How Should We Deal With Gun Violence?

Turner Syndrome is a genetic abnormality which results from an absence or partial absence of the X chromosome, preventing the development of healthy ovaries in women, as well as certain heart defects.  It can be detected by genetic screening prior to birth, but sometimes a diagnosis doesn’t take place until the teen or young adult years. Once diagnosed, “girls and women with Turner Syndrome need ongoing medical care from a variety of specialists,” so says the Mayo Clinic. In other words, it’s a complicated disease.

How often does this disease appear? Roughly 1 out of 2,500 live births. If we take the best estimate for the number of fatal and non-fatal injuries caused by one person shooting a gun at someone else, the incidence of this type of gun violence within the age cohorts 16 through 34, would also be around 1 out of every 2,500 individuals in those age groups.

If we didn’t experience 90,000 fatal and non-fatal intentional gun assaults each year, it would be difficult to argue that gun violence should be considered a public health problem at all. But wait a minute, you say. What about the 20,000 people who end their lives every year by using a gun? Isn’t gun-suicide also a problem that needs to be addressed?

Of course we need to eliminate gun suicides but the issue in that instance is quite simple because overwhelmingly, people who commit gun suicides happen to use a gun that they legally own. And they use a gun because they know using a gun will almost always get done what they want to get done.

But that’s not the case with the homicides and aggravated assaults which account for more than 80% of all gun violence every year. This public health event is almost always committed by individuals who do not have legal access to the gun used in the assault. Which means that even before they use the gun to hurt someone else, they have already committed a serious crime. It’s called ‘illegal possession’ of a firearm which, under Federal law, can be punished by as much as five years in jail.

For all these reasons, I find it difficult to understand how my friends who conduct public health studies on gun violence seem to go out of their way to avoid contact with criminologists who have produced significant research on violent crime. I am referring, for example, to the study by Paul Tracy and Kimberly Kempf-Leonard, Continuity and Discontinuity in Criminal Careers, which analyzed the life histories of the 27,160 men and women born in Philadelphia in 1958, and followed them through 1984; in other words, from birth through age 26.

This longitudinal study allows criminologists to do what public health researchers do not do, namely, develop a profile of potentially high-risk behavior over time, rather than relying on one data entry for one point in time; i.e., when someone with a gun injury shows up for treatment in an ER. Here’s the bottom line: “The frequency of delinquent activity is the most consistent and strongest predictor of adult crime.”

What we get from public health gun research are the immediate symptoms which appear when the injury occurs. What we get from criminology is the case history leading up to the medical event. Can we really develop effective public policies to reduce gun violence without combining both?

This is why I began today’s column with a brief discussion of a medical problem – Turner’s Syndrome – that occurs within the overall population to the same degree as another medical problem – gun violence – occurs within the age cohorts which exhibit the overwhelming number of injuries caused by guns.

Diagnosing and treating Turner’s Syndrome is a very complicated affair. To repeat: it requires ‘ongoing medical care from a variety of specialists.’ Why should we approach gun violence in any less of a comprehensive way?  When it comes to gun violence, public health and criminology should stop avoiding each other and join together to solve this dread disease.

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Shouldn’t Docs And Cops Work Together When It Comes To Guns?

Down in Brazos, Texas, two ER doctors made local headlines by donating a pair of Mossberg shotguns to the local County Constable office.  The guns were donated in memory of Constable Brian Bachmann, a 20-year law enforcement veteran, who was killed while attempting to serve an eviction notice onan enraged individual, the latter after shooting Bachmann then shot and killed a civilian, and wounded two other police officers before being killed himself.

What caught my eye about this story was the fact that it highlighted the relationship between law enforcement and medicine when we think about violence perpetrated with guns.  After all, if we use a phrase like ‘gun violence’ to cover every incident in which someone suffers an injury from a gun, then three-quarters of all violence involving guns also happen to be crimes. In 2013, hospitals treated roughly 60,000 people who were victims of shootings and treated 135,000 victims of stabbings and other serious assaults.  But the resources required to deal with gun assaults is probably ten times higher than what’s needed to deal with stabbings or cuts. And every one of these costly gun crimes also creates significant costs and resource use for the cops.

mossberg                The bottom line is that physicians and police are the two groups which must respond to every, single act of violence committed with a gun.  That being the case, how come we have so little interaction between law enforcement and medical communities when it comes to figuring out how to deal with guns?  Back in 2013, three of the leading public health gun researchers published a truly seminal article calling for more engagement between physicians and public health researchers to figure out how to respond to the risks posed by guns.  But shouldn’t this dyad actually be a triad by adding criminology to the mix?  Because if, as the public health authors propose, people buy and carry guns out of fear, don’t we need to know what makes some people then use these guns to commit crimes?

I think the absence of criminology from the public health – medical gun conversation has only served to make it easier for the NRA and other gun promoters to advance the stupid notion that gun ownership is a prima facie way of dealing with crime based on the equally-stupid notion that every illegal gun use can and should be responded to by simply taking the guns away from the ‘bad guys’ and locking them up for long periods of time.  The fact that public health research indicates that guns first appear on the street in the hands of young teens, many of whom might still be guided into non-criminal pursuits given the proper social and therapeutic interventions, is a response to gun violence that the NRA and its cohorts simply ignore.

The NRA reminds its membership every day that being pro-cop and pro-gun are one and the same.  But their relationship to the law enforcement community is ambivalent at best.  For every Western (and some Eastern) sheriff who says he won’t enforce expanded background checks or other gun controls, there’s another police official arguing against laws to weaken CCW or allow college students to walk around armed.  Lots of cops are gun guys, and the average cop will tell you, and he’s right, that law-abiding gun owners are never a problem when it comes to violence caused by guns.  But these same cops also know that most, if not all the guns they face in the street were stolen from a law-abiding gun owner who forgot to lock his guns away.

Take a look at gun industry promotions and you’ll notice that the term ‘gun violence’ is never used.  In fact, the standard mantra among pro-gun criminologists is that guns actually reduce violence because the ‘good guys’ are carrying so many of them around. The real challenge for public health researchers is not disproving this cynical and self-serving nonsense one more time.  It’s making common cause with all the stakeholders who want to advance sensible solutions for the problem of guns.