Gun Violence as a Public Health Issue

Female doctor speaking to male patient in office.

By Ajay K. Singh, MBBS, FRCP, MBA
November 21, 2017

An interesting viewpoint about gun violence was recently advanced by Nicholas Kristof (with Bill Marsh) in the New York Times.

Kristoff argues that a blanket opposition to guns hasn’t worked and that an alternative approach of regulating guns should be considered. He advocates a “public health approach.”

The article cites some staggering facts:

  1. Guns per 100 people—for the US, 88.8; the next closest Switzerland at 44.7; Canada comes in at 30.8 and Japan 0.6.
  2. Murders per 100,000 people—the US 3.0; the next closest Italy at 0.7; Canada comes in at 0.5.
  3. Research on guns: from 1974 through 2012, the NIH funded just three research awards.

The Kristof article makes some sensible recommendations that seem to resonate with Americans. Here are three that caught my eye:

  1. Background Checks—93% of Americans surveyed agree and yet 1 in 5 guns are obtained without one. Nearly 90% of Americans agree that the mentally ill shouldn’t be buying guns.
  2. Safe storage—making sure guns are inaccessible to children and have trigger locks.
  3. Banning under-21-year-olds from purchasing guns—we don’t let them drink, but allowing a teenager to buy a semi-automatic gun seems sensible?

Other ideas that we could consider with a public health approach include taking a systems approach. How can the health system help reduce gun violence?

  • Could the primary care doctor ask patients about gun ownership, and perhaps even counsel them about safe gun use?
  • Does integrating educating patients about safe storage and making sure guns can’t be fired accidentally seem to make a lot of sense?
  • Could research be funded that predicts which individuals are prone to gun violence? Perhaps, high-risk individuals could be screened and then offered help by the health system?
  • Could sensible controls be built-in that, on the one hand preserve privacy, but at the same time regulate access to guns in people with mental illness? Should people with personality disorders or a history of psychotic illness be allowed to buy guns without undergoing some secondary screening? On a related note, merging databases that screen people as a part of a “background check” with databases that record diagnoses around mental health could be developed.

Whether gun violence abates in the US is a complicated question. At one level, solutions are a function of societal trends, politics, and the power of the gun lobby. Still, thinking about novel ways to frame an important problem isn’t a bad idea. Gun violence kills people, and as Kristof suggests, emphasizing and framing it as a public health issue makes sense. Has anything else worked?


Learn more about Health and Health Care Disparities from a panel of HMS experts.


Ajay Singh, MBBS, FRCP headshotDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

Share your thoughts on solving America’s gun violence crises in the comment section below.

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