Violence is a Public Health Problem
to the FBI there are 240 million firearms in America today. Former U.S. Surgeon
General C. Everett Koop identified violence as a public health issue in 1991.
The Centers for Disease Control tells us "the United States may be a more
violent society than all other industrialized countries." Examining
violence in the context of public health was a relatively new idea and started
appearing in the literature in the 1970's with articles in medical and public
health journals on homicide, gunshot wounds, firearms accidents, etc. Nowhere is
the peculiarly American ambivalence toward violence more evident than in the
issue of guns. From 1968-1994 firearms related deaths increased by more than
is a threat to a community's health and social order. Medical and Public Health
personnel are in unique positions where they can see violence that is not
reported to authorities. Physicians are directly affected by firearm injuries.
In a recent survey 87.7% reported that they personally had treated or knew
someone who had been injured in a gun accident. (Annals of Internal Medicine)
around the world takes different forms. In India, Pakistan, Bangladesh and Sri
Lanka there are honor killings, dowry deaths and female infanticide. In Africa
civil wars rage with devastating consequences to both men and women, not to
speak of AIDS and female ritual castration. In times of war women are more
likely to suffer rape and other human rights violations. At the end of 1999, 56
of the 188 UN member states were involved in violent conflicts, resulting in 35
million refugees and internally displaced people, mostly women and children.
Sexual violence is a strategy in war. Widespread rape has been documented in the
former Yugoslavia, Rwanda, Bangladesh, Uganda, Burma and Somalia. It is a highly
effective means of terrorizing entire communities: because of the emphasis most
cultures place on the sexual virtue of women, the rapist is able to humiliate
who support capitalism in one form or another dominate contemporary American
thinking about policy issues. There has been very little written about the
political economy of a capitalist society in the creation of violence. While
liberal rhetoric "focuses on the need for major social reforms to combat
crime, liberal policies rarely go beyond social tinkering."
of the public, social scientists, and politicians subscribe to the dominant
(i.e. contemporary American capitalist) ideology of crime, which assumes it is
possible to create an effective and humanitarian system of crime control under
the present economic and political framework. Actually these ever-increasing
elite bodies never think of what policies would be truly humanitarian. They
focus rather on the status quo (capitalism) as the best of all worlds and
believe that the crime problem can be solved by quick, sure punishment,
individual change, plus a return to conservative and religious values.
being said, what is the contemporary landscape? By the year 2003, gunfire will
have surpassed automobile accidents as the leading cause of traumatic death in
the U.S. (JAMA 1996). More U.S. teenagers die from gunshot wounds than from all
natural causes combined. Firearms are involved in 65% of suicides among persons
under the age of 25. Suicides among children have been increasing, and the
acquisition of guns makes suicide attempts more successful. For every death
involving firearms, twice as many persons with firearm-related injuries need
hospitalization and five times as many need outpatient care. Firearms in the
home pose more of a threat to members of the household than to intruders. Having
a firearm in the home increases the risk for death by suicide fivefold. The risk
for death by homicide is three times greater.
violence isn't the only form of trouble that has made the transition from
nonmedical cause to medical issue. Alcoholism, narcotic abuse, domestic
violence, and tobacco use were all once considered the province of the courts,
the church, or society at large, not medicine. All have been reframed, and
rightly so, in medical and public health terms. Alcoholism is now considered
substantially a medical problem - an actual disease - with the usual genetic,
biological, chemical, and social dimensions. Why this model has not spread to
drugs is still a very complicated story involving money, greed, and the
economies of many countries. The U.S. is the ringleader. If William F. Buckley
favors legalizing drugs why do so many others object. Obviously there are no
gun violence as a medical concern seems, for the time being, to make good sense,
because the public dialogue can be changed radically. This is why a number of
doctors have begun to think of gun violence as a public health issue. Have they
thought about it in a meaningful way? Medical schools and the clinicians they
produce have "never been very receptive to the public health
perspective." Even if most internists and surgeons are already convinced
that firearms are a medical and public health problem, most have not yet managed
to make the leap from belief to practice.
toward understanding a problem as complex and elusive as violence has been slow.
"At the end of the 20th century, we are as close to understanding violence
as we were to understanding medicine in the mid-1800s," observed Felton
Earls director of the Project on Human Development in Chicago Neighborhoods.
This project will track 6,000 children in 80 Chicago neighborhoods until 2003 in
an attempt to identify factors that risk violent behaviors. The study
encompasses African-American, Latino, white and mixed ethnic neighborhoods, and
all social classes. "By a detailed study of Chicago, we sample the whole
universe of urban America," he says.
Doctor, Deborah Prothrow-Smith has crusaded to bring violence prevention within
the rubric of public health. Her 1991 book "Deadly Consequences"
combines anecdote and analysis to support the public health approach to
violence. In her book there is no coverage of state or corporate crime. Smoking
is seen as a public health problem but there is no blame heaped on the tobacco
industry or the government. One chapter is devoted to the corrupting effects of
the media and handguns are viewed as contributing to the crime problem. There
are concerns about drugs, poverty, and the underclass, but there are no
proposals of a radical nature to deal with them. She does not answer those who
suggest that violent urges lie in the genes and are not amenable to social
programs or medical intervention.
after day, 100 people die from guns-and half of these are suicides. Clearly it's
an American problem. Almost no other countries allow handguns for personal
enjoyment," observes David Hemenway, deputy Director of the Injury
Prevention Center and Professor in the Department of Health Policy and
Management. He points out that there has been relatively little research on guns
given their public health importance. Accordingly, he has become something of a
one-man firearms think tank investigating everything from who owns what to who
belongs to the National Rifle Organization.
found, for example, that men are more likely town guns than women. Republicans
are more likely to be armed than Democrats - common sense to me. But contrary to
common sense gun owners who have had firearms training are more likely than
others to be among the 1 in 5 who store guns loaded and unlocked. Maybe they are
just more into it. "It seems that training is associated with poor storage
habits." Hemingway's studies suggest that training in conflict resolution
and open family discussions may protect children from catching the handgun
"bug." Is this just a band-aid solution? Maybe the law and order
approach is not the way to go; rather money should be shifted from the war on
crime to solving social problems. "As a society we tend to look at social
ills piecemeal with a focus on cosmetically fixing the apparent result without
correcting the root causes of the problem." If violence is a health issue,
then its prevention will be pursued honestly when major medical journals begin
to publish articles that cite capitalism, racism, and sexism as causes.
Against Handgun Injury is a new organization with a broad base of 13 clinical
and medical societies in its membership. This group will soon try to lobby for
greater data collection among other things. They hope to track the behavioral
aspect of patients by asking detailed questions in hospital, ER and out patient
centers. I cannot criticize these efforts but they seem a little tame.
is very little in the literature about the Second Amendment and gun control from
Public Health advocates. The rationale heard most often among supporters of gun
ownership is that the Second Amendment gives the individual a right to own a
weapon. Ancestor worship among the political elite still flourishes, and we as a
nation pay homage to the wisdom of the "Founding Fathers." These
people believe in strict interpretation of the Constitution. This is their true
goal to recover its "original meaning" or the "original
intentions" of its adopters. "Originalism, as it is called, assumes
that a fixed set of meanings was locked into the Constitution at the moment of
its adoption, and that these meanings enjoy a supreme legal authority that
should guide and constrain the course of interpretation." In my opinion
this is absurd. We do not have the same country we did in 1787 and in many ways
our Constitution and our so-called Republic are "frozen". Nothing in
the Constitution literally directs us to prefer its original meaning over all
other modes of interpretation.
in all forms 1) weapons 2) media images 3) insensitivity towards human life 4)
the degrading way women are treated all over the world, etc is growing and has
reached epidemic proportions. I personally do not agree with Ivan Illich and his
raging against the medicalization of much of human activity. What bothers this
20th century Rousseau is that "medicalization destroys the natural ability
of individual persons to cope with adversity and to heal themselves."
Medicalization, he asserts, "deadens people's native sans culottes wisdom,
infantalizes them, and suppresses their autonomy, and erodes support by their
community." This is too sweeping and somewhat naïve.
Dorothy Guellec email@example.com