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14 Mar 2018

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY

The spate of United States school deaths, most recently at Marjory Stoneman Douglas High School in Parkland, Florida, on February 14, has elicited a response different from the three which have become standard issue in America. 

These are the three ineffective approaches:

First, powerful political figures go only as far as expressing distress and promising victims and their families that they will be mentioned in their prayers, held in their hearts, and remembered. 

Second, calls for gun control are dismissed by law-makers as being inappropriate, insensitive and mistaken. Allow for the heat to dissipate, the dust to settle, before considering the supply of guns and ammunition. Pro-gun associations add their voices to the naysayers and spruik ‘tweetoids’ like: “The only thing that will stop a crazy person with a gun is a sane person with a gun.”

Third, public outrage, about both the lethal event and the lack of substantive political action, usually runs out of fuel in two or three weeks; other headlines and concerns take its place – until next time.

On this occasion, though, student survivors took their concerns via demonstrations and public outcry to Washington and won an audience with President Donald Trump. He tweeted:

“Armed Educators (and trusted people who work within a school) love our students and will protect them. Very smart people. Must be firearms adept & have annual training. Should get yearly bonus. Shootings will not happen again - a big & very inexpensive deterrent. Up to States.”

Why should gun control feature on a public health agenda, beyond the obvious associated loss of many lives? Is it not purely a ‘law and order’ matter?  Three reasons stand out as to why it should be viewed through a public health lens.

These are the three things public health can do:

First, the attitude towards weapons and their availability reflects not just the attitude of individuals, but of entire communities. To achieve effective weapon control, almost everyone’s attitude must change. Fear and alienation require action; few would argue that having your own familiar weapon can be reassuring. So we are addressing public attitudes that maintain a high tolerance of these hazardous devices.

Public health is well versed in the importance of upstream forces causing distortions to health downstream – for example, poverty, perceived unfair financial disparity and poor levels of literacy. Sociological insights into the social causes of the risk factors causing disease are fundamental for public health success.

These school massacres can each be traced to a single gunman, somewhat similar to ‘Typhoid’ Mary in the early 20th century in America. What was this gunman’s social background?

But more broadly, what is America’s social background, such that the whole population is so fearful that they feel the need for guns. Estimates (there are no ‘gun census’ figures) are that there are about 89 firearms per 100 people. Perpetrators of criminal actions, such as at Parkland, live in a social milieu. In a different society, with different levels of fear, and less dependence on weapon ownership for security, they might well have had a different attitude.

Second, public health pays serious attention, not only to the general social background to health and illness, but to the particularity of individuals and the threat they might pose to society’s well-being. Although quarantine is little used, the principle of identifying and managing those placing the larger community in danger should be considered. Perhaps it generally is – perhaps the FBI could point to occasions where its surveillance has prevented such mayhem. But might it not be possible to do more in this preventive vein?

Third, public health has a tradition of action which does not tolerate the perpetuation of illness and death. In fact, were John Snow with us – he of the Broad Street pump – he might well object to the first point I made about public health and gun control! He was an empirical interventionist. He considered the facts and acted accordingly. It is said of him that he was sceptical about the prevailing theory that miasmas – bad air – led to cholera and plague; by speaking with citizens in the affected community, he established a connection between those who died of cholera and the use of water drawn via the Broad Street pump and water supplied by the Southwark and Vauxhall water companies. He wrote:

“The result of the inquiry, then, is, that there has been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump well.

I had an interview with the Board of Guardians of St James's parish, on the evening of the 7th inst [7 September 1854], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.”

So there is a place for action, indeed for occasional confiscation, in public health! The contribution of the science of public health to the resolution of gun violence might require public health’s full range of capacities.

 


Published: 14 Mar 2018