Applying public health successes to reduce gun violence

February 16, 2013

[My latest Daily Kos piece, which I’ll cross-post here. Been a prolific week! Have to thank Sue for showing me the latest issue of JAMA. I might not have written at all the last couple of days without it. But this one is a lesson in moderation, skepticism; it’s about taking on ideas I don’t find palatable for a good cause, like taking the NRA a bit seriously for a change.]

Yesterday, I wrote about an article in the latest issue of The Journal of the American Medical Association to show how the NRA has silenced various government agencies and scientists, suppressing research into gun violence, in order to demonstrate the callous disregard of some gun enthusiasts for the Bill of Rights.

This was not the only JAMA article to discuss the issue of gun violence, however. Today I’d like to spread the word on what lessons we can learn from other successful public health and safety campaigns, and how doctors suggest we apply them to curb gun violence.


In seeking to apply what we’ve learned from such public health campaigns as we’ve undertaken concerning tobacco, accidental poisoning, and cars, the JAMA writers suggest taking on social, cultural, and educational causes for gun violence. Not that they suggest doing this instead of the current legislative proposals addressing ideas of gun ownership.

Although such commonsense regulations on ownership warrant implementation, a broader public health perspective is imperative. Gun violence arises from sociocultural, educational, behavioral, and product safety issues that transcend gun ownership alone. Addressing this crisis will require a comprehensive, multidimensional strategy. Toward that end, much can be learned from prior public health successes in changing the prevalence, social norms, and cultures of harmful behaviors.2- 6

Using the example of taxes on tobacco products, which help to fund prevention and better represent the cost smoking exacts upon society, they recommend a national tax on guns and ammo for similar purposes.

A new, substantial national tax on all firearms and ammunition would provide stable revenue to meaningfully target gun violence prevention. This revenue should fund a national endowment to benefit those harmed by gun violence and their families; a sustained public awareness campaign to increase gun safety, reduce gun violence, and assist in recognition of at-risk individuals; and stronger enforcement of existing gun laws. Such efforts would not necessarily be intended to reduce ownership, a key regulatory and political distinction.

Given the conservative penchant for ‘sin taxes’ to reduce behavior, I wonder if that political distinction could hold in practice. But if funding is needed for better enforcement, a standard NRA line, why not secure such funding directly from guns and ammo, and thus apply some sense of responsibility to gun enthusiasts that they may currently avoid?

And when it comes to the media — movies, TV, ads, video games — the NRA is quick to blame these things for gun violence. And there is a lesson to learn from history here as well, in how we addressed cigarettes.

Strategic use of media, education, celebrities, peers, teachers, and physicians served to shift sociocultural norms toward cigarettes as symbols of “weakness, irrationality, and addiction.”3 An analogous campaign could equate gun violence with weakness, irrationality, and cowardice. In today’s society, US adults and especially youth view a staggering amount of graphic violence in television shows, commercials, movies, and video games, much of it idolized and glorified. 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 NRA of course has a documented history of hypocrisy when it comes to the glorification of gun violence in our society. They noisily lament its appearance in movies, and attack celebrities with a record of both criticizing gun enthusiasm and profiting from it through their acting careers. But the NRA does its fair share of profiteering and glorification of gun violence through the entertainment industry. This was the NRA promotional video celebrating “Hollywood Guns” that I wrote about before, since deleted from their website, but preserved for posterity by Media Matters.


My own views on this potential use of media are mixed. Observing the NRA’s behavior, I see gun enthusiasts eager to blame something, anything else for the problem, while for their precious guns they strive to maintain the appearance of driven snow. My gut instinct is to take the opposite tack. But the JAMA article points out widespread, bipartisan conviction that decreasing the depiction of gun violence in our entertainment would reduce gun violence.

Now, a majority opinion poll doesn’t mean they are necessarily correct. But this is a democracy, and such majorities at least require respect; they may be an obstacle to overcome, but they can’t be ignored. And it may be foolish to just jerk my knee at the NRA. So while they do not get the free pass of ‘it’s video games/music/movies and not guns,’ history teaches us that taking this on from both angles may be warranted. As the JAMA writers suggest, let’s not just pass laws tackling gun ownership or address societal causes; let’s do both.

Not that I’m a big Call of Duty fan, but I have a stack of violent games and movies on my shelves. This would affect me directly! But if I’m not willing to change, what can I tell the gun enthusiasts, eh? The least I can do to possibly save lives is to modify my sources of entertainment to diminish the glorification of gun violence.

The article goes on to draw from the examples of safety measures taken to reduce accidental poisonings, and deaths from automobile accidents. They point out the substantial progress we’ve made — a 75% reduction in childhood poisonings, for example, as a result of better safety measures, changes to products, and national networks dedicated to education and prevention. Likewise, they cite a curious statistic (well, I found it curious anyway) of deaths per mile reduced by more than 90%. Fun with science, I suppose; you get some interesting units of measurement. But we’re all familiar with the variety of measures taken to make cars safer. Child seats, seat belts, education and licensing, air bags, safety glass, not to mention changes to the roads…it goes on, but just imagine that kind of comprehensive approach to making guns in our society safer.

As opposed to the current strategy: marketing by gun manufacturers, paranoia and fear ginned up by the likes of the NRA, and manufacturing simply to make guns more effective killing machines, more convenient for the user, more…sexy…if there is such a thing.

This article in JAMA sums up the different potential applications of our established public health success to reduce gun violence in a table, and I’ve included it below to hopefully promote discussion and more proposals for legislation. What I found interesting about this was that it takes the NRA’s off-handed blame-slinging seriously — I’m skeptical that gun enthusiasts do, themselves. But if they do, it seems there should be some real common ground to be found here. And to curb gun violence, if it’s there I want to find it.





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