Violence is a Public-Health Emergency


It's almost impossible to solve a problem without defining what the problem is. And if a problem like school shootings seems like one on which we have made no progress toward a solution, then it is well worth putting our attention to the matter of giving it a definition.

If school shootings (and other mass-casualty violence) don't qualify as a public-health issue, then what is?

Consider these six characteristics that should make these events clear cases of public-health concern:

Aspect #1: It has elements of contagion. Just like the spread of a virus, this kind of violence spreads, in part, through contact. That is, the more these events capture public attention, the more likely it is that new perpetrators get the idea to try the same thing. We have statistical evidence to tell us these are contagious events -- but we also have the anecdotal evidence staring all of us in the face: The more these awful things have happened, the more they happen again.

Aspect #2: Some of the root causes are biological phenomena. It's practically a reflex by now to say that these events are evidence of a mental-health problem. And, yes, almost by definition, they must be: Nobody would perpetrate a mass killing unless they were psychologically disturbed in some way. But the phrase has become a crutch for avoiding the problem, rather than a call to action. So let us address the biological aspect seriously. It is a mistake to act as if the brain itself is something other than an organ of the body, and one that can be diseased.

Aspect #3: Some of the root causes are social phenomena. Unlike diseases that are strictly inherited (like cystic fibrosis or sickle-cell anemia), mass violence only takes place within a social context. It depends on human beings being social animals who interact with one another. And it is, in part, related to how Americans engage with one another; that much should be self-evident from the fact we have far more of these events (even proportional to our population) than in any comparable country. Thus we cannot prevent or treat it without a public approach.

Aspect #4: It places members of the public at imminent risk of harm or death. Far more people are killed by violence than by most contagious diseases. We have gone to extreme measures to restrict and monitor air travel, for instance, in the face of contagious diseases like SARS and Ebola, entirely in the name of public health.

Aspect #5: Little or no meaningful protection can be obtained through individual action. Any ordinary member of the public is at some risk of exposure to an attack, and there is little or nothing that can be done to avoid it. There is no option to vaccinate or otherwise take preventive care of one's self without community action and the mobilization of mass-scale resources. If the individual cannot self-protect, then it becomes a matter for the community to undertake.

Aspect #6: The results are within the top five leading causes of death for a large segment of the population. While mass shootings in particular may not represent a leading cause of death, homicide in general is one of the top four causes of death among every age bracket between ages 1 and 34. Broadly taken, interpersonal violence is a deadly American epidemic. Undoubtedly, the lessons we learn from addressing the problem will be scalable; the things we can do to prevent violence from one individual to another will be things we can do to prevent violence from one person to many, and vice versa.

So: We can define the problem as a matter of public health, and we must address it as one as well.

Treating this as a matter for politics alone has been a dead end; it's time to face the violence epidemic for what it is, and put the appropriate expertise and adequate resources into fixing this just as we would any other solvable public-health crisis. These six aspects of the problem place it squarely in the realm of public health, and we ought to have the same level of commitment to addressing the problem as we would to any other crisis in public health.

The resources appropriate to a significant, deadly, and contagious epidemic ought to be appropriated to the issue of homicide in America. The resources ought to be allocated to research, prevention, and harm mitigation just as they would if we faced a pandemic flu or a mysterious airborne illness. And in the end, we need to act on what we learn about mass violence with the same gravity as we would place on any other epidemic. Moreover, we must stop saying that "now is not the time" to deal seriously with the problem. These are no longer isolated incidents; they are part of a continuous problem.

America has tackled deadly outbreaks of diseases like influenza and polio before; faced with the evidence, we ought to tackle this epidemic with commensurate seriousness. That requires a combination of resources, urgency, and dedicated expertise -- as well as a public commitment to acting on the best advice we can obtain from the best-informed experts we can enlist.

Brian Gongol

Brian Gongol

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