Still, no handguns or semiautomatic rifles can be purchased for personal use. In the United Kingdom, ownership of handguns, semi-automatic and pump-action firearms is completely forbidden. The government spent over $200 million to buy back privately held firearms.

Mass shootings and terrorist attacks, while the most visible forms of gun violence, account for only a small fraction of firearm morbidity and mortality in the United States. These threats, however, have changed the way we Americans live, work, travel and play. They have also changed the questions and advice pediatricians now routinely discuss with children and families. As I witness a tide of citizens demanding universal access to the human right to healthcare, I hope that we will also act together to keep our children safe and enable them to live to their fullest potential. Health professionals, lawmakers, public officials, teachers, business leaders and neighbors — all of us are needed to stop the trauma, protect the public’s health and make America healthy again.

Dr. Peter Gorski is professor of Pediatrics and Humanities, Health & Society at the Wertheim College of Medicine at Florida International University. He also is professor of public health at the University of Miami’s Miller School of Medicine.

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