Public Health Solutions: Gun Violence

Gun violence accounts for approximately 35,000 deaths and 89,600 injuries annually in the United States (Gun Violence in America, 2018). It consists of both intentional and unintentional assault, domestic and family violence, law enforcement intervention, homicide, suicide, self-harm, and undetermined causes (Gun Violence in America, 2018). According to Santhanam (2018), in 2016 the United States ranked second in gun-related deaths, after Brazil and before India. Gun violence is a prominent issue in American society and is certainly a public health issue that requires further addressing. Many gun-related deaths and injuries are avoidable and can be prevented with the right public health solutions.

The most important solutions are education, law and policy, and a prerequisite process. Combining all of these and implementing them would decrease gun violence and positively influence public health by creating opportunities and resources that encourage healthiness. Education is an important part of public health and oftentimes necessary to create and maintain healthy populations. One way education can play a role in a public health approach to gun violence is training physicians in gun safety (MacLahlan, 2018). According to Damari et al. (2018), surveys revealed that not only do most physicians believe gun safety counseling is within physicians' practice, but many believe it decreases gun-related deaths as a result of suicide and homicide as well.

In fact, American Academy of Family Physicians, American Academy of Pediatrics, The American College of Obstetricians and Gynecologists, American College of Physicians and the American Psychiatric Association all called on Trump and Congress to take action against gun violence after the Parkland shooting (America's Frontline Physicians, 2018). Physicians practicing counseling in gun safety is considered essential in gun violence prevention (Damari et al., 2018). Yet, physicians do not have training in gun safety and therefore only 25% have the appropriate counseling conversations regarding it with their patients (Damari et al., 2018). Continuing Medical Education (CME) in gun violence prevention would be necessary for medical professionals such as family doctors, psychiatrists, psychologists, pediatricians, nurses, internists, and even surgeons. Physicians and medical professionals trained in gun safety counseling would be able to better screen patients, determine competency, and contribute to reducing gun violence and gun-related deaths (Damari et al., 2018). They would feel more confident in doing so therefore the physician to patient gun safety conversations would increase as well (Damari et al., 2018).

Creating and amending laws regarding guns is incredibly important for a society, such as ours, that continues to see high mortality and morbidity rates as a result of gun violence. Anti-gun/pro-gun control organizations, some politicians, and regular citizens have been fighting to reduce gun violence for decades, yet the issue remains. It is up to the people to vote for the right politicians. Public health efforts continue to be made to move in the direction of reducing gun violence, but Congress keeps getting in the way of change. There have been laws that have positively impacted gun violence such as the Brady Handgun Violence Prevention Act, which requires a five-day waiting period and background checks for handgun purchases (Brady Campaign, 2018). Since 1994 when the Brady bill was enacted, three million gun purchases have been blocked from criminals, domestic abusers and others unfit to own a gun (Brady Campaign, 2018). This is not nearly enough to solve the issue as we rank 20th in gun death rate by country alongside the Dominican Republic at 11 deaths per 100,000 Americans (Santhanam, 2018).

In 2013, the Obama administration attempted to amend the Brady bill by proposing universal background checks and an assault weapon ban, but Congress opposed (Johnson, 2014). The Brady bill currently only requires federally licensed dealers to background check and a waiting period in states that don't have an alternative to background checks resulting in background checks being conducted with only 60% of all gun sales (Effectiveness of the Brady Act, 2018). The National Instant Criminal Background Check System only blocks those convicted of certain crimes, fugitives, known substance users, illegal immigrants, dishonorably discharged, mentally ill, and renounced citizens (18 U.S. Code, 2018). According to Effectiveness of the Brady Act (2018), states with expansive background check laws have seen 48% less gun trafficking, 38% less women shot due to domestic violence, 17% less gun-related assaults, and 53% less gun-related suicides compared to states without expansive background checks (Effectiveness of the Brady Act, 2018). To emphasize this point, Missouri's repeal of its licensing law proves that gun laws are necessary. The state eliminated the requirement of private sellers to perform background checks in 2007, which was directly linked to a 25% increase in gun-related homicides and a 16% increase in gun-related suicides (Effectiveness of the Brady Act, 2018). Making universal background checks a requirement of all licensed dealers, not just federal, as well as amending the Brady bill so all 50 states must follow the same gun laws would further reduce gun violence and potentially cut gun-related deaths in half by 2025 (Brady Campaign, 2018).

Japan is a good example of how and why gun control can solve gun violence. One must successfully complete a very long process in order to buy a gun in Japan. It begins with a training session that is only held once a month and requires a full day's time (Denzer, 2017). Then, an exam and more training at a licensed shooting range in which one needs proof of residency, photo ID, and a complete list of past jobs and addresses must be completed (Denzer, 2017). Next, a certificate of competency must be earned by completing a professional mental health assessment and local police interview you (Denzer, 2017). Another training session consisting of classroom overview, a gun safety exam which must be passed by at least 95%, and both a range and target session are completed (Denzer, 2017). Police officers make surprise visits to neighbors, the person's workplace, etc., to interview them (Denzer, 2017). Even with a temporary license, however, one can only purchase a gun and an official license is required to take one home (Denzer, 2017). This extensive process takes around four months to complete and shows who is trustworthy with a gun. Japan and other countries such as Australia, Norway, and the United Kingdom, have nearly eliminated gun-related deaths due to strict gun control laws (Masters, 2016). Despite the United States being six times as large as a country like the United Kingdom, 160 times as many gun-related deaths is still outrageously neglectful of its citizens' well-being (Weller, 2018). Following these countries by example would greatly benefit American society's public health. Both written and shooting exams, home inspections, safe storage, limited gun shops, banning certain guns, and thorough competency assessments as well as extensive background checks are necessary to make it harder to obtain a gun.

The difference between the United States and the other countries that have seen tremendous success in decreasing gun violence is many, 42% in fact, Americans prioritize gun rights over gun safety (Drake, 2014). I believe because of Americans' devout attachment to guns that those who truly want to be responsible gun owners would endure a long process to obtain a gun, especially because half of Americans believe in controlling gun ownership (Drake, 2014). A prerequisite process influenced by Japan's, but not necessarily as strict, would allow proper gun owners to still own guns but make it much harder to illegally obtain them therefore descreasing gun violence tremendously. Gun violence takes away health opportunities in communities such as exercising in safe neighborhoods, healthy businesses investing in safe areas, and federal spending on health approaches (Addressing Violence, 2017). It also devalues communities and diminishes resources for education and the economy (Addressing Violence, 2017). Violence overall increases medical and mental illness (Addressing Violence, 2017). Combining education, law and policy, and a prerequisite process would create safer and healthier communities and reduce gun violence.

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