On the Public-Health Approach to Gun Violence

Overdue recognition of a public health crisis, or one more attempt to medicalize social and political issues?
Andrew Winning/Reuters

A just-published opinion piece in the Journal of the American Medical Association outlines a strategy against gun violence modeled on those used to reduce smoking, unintentional poisoning, and highway deaths. While I can't argue with their goal, their paper doesn't completely address obvious problems in applying public health concepts to guns.

In principle the idea of taxing firearms and ammunition to support better enforcement of gun laws is sensible.  But the authors don't mention how they would deal with the current wave of panic-buying of weapons and cartridges by firearms enthusiasts, a possible mental health problem in its own right.

There's a further irony behind the public health movement and firearms. While some historians argue that Prohibition worked in its public health goals, the ban nevertheless promoted the very gun violence -- and fascination with automatic weapons -- that have been with us ever since. And the Anti-Saloon League's political tactics as a single-issue pressure group, pioneered by Wayne B. Wheeler, helped pave the way for the NRA's current power, which has put to shame the political power of the AMA, even at its peak.

It's also possible to require firearms to have electronic controls, as laws mandate for safety belts and air bags. The New York Times is bringing up the "smart gun" again (see another review of the topic from 1999), but there's a fundamental difference between firearms and automobiles. The latter nearly all fall apart after 20 years or so without expensive restoration. Firearms are among the most durable products of technology. Survivalist sites praise pre-1899 models for their exemption from many Federal regulations and usability, especially after conversion. In 1964, half of all the Purdey shotguns ever produced were still in use, according to Sports Illustrated. (Old weapons that have not been properly maintained can, of course, present hazards of their own if not inspected by experts.) Carefully stored cartridges can also last decades. Today's panic buyers are aware of this, and there are enough pre-smart guns even in legal circulation to last for a century.  Of course, the same is true of distilled beverages, so the wealthy and upper middle class could stock up before Prohibition.

Public health measures like registration, inspection, and mandatory education -- treating guns like cars -- would work if enough gun owners supported them. But here a weak point in the proposal appears. The media are supposed to cooperate in portraying gun violence as a sign of "weakness, irrationality, and cowardice," by analogy with smoking:

A generation ago, many popular movie heroes smoked. Today, many movie heroes shoot at other people. To protect children, current policies strictly restrict obscenities and sexual imagery, yet remain permissive of gun violence. 
The trouble is that to show perpetrators of gun violence as weak and cowardly, they must be defeated by strong, brave troops or police officers, usually using deadly force of their own. And the hideous nature of many firearms wounds, whether inflicted by good or bad guys, is today generally unfit for print or screen. Should gun violence be more rather than less explicit? (As a tiny kid I was entranced by Al Capp's Fearless Fosdick and his recovery from swiss-cheese bullet holes.) And as Fox News has reported, the Obama campaign saw no problems in accepting contributions from the very purveyors of gory imagery.

The paper's conclusion takes a moderate position, recognizing that firearms can be used safely and advocating better regulation and education, not radical change. But as with Prohibition's response to the real evils of the saloon that Wayne Wheeler had experienced in his own life, it's not so easy for Americans to keep a sensible balance.