Linda Degutis, DrPH, MSN and Howard Spivak, MD, are co-editors of “Gun Violence Prevention: A Public Health Approach,” a new APHA Press book that focuses on making people safer from the violence of firearms, rather than focusing solely on eliminating firearms. Prevention and risk evaluation must be taken into account. As mass shootings and everyday gun violence continue to shock the nation, Degutis and Spivak talk about the importance of finding common ground with U.S. gun owners, the proliferation of violence, and how to approach the problem through a public health lens.

What is a public health approach to gun violence?

Spivak: One of the things I love about public health is that it integrates science with social awareness. You use science to support and measure what you’re doing, but you also need an awareness of the social and cultural context within which you’re working to be able to successfully apply the science. That’s what this book does.

If you want to change things, you have to work at the local, state and federal levels. We have a complicated system of laws, which is a strong argument for a public health approach that comes at the issue from multiple directions and isn’t looking for a magic bullet. You don’t fix complex problems with a single simple solution. A public health approach is comprehensive. 

Degutis: Gun violence is a public health problem because so many people die, are injured, have long-term disabilities, mental health issues as a result. The preference is to stop gun violence before it happens. That takes a multi-sector approach with public health acting, perhaps, as a convener to help people on different sides of the issue work together on prevention. And we have to base our approaches on evidence that they work, not on how good they feel. 

How can we create a constructive dialogue and find common ground to make progress

Degutis: When you use terminology like “gun control,” that puts people on the defensive. It makes it hard to have a useful dialogue. If we approach it from a point of trying to understand each other and coming to an agreed-upon endpoint, like “no one dies of gun violence,” that would be ideal. Then we can work together on strategies to keep people from dying. We keep the focus on safety.

Spivak: That’s right, we need a higher-level approach. People have been looking for “the answer” for this, but as with most public health approaches, there isn’t a single answer or strategy, but rather a combination things. We have to approach this with a multi-dimensional and multi-directional perspective. That feels complicated, but it just means thinking about the cluster of things you can do to reduce risk and lead to prevention. Quick fixes rarely work.

We’re not talking about “regulating” people. We’re talking about “keeping people safe.” Across the political spectrum, there’s general agreement that people want the same things. When you agree upon a common goal, you can have a healthier discussion about how to get there.

Can you tell us more about how the way we talk about the issues matters?

Spivak: “Defund the police” is a great example of how the way we use language is important. That’s an unfortunate label and easily manipulated. It’s really talking about a more thoughtful use of resources and not simply throwing money into a single approach. It’s about supporting a policing system, while also investing in communities in ways that reduce the risk factors within them. For instance, we know that issues of poverty and racism are major contributing factors to risk of violence of all types, including and maybe in particular gun violence.

How can we reduce police violence?

Spivak: Police firearm violence gets a lot of attention, but the number of deaths or injuries due to police violence is a small piece of a larger problem. Like with all other elements of this epidemic of violence we’re dealing with, there isn’t a single solution to police violence.

For instance, training and education are important, but they don’t typically result in behavior change. You can’t train implicit bias out of people. We need a fresh look at policing overall, ask who is being hired, what are the reward systems in policing that affect behavior, even what do police do.

Routine traffic stops are often the instigator of negative events between police and community members. And we’ve delegated responsibility to the police to be the mental health providers of last resort. That’s bad policy. We shouldn’t expect police to do this. We need to rethink what makes sense, and that happens at the state and local level.

Is this part of a larger problem of violence?

Degutis: Yes, it’s not just guns. It’s violence as the underlying factor. The gun is used as an instrument of violence. And violence exists equally across the spectrum of those who have resources and those who don’t. Kids of all backgrounds see violence at home and in their community as the model for how to resolve conflict and they repeat it.

What do you want people to get from your book?

Degutis: I see this as serving as a reference for the various aspects of gun violence and a way to increase understanding of the issues. For instance, a lot of people don’t know that 60% of gun deaths in the U.S. are suicides, or that 1 in 4 women have experienced intimate partner violence in their lifetime. Guns aren’t just about gang violence like we see on TV.

We hope to give policymakers a better understanding of the reality of the situation, the data and what it means. We want people to know how critical the need is for research and timely data on gun violence, how important it is for measuring change, assessing the impact of a strategy. That’s really lacking.

Spivak: I think this book is a starting point, a way to start thinking about firearm-related violence in a different way, based on the data that’s out there and looking at the misperceptions that contribute to the problem. This book gives people a healthier framework for looking at the issues in a more constructive way.

Can you give us an example of a healthier framework for making progress?

Degutis: That’s why we included the chapter on motor vehicles in the book. It took a number of years, but there were multiple strategies that, over time, reduced vehicular fatalities in the U.S. There was evidence that child safety seats protected children in a crash, so the American Pediatric Association worked to get every state to adopt child restraint laws. 

Raising the minimum drinking age to 21 and passing impaired driving laws reduced drunk driving fatalities. Vehicle design changed to absorb impact and reduce injuries. Roads were made safer, graduated drivers licenses introduced. We have cars, so we made them safer. We have guns, so the question is how do we keep people safe from them?

Caption: A memorial in Highland Park in northeast Los Angeles marks the site of where two teenagers were shot and killed on their walk home from high school in 2009. Photo by Waltarrrrr, via Flickr/Creative Commons