How a Public Health Approach Could Reduce Gun Violence

Over Memorial Day weekend, a dozen mass shootings—in which four or more people were shot or killed per incident—occurred in the United States. These events took place just days after the horrific school shooting in Uvalde, Texas, in which a gunman killed 19 students and two teachers and injured 17 others at Robb Elementary School.

Ten days before the Uvalde shooting, a gunman opened fire in a Buffalo supermarket, killing 10 people and injuring three, almost all of them Black. The list of mass shootings grows unabatedly, and in the continuing public discussion about gun violence, experts often suggest a public health approach may offer solutions.

“Public health is about trying to change conditions that are not acceptable to people's health and lives. It’s about making a commitment to deal with an unacceptable issue until it’s solved and building the solution into the infrastructure of our society,” says Michael Siegel, visiting professor of public health and community medicine at Tufts University School of Medicine.

Siegel has spent decades researching firearm violence, analyzing everything from who owns guns in America to why gun violence increased during the COVID-19 pandemic. He recently spoke with Tufts Now to outline what a public health approach to firearm violence would entail.

Tufts Now: How would treating guns as a public health threat help reduce gun violence?

Michael Siegel: Take tobacco as an example. Tobacco is also a public health problem, but from a public health perspective, we don’t view smokers as the problem. Instead, we look at the systematic or societal factors causing tobacco consumption. The fight against tobacco is against the tobacco industry’s behavior and influence, not against smokers. And we’ve been successful.

If you go back just 20 years, the tobacco industry had just as much power as the National Rifle Association (NRA) does today. But it all changed because we went after the tobacco industry, showed how they preyed on kids with marketing, and it became unacceptable to society.

In the same way, the implication of that for the gun issue is to not blame gun owners, per se, for the problem of firearm violence. We have to think beyond that, view it as a societal problem, and look to the corporations, manufacturers, and especially the gun lobby, as the source of the problem. With gun violence, there's a tendency for some people in public health to blame gun owners. Our research has shown that, as a result, a lot of gun owners have become alienated from gun violence prevention.

Is there racial disparity in gun violence? Does it affect some communities more than others?

There are two goals of public health: One is to reduce overall morbidity and mortality and the other is to reduce health disparities of all types. With the gun issue, the most outstanding disparity is the racial disparity in firearm victimization. It’s not just police shootings, as tragic as they are. Gun violence is going on in urban communities, often communities of color, every day. It doesn’t always make the news, but about a hundred people die in the U.S. every day from gunshots.

The burden is disproportionately on people of color, especially the African American population. Viewing this as a public health issue means we have to make a commitment to reduce racial disparities, not just the overall levels of firearm violence, and that means paying attention to what’s going on in our cities and communities of color.

Our research has found that the primary predictor of racial disparities in gun violence in different locations is the degree of structural racism. In other words, the historical legacy of past racial injustices—discrimination in education, employment, incarceration, and home loan policies—predicts current levels of racial disparities in gun violence. We've found that there's a direct connection between structural racism and gun violence. If we want to get to the core of the problem, certainly one of the things that needs to be addressed is structural racism.

What are the greatest predictors of gun violence? Is poor mental health an accurate predictor?

Public health tends to look at issues from the proximal level and the distal level. In other words, there are factors that are closest to the problem (proximal) and factors that point way back to underlying causes (distal). There's no question we have to address both. However, because the situation with gun violence is so dire and unacceptable, there needs to be immediate action where we can have an influence. It takes a long time to solve underlying problems, and we can't wait for that.

For this violence to occur, two things are needed: a person and a gun. We can't look at someone and know if they’re a criminal or not. But we can look at someone’s history and ask, is this person at high risk for violence?

We know that the greatest risk factor for violence is a history of violence or threatened violence. It's much more predictive than any other factor, including mental health. There's a misconception that people with mental health issues are the most dangerous. And that’s not true. People with mental health issues are no more likely to commit violence than anyone else. The people who are more likely to commit violence than anyone else are people who have already committed violence.

How can policymakers reduce gun violence from a federal or state level?

As a society, the most important thing we can do is make sure that people with a history of violence don’t have access to guns. But we can’t look at someone and know whether they have a history of violence, and that’s why universal background checks are essential.

We also need a permitting system to obtain a gun. It is to the benefit of gun owners because once you’re certified as not having a history of violence, you can get your permit and purchase and use guns to your heart’s delight. Kind of like a driver’s license for a car. Obviously, if you do something to disqualify yourself, then you lose your license. It should be the same with guns.

Over time, we’ll need to able to rescind licenses if people become prohibited from having a gun through their actions. Perhaps at the time they purchased a gun, they were completely stable, but something happened in their life, and they became a danger. Red flag laws allow law enforcement to take guns from people who are deemed a risk to others or themselves.

Our research estimates this package of policies would reduce overall firearm homicide by 35 percent. The fortunate thing is that we found these policies are largely supported, not just by the public, but gun owners specifically. Policy makers are just afraid to enact them because they don’t want to stand up to the NRA or lose votes from a small percentage of their constituents.