Monday, August 13, 2012

Gun Violence is a Public Health Issue

The following article appeared in the STrib over the weekend, from the AP. It compares gun violence to problems in our society from tobacco, auto accidents, alcohol, unwanted and teen pregnancy, and viral illnesses.  When this many people are killed or injured, gun violence becomes a legitimate public health issue  rather than ONLY an issue of individual rights.
Whenever a substance or a product as much as any microbe is a problem resulting in death and serious injury or illness, it appropriately belongs in the sphere of public health as the target for public policy.  The reason? Because as much as it may appear to be something which strictly involves individuals on a person by person basis, the actual costs and impact goes far further, in a ripple effect. Another example would be when individual parents choose not to vaccinate their children, resulting in epidemics of preventable diseases, which is increasingly a problem.  Not only are the unvaccinated children becoming ill and even dying at an unprecedented and completely avoidable rate, but the more virulent muttions of those illnesses become a greater threat to the immunity of those who are vaccinated, and place a greater burden on our schools, and on our community health resources.
When working people are ill, for example, they affect others in the workforce, their absence or an inability to perform at optimum level affects the labor force generally and their employer specifically.  That is as true of the effects of firearm violence as it is the flu. So that general welfare concept in our U.S. Constitution has a capitalist facet.
Absenteeism is extremely costly to our economy, for example:
American businesses lose an average of 2.8 million work days each year due to unplanned absences (U.S. Bureau of Labor Statistics). In dollars, these absences cost upwards of $74 billion.   
'Presenteeism' is the "impact of at-work lost productivity.  Off-task workers cost businesses an average of $250 billion a year, or approximately $2,000 per worker.
When businesses have  these kinds of economic issues, we have less growth, and we are less competitive in the global economic market.  It affects tax bases, it affects so many other aspects of our society generally in terms of very real costs, and our economy and governments very tangibly.  That ripple effect that goes far beyond the individual or family is the reason for the U.S. Constitution to have MULTIPLE references to General Welfare in the context of not only federal government, but the term also occurs in charters and constitutions of state and local governments in the United States.

Notably the preamble of the U.S. Constitution declares:

"We the people of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

and Article I, Section 8 states:

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States; 


So clearly there was an understanding and awreness of how are success is interconnected, and should be regulated, and that there should be nationally funded efforts on the part of our government, as conceived by the founding fathers to promote and ensure that larger welfare of us as a larger group entity rather than to treat us ONLY as separate, unconnected individuals.  Gun violence harms all of us, without any upside other than empty claims that we are free.  The u.S. Constitution was never intended to be a suicide pact, it was never intended to enact the 2nd Amendment to kill and injure our citizens in such enormous numbers, or to make it so easy for convicted criminals, drug users and abusers (including alcoholics), domestic abusers and stalkers, those who as members of hate groups are a violent danger to their fellow citizens, or those who are known to those around them to be dangerously mentally ill and a danger to others or themselves. 

More than that, given the beliefs of our founding fathers, there is on doubt that they never would have accepted the rate of suicides we have in this country from firearms; clearly numerous studies have documented that firearms suicides are more lethal, and far more a weapon of impulse than any other method of self-destruction.

As a nation, we desperately need a rational and pragmatic approach to firearms, rather than the prevailing very destructive and unsuccessful emotional basis for how we deal with firearms and firearm violence.  We especially need to end the exploitation of the highly emotional attitudes towards firearms that takes place by those who profit from that gun violence.

From the AP by way of the STrib:

Doctors target gun violence as a social disease

  • Article by: MARILYNN MARCHIONE , Associated Press
  • Updated: August 12, 2012 - 7:40 PM
MILWAUKEE - Is a gun like a virus, a car, tobacco or alcohol? Yes, say public health experts, who in the wake of recent mass shootings are calling for a fresh look at gun violence as a social disease.
What we need, they say, is a public health approach to the problem, like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago, even as the number of vehicles on the road rose.
One example: Guardrails are now curved to the ground instead of having sharp metal ends that stick out and pose a hazard in a crash.
"People used to spear themselves and we blamed the drivers for that," said Dr. Garen Wintemute, an emergency medicine professor who directs the Violence Prevention Research Program at the University of California, Davis.
It wasn't enough back then to curb deaths just by trying to make people better drivers, and it isn't enough now to tackle gun violence by focusing solely on the people doing the shooting, he and other doctors say.
They want a science-based, pragmatic approach based on the reality of a society saturated with guns and seek better ways of preventing harm from them.
Hargarten. He found himself treating victims of the Sikh temple shootings at the emergency department he heads in Milwaukee. Seven people were killed, including the gunman, and three were seriously injured.
It happened two weeks after the shooting that killed 12 people and injured 58 at a movie theater in Colorado, and two days before a man pleaded guilty to killing six people and wounding 13, including then-Rep. Gabrielle Giffords, in Tucson, Ariz., last year.
"What I'm struggling with is, is this the new social norm? This is what we're going to have to live with if we have more personal access to firearms," said Hargarten, emergency medicine chief at Froedtert Hospital and director of the Injury Research Center at the Medical College of Wisconsin. "We have a public health issue to discuss. Do we wait for the next outbreak or is there something we can do to prevent it?"
About 260 million to 300 million firearms are owned by civilians in the United States; about one-third of American homes have one. Guns are used in two-thirds of homicides, according to the FBI. About 9 percent of all violent crimes involve a gun — roughly 338,000 cases each year.
Mass shootings don't seem to be on the rise, but not all police agencies report details like the number of victims per shooting and reporting lags by more than a year, so recent trends are not known.
"The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," said Wintemute, the California researcher.
More than 73,000 emergency room visits in 2010 were for firearm-related injuries, the Centers for Disease Control and Prevention estimates.
At the same time, violent crime has been falling and the murder rate is less than half what it was two decades ago. And Gallup polls have shown support for stricter gun laws has been falling since 1990. Last year 55 percent of Americans said gun laws should remain the same or become more lenient.
Dr. David Satcher tried to make gun violence a public health issue when he became CDC director in 1993. Four years later, laws that allow the carrying of concealed weapons drew attention when two women were shot at an Indianapolis restaurant after a patron's gun fell out of his pocket and accidentally fired. Ironically, the victims were health educators in town for an American Public Health Association convention.
That same year, Hargarten won a federal grant to establish the nation's first Firearm Injury Center at the Medical College of Wisconsin.
"Unlike almost all other consumer products, there is no national product safety oversight of firearms," he wrote in the Wisconsin Medical Journal.
That's just one aspect of a public health approach. Other elements:
_"Host" factors: What makes someone more likely to shoot, or someone more likely to be a victim. One recent study found firearm owners were more likely than those with no firearms at home to binge drink or to drink and drive, and other research has tied alcohol and gun violence. That suggests that people with driving under the influence convictions should be barred from buying a gun, Wintemute said.
_Product features: Which firearms are most dangerous and why. Manufacturers could be pressured to fix design defects that let guns go off accidentally, and to add technology that allows only the owner of the gun to fire it (many police officers and others are shot with their own weapons). Bans on assault weapons and multiple magazines that allow rapid and repeat firing are other possible steps.

_"Environmental" risk factors: What conditions allow or contribute to shootings. Gun shops must do background checks and refuse to sell firearms to people convicted of felonies or domestic violence misdemeanors, but those convicted of other violent misdemeanors can buy whatever they want. The rules also don't apply to private sales, which one study estimates as 40 percent of the market.
_Disease patterns, observing how a problem spreads. Gun ownership — a precursor to gun violence — can spread "much like an infectious disease circulates," said Daniel Webster, a health policy expert and co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore.
"There's sort of a contagion phenomenon" after a shooting, where people feel they need to have a gun for protection or retaliation, he said.
That's already evident in the wake of the Colorado movie-theater shootings. Last week, reports popped up around the nation of people bringing guns to "Batman" movies. Some of them said they did so for protection.
___
Associated Press writer Pete Yost in Washington contributed to this report.
___
Online:
Violence prevention research: http://www.ucdmc.ucdavis.edu/vprp
CDC injury prevention: http://www.cdc.gov/violenceprevention/nvdrs/

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