Gun Violence Prevention: A Public Health Challenge


Bob Hughes, Former President & CEO

Public health, which uses science and data to pursue practical results, is a powerful way to address health issues that influence a large number of people who share a common set of circumstances. By taking a public health approach, our nation and our state have made significant advances on thorny, even controversial population health issues. We’ve protected people from sexually transmitted diseases, toxins in our air and water, workplace injuries, addictive tobacco products, and vaccine-preventable diseases. As a result, our families, neighbors, colleagues, acquaintances, and loved ones have greater well-being.

There’s another public health problem that’s facing Missouri – one that affects the health and well-being of individuals, families, and communities. It’s the problem of gun injuries and death, which includes self-directed violence, interpersonal violence, and accidental shootings. Suicides, homicides, and accidental deaths have different causes and circumstances, but they are all affecting Missouri’s health, well-being, and peace of mind. Gun-death rates in Missouri are above the national average. From 2013-2017, 69 Missouri counties reported gun death rates above the national average and 38 counties reported it as being above the state average. The harm is being felt throughout the state, by way of homicides and suicides – and each death takes a physical, emotional, and economic toll on loved ones and has ripple effects throughout the community and state.

If the history of public health has shown anything, it’s that problems that seem too big to solve can, in reality, be reduced dramatically and that the solutions are often ideas we haven’t tried yet. Progress on other public health issues has been accomplished through application of prevention research. As public health researchers have pointed out, “Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%. Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively. This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions.”

Our challenge is to do the same with gun violence in Missouri.  How can we better protect Missouri residents from being injured or killed by a gun?

A first step is to build greater understanding of how the involvement of a gun affects the outcomes of a situation. Accidents happen, conflicts happen, and mental health crises happen. But when a gun is involved, the equation changes and the likelihood of a death increases dramatically.

Take suicide as an example. For many people, the most surprising fact about gun deaths is how much suicides dominate the data; about 60% of gun-involved deaths are suicides. Across the country on New Year’s Day, 177 lives ended because of gun violence; 132 were suicides.

These proportions aren’t what you’d expect from keeping an eye on the news. Media attention about gun violence tends to focus on mass shootings and homicides. But the fact is, suicides are much more frequent. It’s become the 10th leading cause of death in the U.S., and rates in Missouri are 33% higher than the national rate. This is a problem that deserves our state’s attention. To tackle this problem, we must recognize that the means a person uses to attempt suicide matters. Nine out of 10 people who attempt suicide and survive will not go on to die by suicide at a later date. But because guns are much more deadly than other means, people who use them to attempt suicide are much more likely to die. It’s happening in Missouri. To complement the emerging suicide-prevention work already taking place across Missouri, MFH will be launching a new initiative to focus specifically on gun-related suicide.

Another important step is to better understand what approaches will reduce gun-related deaths and injuries in the diverse communities that make up Missouri. What works in urban areas might not be the right fit for rural areas, and vice versa. Community-specific programs will be essential. St. Louis is supporting the launch of the well-respected Cure Violence program. MFH is supporting several community-based projects to address interpersonal firearm violence.  Additional activities will be needed to make progress in various communities, ranging from improved police-community relationships, better data reporting systems, and fuller public conversation about the effective steps we can all agree make sense.

And perhaps most importantly, we need research to help us understand these issues better. There is positive momentum toward developing objective, practical, evidence-based ways to prevent injuries and death. Recently the federal government announced that $25 million will be available for gun research, which is the first time funds have been available in nearly 20 years. Kaiser Permanente has committed $2 million to reducing gun violence among its patients. In addition, MFH recently announced a partnership with the National Collaborative on Gun Violence Research.

Progress will take time, but by working and learning together, we believe our future will include another major public health accomplishment: the end of the heavy health burden of gun injuries and deaths.