You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Thursday, August 19, 2010

Making Peace with Health Promotion

Last Christmas a family member gave me a membership to the National Rifle Association (NRA). It was a gag gift because he knows there are few people in the U.S. more opposed to what the NRA stands for. The NRA and I are in different time zones: I’m in Eastern time zone and it is in the Twilight Zone!  It is more than a disagreement. Let me clarify that I respect many gun owners and the right of responsible gun ownership. I just think the NRA is absolutely wrong about the propagation of a safe society and what would get us there.

This is relevant in a health promotion context because violence is a public health problem, sure-as-shootin. Violence has health implications because it is linked to death, injury, disability, and anxiety disorders. In addition, there is confidence in many quarters that violence can be prevented or at least reduced. Finally, a law enforcement approach will only take us so far. A more ecological perspective such as a comprehensive public health program shows much more promise. This would include school and public education, and media restrictions respectful of 1st Amendment rights but responsive to relentless portrayals of brutality and mayhem in movies, TV and video games. Other components would include finding ways to promote young people bonding with mainstream society values, family support, strategies to help youth identify with school values and complete more education, connecting kids with positive role models (e.g. Big Brothers Big Sisters), community focused policing, and of course paying attention to guns.

Gun control is not a magic bullet for community violence, but the evidence is clear that the explosion of guns into more and more places carried by more and more people does not promote the public’s health. Evidence shows that the presence of guns in communities and households is directly related to homicide and suicide rates. So what about gun control?

In general, gun restrictions have not been found to be effective in decreasing homicide and community violence. The Brady bill blocked a lot of gun sales but it was not possible to link this to decreased violence. With an estimated 200 million privately owned guns, restrictions are not enough to matter. However, the NRA encourages gun ownership by more and more people. Their view is summarized by “Guns don’t kill people, people do!” It makes a memorable slogan but otherwise is without merit. One could make a similar claim about autos: “Cars don’t kill people, drivers do!” This is equally false. Just like we have to address highway safety in a wholistic way , including regulation of the design and production of cars and who drives them, gun restrictions must be part of a comprehensive approach to violence prevention.

The NRA rejects out-of-hand a public health solution, approving no counter measures other than safe shooting courses. This is dishonest and disconnected from community conditions breeding and enabling violence.

It is worth noting that while it is easy to make the case for violence as a public health problem, there is a remarkable void of attention to violence by traditional public health agencies. At the federal level, the Centers for Disease Control has a unit devoted to violence; a few years back the NRA aggressively (but unsuccessfully) worked the political system to get CDC funding for violence prevention blocked. At state and local levels, violence prevention mostly reverts back to law enforcement; some school systems include anti-violence education in their curriculum, and some of those efforts have had modest results in students practicing more peaceful lifestyles.

Up to now, trends in violence and suicide have been mostly out-of-sync and unrelated to violence prevention efforts. The NRA is a barrier to a more promising public health approach, in the belief that violence would go away if all the “good “people were armed. In reality, much of our violence is not perpetrated by “bad” people, but by good people having a bad day.

In the classic words of Pogo, “We have met the enemy and he is us.”

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