By Cathy Troisi and Stephen Williams - Special to the American-Statesman
The news from Orlando has broken our hearts yet again. This was the largest mass murder in US history, but every year in the U.S., an estimated 30,000 persons die from injuries involving guns, including unbearably, 1,500 children. Regardless of where you stand on the role of guns in society, we would all agree that we need to decrease these numbers. We believe that taking a public health approach, similar to that successfully used to decrease deaths from automobiles is the method we need to use to do this.
Six times as many people drove in 2000 as in 1925 and the number of cars increased by eleven-fold with the number of miles driven 10 times higher. One might therefore anticipate that more people are dying in motor-vehicle-related crashes — and yet the data show otherwise. The annual death rate, calculated per vehicle miles traveled, has declined by an incredible 90 percent. What improvements led to remarkable achievement?
This decrease in motor-vehicle fatalities is due in large part to the work of a public health physician, William Haddon, who applied standard public health methods to this problem. Public health workers, leaders and advocates took a three-pronged approach to increase road safety targeting cars, roads, and drivers through both technological advances and policies.
The 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act set standards for both safer motor vehicles and highways. Car design was improved to afford better protection to occupants in case of a crash. New car safety features such as safety belts, shatter-resistant windshields, heads rests, etc., increased the likelihood that persons involved in a crash would survive and would suffer fewer or less severe injuries. Roads were redesigned – road reflectors, center stripes, breakaway sign and utility poles, improved lighting, guard rails were added to advance safety.
While these changes led to rapid decreases in motor-vehicle deaths, these were not the only improvements. Driver behavior changed due to a combination of laws and education as well as changes in social acceptability of certain behaviors. There was greater enforcement of laws against driving while intoxicated, underage drinking, open containers and requirements for safety-belt and child-safety seats. Graduated licensing laws aimed at beginning drivers made the process of learning to drive safer. Groups such as Mothers Against Drunk Driving changed the social acceptability of DWI while other groups educated about the importance of using child safety seats. Other policies that have contributed to motor-vehicle safety include car safety inspections, speed limit changes, and traffic regulations.
Preventing motor-vehicle related injuries required a public health approach using technology, policies, and behavior change. We need to use these tools to stem the tide of gun-related injuries. We need data about what works and doesn’t work which requires lifting the ban on research dollars to study this. We need to work with the gun industry to design safer “smart” guns just as we have safer cars. We need an understanding of which policies work, and which don’t, to protect people from injuries caused by guns. We need research into understanding and addressing violent behaviors including suicide prevention.
According to a statement by Dr. Georges Benjamin, executive director of the American Public Health Association, “health epidemics don’t end unless we intervene taking the best science about what does and does not work and using it. The epidemic of intentional gun violence can be reversed with a science-based approach. It happened with Ebola, it worked for automobile crashes and it can absolutely reduce gun violence.” To accomplish this, it’s time to reduce the rhetoric and have open conversations about this epidemic, agree on a common goal, and work together to reduce these preventable injuries and deaths. No more Orlandos.
Catherine Troisi is an epidemiologist and chair-designate of the American Public Health Action Board. Stephen Williams is director of the Houston Health Department.