Gun Violence as a Public Health Issue? UNC Researchers Weigh In

In the aftermath of a recent spate of mass shootings, gun violence is back at the center of American political discourse. It can be a highly charged issue — but is there a less polarizing way to approach the discussion, one that can overcome divisions and help us move the dial on solutions?

In Chapel Hill, researchers at UNC’s Injury Prevention Research Center (IPRC) are studying gun violence as a public health issue. (Gun violence kills about 40,000 Americans each year, roughly equivalent to the death rate from liver disease or influenza and pneumonia.)

What happens if we tackle the gun violence issue from that perspective? What can a public health approach tell us about how to reduce firearm-related deaths and injuries?

97.9 The Hill’s Aaron Keck spoke with IPRC associate director Beth Moracco and Shabbar Ranapurwala, the IPRC’s assistant director for research methods. Both Moracco and Ranapurwala also teach in UNC’s Gillings School for Global Public Health, with research that addresses the causes of gun violence and ways to address it.

Listen to their conversation.

Aaron Keck: Let’s get started with the very basic question. What do we know about the causes of gun violence?

Beth Moracco: I think it’s like any other public health issue: there are multiple causal factors. A lot of gun violence has its origins in other types of violence: gender based violence, or people who have suicidal intent or mental health issues. So access to guns, a very lethal product, can exacerbate or amplify these other types of issues. In these recent mass shootings, for example: Buffalo was motivated by white supremacy, (and) for Uvalde, it appears the shooter had some mental health issues. The typical public health causal factors can be underlying, but the fact that there is easy access to a very lethal means just amplifies the effect.

Shabbar Ranapurwala: We know violence has existed in all forms, but now with more easy access to more lethal forms to perpetuate that violence, it puts many more people at risk. We can think about less lethal means: there have been incidences of stabbings in London and other places, but not as many people die, because (the means are) not that lethal.

Keck: We’re talking about (gun violence) because of these specific mass shooting incidents, but a lot of gun violence takes the form of suicide (or) domestic violence. A lot of gun violence, the vast majority of gun violence, is not mass shootings. It’s these smaller incidents that don’t make the news.

Moracco: Absolutely. We know that actually it’s death by suicide that is the leading type of death perpetuated by gun violence, followed by homicide – and (homicide) has origins, as we said, in mental health, intimate partner violence, sexual violence. So addressing those causes, as well as access to firearms, can actually reduce lethal and non-lethal violence.

Ranapurwala: There is a lot of evidence about having domestic violence protective orders for gender-based violence. That prevents violence in the homes. And having extreme risk protective orders, for people who are really in a depressed state and are likely to hurt themselves or others around them, so that they don’t get access to firearms in those acute moments — those kinds of things can prevent larger calamities from happening.

Keck: You’ve already both mentioned a couple of measures that that can be effective at addressing gun violence — what laws, what policies would be the most effective? And what policies would be the least effective? There are a lot of suggestions that are being tossed around for what we should do — (but) what shouldn’t we do?

Moracco: We actually have some laws (already) on the books that we could do a better job of implementing and enforcing. Shabbar mentioned domestic violence protective orders: well, North Carolina is actually the only state that requires judges to inquire about access to guns during the protective order hearing process. And there’s an opportunity there by law to restrict access to firearms in a domestic violence protective order, both in the emergency order and in final orders, that restricts access in terms of purchasing possession or concealed carry permits or any kind of access to guns (or) ammunition. We know those laws can be effective, other research has shown that in other states, but what we are seeing are some gaps in implementation. So that’s one place that we could start.

There have been pretty serious restrictions on funding for gun violence research for the past 25 years — thankfully, that has improved — but the research that has been done does indicate (that) extreme risk protective orders can be effective. There’s widespread support for background checks, (and) there’s some evidence that those can also be effective. And there are lots of other strategies that we can evaluate, like safe storage laws. So I think there’s a lot that we could do in terms of new legislation. But there’s also existing legislation that has widespread support that already exists, that we could do a better job (of enforcing).

Ranapurwala: Background checks are a way to implement a lot of the laws that we already have on the books. If somebody has a domestic violence protective order against them and they go to buy a firearm — the judge could have restricted them from buying a firearm, (but) unless you do a background check on them, you are not going to be able to implement that. They’re still going to be able to easily get a gun from a local store, and as much ammunition as they want to.

Moracco: In public health, we’ve learned from other issues. If you look at automobiles, for example: we found when you raised the minimum drinking age, when you (imposed) stricter licensing restrictions, you saw deaths from motor vehicle crashes go down. Same thing with smoking. One of the benefits of looking at gun violence as a public health issue is that it can take the politics out of it. If you look at something that causes over 40,000 deaths a year, that’s a public health issue. We need to look at it the way that we look at cigarettes, cars, other things that cause injury and death.

Keck: I just had a conversation with a couple of advocates for the North Carolina AIDS Action Network, NCAAN, and they have that exact same experience. You go to Raleigh and you talk with lawmakers — and you’ve got a very politically charged issue, AIDS and HIV, that leads to discussion of sexual orientation, all of these hot-button red-meat issues. But you talk about it as a public health issue, and all of a sudden, now you can get everyone on your side, Democrats, Republicans, everyone. Do you have that experience when you talk to folks?

Ranapurwala: Beth has more experience in that than I do.

Moracco: Especially also doing work in gender based violence, which can also be very charged and really gets to people’s core values around family and around privacy.

What I try to do is find common ground. And public health is a really good mechanism to do that. Because you say, well, let’s look at this as something that causes injury and death, how can we (address it)? Maybe it’s making guns safer. Maybe it’s making storage of guns safer. Maybe it’s making ownership and access to firearms safer, through background checks, educational requirements, permitting and licensing and things like that. What I’ve found is that if you take it from this perspective of “this is something that’s causing a lot of, of death and disability in our society,” that’s where I think we do find some common ground. I’m not a legal scholar, so I’m not going to debate someone about the Second Amendment, but I can say, you know, here’s what we know about making products safer, about background checks, here’s what the research says.

Ranapurwala: I’m not going to debate about Second Amendment rights either. However, I feel that there is no doubt in all of these policies. I think there’s a lot of misconception that these policies are going to somehow infringe on the Second Amendment. They don’t. They don’t preclude people from having firearms for their own safety. (Just) have a license to do so. I come from India. We need to have licenses for all types of guns in India — and with the amount of violence we have in India, if we had very easy access to firearms, the situation would be far worse.

Keck: We’ve been talking about laws that are most relevant on the state and federal level. We’ve got a lot of listeners. Many of them are local elected officials, town and county. Are there things that can be done on the local level to address this? And even if people are not elected officials, what can individuals do?

Moracco: A lot of firearm regulations are actually enacted at the state level. In fact, North Carolina, particularly around domestic violence, has very progressive, well-thought-out legislation. So as I mentioned before, implementation and enforcement of existing legislation.

And then I think just as individuals, we can talk to and ask about gun access. I’m a parent, and when my children were younger, I would always ask, if my kids were going over to play at someone’s house, “do you have guns in the home? Are they locked and unloaded? How are they stored?” Things like that.

And I think letting our elected officials know that we care about this issue and that we are in favor of universal background checks, safe storage laws, things that are kind of common sense. I think there is some worry that this is going to alienate voters. I actually don’t think that’s the case. Every poll that’s been done, every survey, has shown widespread support. But maybe we need to remind our elected officials that we support these types of laws.

Ranapurwala: Another thing I think we need to remind our elected officials is that if we close our eyes to a problem, then the problem doesn’t stop existing. This is essentially what the US had for many years done, in not having ways to collect information or data around firearm violence, not allowing funding for those data to be captured in a good way.

We need to do a better job as a country to invest in systems. We have wonderful data about motor vehicle crashes. We have wonderful data about opioids, overdoses. Big pharma companies have been sued because of those things. Why not invest in more information that will generate information? Inform everybody on either side of the aisle? Then a more informative debate would follow.

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