More Experts Approaching Gun Violence as a Public Health Issue

Mass shootings are up, but gun violence overall is down. Still, in some regions it represents a persistent threat to communities’ physical and emotional health, and some experts say it’s as much a public health issue as air pollution or second-hand smoke.

Growing up as a teen in Chicago, Tio Hardiman had to change how he viewed the violence around him simply to survive.

“Violence was the norm. With people getting beat up, shot, and all that kind of stuff, the mindset as teenager was ‘as long as it didn’t happen to me, everything would be OK,’” Hardiman, executive director of Violence Interrupters, a not-for-profit organization, told Healthline.

Through those experiences, along with his current work mediating conflicts in some of the toughest neighborhoods in the city, Hardiman knows firsthand the terrible toll that guns can have on communities.

“A lot of families, where they’ve lost their son or daughter to gun violence, are traumatized,” he said. “Families are devastated. You’ve got kids that have lost their fathers or their brothers and sisters.”

Gun Violence

According to the Centers for Disease Control and Prevention (CDC), there were almost as many gun-related deaths in 2013 as there were from motor vehicle accidents in the United States.

From this perspective, many doctors and researchers have begun to approach the issue as they would any other public health threat. And some are calling on the federal government to join the effort.

“When you talk about health and well-being, it’s hard to have that conversation without thinking about gun violence and its impact on the health and well-being of communities and states and countries where gun violence happens,” Shannon Frattaroli, PhD, an associate professor at the Johns Hopkins Bloomberg School of Public Health, told Healthline.

This approach has already been successful in tackling other health issues that affect a wide segment of the population, such as air pollution and second-hand cigarette smoke.

When you talk about health and well-being, it’s hard to have that conversation without thinking about gun violence.
Shannon Frattaroli, Johns Hopkins Bloomberg School of Public Health

Part of this tactic means better understanding the nature and scope of the problem, which is no small feat. For example, the government doesn’t track mass shootings in real time, so that information has to come from other sources.

It also means understanding what drives people to commit violence. In the case of mass shootings, this may not be what many people think.

“Mental illness, in and of itself, isn’t a risk factor for committing violence,” Frattaroli said. “We see that people who are suffering from mental illness are more likely to be victims of gun violence than those who are not suffering from mental illness.”

A public health approach might also include taking care of those directly and indirectly affected by gun violence.

“Maybe we need some kind of public mental health initiative or mental health first aid that’s developed and made available on a more proactive basis,” said Dr. Jeffrey Lieberman, a professor of psychiatry and the chairman of the Department of Psychiatry at the Columbia University College of Physicians and Surgeons.

In the end, these are all ideas for helping communities stay healthy, even when afflicted with shooting deaths and injuries.

“The community needs to heal,” Hardiman, “and there’s a lot of pain in the community associated with gun violence.”

Read More: PTSD Linked to Faster Aging, Earlier Death »

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Long-Lasting Effects

Like other traumatic events — such as natural disasters and sexual assault — the distress of gun violence often extends far beyond the incident itself.

“Traumatic events can have a powerful psychological, mental, or emotional impact on people,” Lieberman told Healthline.

Even after someone has recovered from the initial shock of a traumatic event and their physical wounds have healed, psychological effects can persist. These may show up as difficulty sleeping or feeling nervous or anxious, for no reason. Some people may experience a quickened heartbeat, dizziness, difficulty breathing, or sweating — as if they were reliving the event.

People have individual susceptibilities to these events. Some people are more resilient. Other people are less resilient.
Dr. Jeffrey Lieberman, Columbia University College of Physicians and Surgeons

All of these are signs of post-traumatic stress disorder, or PTSD, which can affect both mental and physical health.

“Some families can’t even make a rebound after the fact,” said Hardiman, “because they end up needing psychiatric care. And some people need a lot of emotional care.”

PTSD can result from any traumatic experience, but not everyone responds to an event in the same way.

“People have individual susceptibilities to these events,” said Lieberman. “Some people are more resilient. Other people are less resilient.”

Read More: PTSD Can Last for Years in People Who Witness Traumas Like 9/11 »

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The Loss of Safe Zones

Homicides are part of the overall picture of gun violence, but they are not the largest component.

“When you look at the problem of gun violence in the United States, most gun violence in this country is the result of suicides,” Frattaroli said.

According to the CDC, there were 33,636 gun-related deaths in the United States in 2013. More than 21,000 of these were suicides and 11,208 were homicides.

Recent mass shootings like the ones in San Bernardino or at Umpqua Community College, though, have shifted the conversation about gun violence to these highly public incidents. While these events garner media attention, they represent only a fraction of the total number of gun-related deaths that occur in the United States.

According to the non-profit Mass Shooting Tracker website, to date there have been 353 mass shootings in 2015 with a total of 462 mass shooting gun deaths. A mass shooting is defined as one in which at least four people were killed or injured. Despite these numbers, many feel that the media focus on these events is justified.

“Mass shootings are certainly getting a lot of attention and deservedly so,” Frattaroli said. “They’re shocking events that really strike at the core of the communities in which they happen.”

One possible reason is that public mass shootings represent a loss of the “safe” zones in our society.

“What’s happened more recently is that this kind of traumatic experience has penetrated normal civilian life in the most ordinary and normal circumstances in the form of these random acts of violence with firearms and explosives,” Lieberman said.

These kinds of events are not a recent phenomenon in the United States. Between 1966 and 2012, the country experienced 90 mass shootings. This accounts for nearly a third of the mass shootings worldwide during that time, but excludes killings related to gangs and domestic violence.

However, a 2014 study by Harvard School of Public Health and Northeastern University found that public mass shootings have tripled since 2011. By 2012 they occurred every 64 days on average. During the previous 29 years, they occurred every 200 days on average.

The increasing frequency of mass shootings may also contribute to wider anxiety in the country.

“There’s this anticipation of the possibility of these things occurring,” Lieberman said. “People begin to worry, and they begin to be fearful and avoid doing things.”

They may avoid going out into public places. Or traveling. After the terrorist attacks in Paris that killed and injured hundreds, many people admitted to feeling reluctant to travel to the city.

Read More: Preventing Suicide, One Blister Pack and Bridge Barrier at a Time »

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The Ripple Effect of Gun Violence

Even soldiers who go into battle expecting to be shot at or have grenades lobbed at them experience PTSD.

One study estimates that between 11 and 17 percent of American combat veterans from Iraq and Afghanistan wars have PTSD. In contrast, between 5 and 10 percent of the general population will get PTSD at some point in their lives.

Still, it’s the shock of violent events in “safe” zones that may take a greater toll on people.

“When you go to the mall or you’re in school and someone comes in and just randomly begins killing people, that’s even more horrific,” Lieberman said.

Those at the center of a shooting — who were shot themselves or near someone else who was shot — may be the most severely affected. But the damage on people’s psyches is not limited to merely that group.

“It’s like when you drop a stone in a pond; you have a ripple effect,” said Lieberman.

People who were at the periphery of a shooting — who may have had to flee or hide — can also be impacted psychologically. So can family members of victims. Widespread media coverage of mass shootings, along with social media exposure, has also changed how information on gun violence is communicated to society.

“Even if you’re not present at the scene of one of these incidents,” said Lieberman “you can still be affected just by your exposure to the media.”

Read More: With Ban Lifted, New Research Shows How Firearm Access Increases Homicides »

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High Violence in Some Urban Areas

In spite of the rise in public mass shootings in recent years, the overall level of homicides in the United States has decreased since the late 1990s.

According to the Pew Research Center, there were 3.6 homicides per 100,000 people in 2013. This is down from 7 in 1993. But these overall numbers for the country don’t reflect the violence that continues in some cities.

Urban violence sometimes rivals that of other countries with high murder rates. According to the Federal Bureau of Investigation, Chicago had 411 murders in 2014, many of them gun-related. This puts the homicide rate at 15.1 murders per 100,000 people. That’s four times the national rate.

In the West Garfield Park neighborhood, where 40 percent of the households are below the poverty line, the homicide rate was 116 per 100,000 in 2014. This is above the homicide rate in Honduras  — 90 per 100,000 — the highest in the world.

Since the Sandy Hook Elementary School shooting in 2012, Chicago has had 192 mass shootings, if you include incidents in which at least three people were shot. These statistics for Chicago are staggering, but they don’t show the entire damage done to communities by gun violence.

A lot of people have become numb or desensitized when it comes down to the overall issue of gun violence.
Tio Hardiman, Violence Interrupters

Some research has found higher rates of PTSD in low-income, urban neighborhoods than in military veterans. And then there are the innocent bystanders killed by gunfire.

Like the 11-year-old girl who was killed while she was at a sleepover. Or the 21-year-old woman sitting on a porch who was killed by gunfire intended for someone else.

In the end, even these cases may not overcome the numbing effect of ongoing gun violence in some of Chicago’s toughest neighborhoods.

“Here in Chicago, especially in some of the crime-ridden communities on the south and west side of Chicago,” Hardiman said, “a lot of people have become numb or desensitized when it comes down to the overall issue of gun violence.”

Read More: Police Killings and Police Deaths Should Be Treated as Public Health Issues »