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What it would take to treat gun violence as a public health crisis


Earlier today, two people died and two were injured in a shooting at an apartment complex in suburban Milwaukee. Last night, a person was shot and killed at church in Aurora, Colorado, and a person was shot in Blacksburg, Va., near the Virginia Tech campus. All this in about the last 24 hours. America is experiencing an epidemic, and we're not talking about COVID or the flu. We're talking about gun violence. For years, professionals from many different disciplines have agreed that treating gun violence like a public health crisis and not just a crime problem could help stem this wave of injury and death. So we wondered why, in a country so scientifically advanced, has there been so little evidence-based research into stemming gun violence, and why Dr. Rochelle Walensky was the first CDC director in decades to publicly describe gun violence in America as a, quote, "serious public health threat," unquote?

We called Dr. Mark Rosenberg for his take on this because he was instrumental in establishing CDC's National Center for Injury Prevention and Control and became the first permanent director in 1994. He served as director for the center and assistant surgeon general until 1999. Dr. Rosenberg, thank you so much for speaking with us.

MARK ROSENBERG: It's a pleasure to be here.

MARTIN: So you advocated for a science-based approach to gun violence prevention almost 30 years ago. So for people who are unfamiliar, can you as briefly as you can explain what it means to take a public health approach to gun violence?

ROSENBERG: Sure. A public health approach has three important parts. The first is that it's based on science. The second is it's focused on prevention. And the third is that it's collaborative by nature. Let me tell you a little what we mean by based on science. That means we're going to ask and answer four questions - simple questions. The first question is, what's the problem? Who gets killed? Where are they killed? How were they shot? With what kind of weapons? Where does the gun come from? What, why, when, how, where? Second question is, what are the causes? What's the role of drugs and alcohol? What's the role of domestic violence? What's the role of kids having too easy access to weapons in their home? The third question we ask in a scientific approach is, what works to prevent these shootings and these killings? And there's only one way to know what works. It's not what you think, it's what you can demonstrate and prove. The fourth question science asks is, once you have an intervention that works in your test setting, how do you scale it up? How do you translate programs into policy and legislation? That's what science will bring.

MARTIN: I think when a lot of people think about gun violence, their mind immediately goes to homicide or a mass shooting. What I'm hearing you say is this encompasses all these things. I mean, it encompasses self-harm. It encompasses a child playing with an adult's gun and then a terrible accident.

ROSENBERG: Absolutely. And it's a very good point you're making. Most gun fatalities are not homicides. That's what people think of first, but probably 50% to 60% of all gun deaths are suicides and self-directed harm. If you add the homicides and the suicides you're covering, probably 94%, 95% of all gun deaths. A small number are unintentional shootings, but I would say this scientific approach works for all types of shootings.

MARTIN: There's a key issue that I think some people know, but I'm assuming many people don't, which is that until a few years ago, 2019, there had been no federal funding for research on gun violence since the 1990s. And this happened during your time at the CDC. As briefly as you can, can you take us through what happened? I mean, what led to the Dickey Amendment?

ROSENBERG: Sure. We started looking to use science to find answers to these four questions in the 1980s, but the NRA thought that this would not be good for selling more guns. So they started attacking our research and they started lobbying to get us unfunded. And there were some people in Congress who bought the NRA line and said, we've got to stop this before we lose all the guns. The Dickey Amendment was a warning that basically said if you do any research on gun violence, we're going to say that you're advocating gun control. It doesn't matter to us if you are or if you're not. And within a few years, the amount of research CDC was doing on gun violence prevention fell by more than 90%. It effectually came to a halt.

MARTIN: Yeah, I take it that your concern here isn't just that gun rights supporters like the NRA have taken this kind of, I don't want to see anything, I don't want to hear position on safety policies. But your concern is also that people on the left don't really know what to advocate either. I mean, it sounds to me like you're saying that even well-intended prescriptions might not work because we don't really know what would work.

ROSENBERG: We absolutely don't know what would work. There's some indications for some things that they're likely to work, but before you can put them into place, you need evidence. You know, we are asking politicians to vote on policies and programs when they have no idea if what they're voting for will help or will hurt. And we can get them the answers. We shouldn't be putting them in that position.

MARTIN: So the past two years, the CDC has finally started funding these various projects again. I know you don't work there anymore and haven't for some time. Do you have a sense of what their research priorities are? And if not, what do you think they should be if you're willing to give us an opinion about that?

ROSENBERG: The first priority and the first objective is to find out the answer to what's the problem and what are the causes? Who were the shooters? What motivates them? What drives them? Their second big objective is, what works? How can we prevent gun suicides? How can we prevent gun homicides? How can we prevent domestic violence shootings? So CDC is absolutely focused on the right questions. The question that I think is just as important and I hope it will get a lot of attention is what works not only to prevent the shootings, but what works to protect the rights of law-abiding American gun owners? And this is really, really important because people were told that if you investigate, if you do the research, you'll lose all your guns. If we investigate who shouldn't have guns, how we can keep them out of their hands, we can keep people from getting killed, whether it's suicide or homicide by guns without banning guns.

MARTIN: I understand that you are an advocate and have been for decades of, we have to know more before we know what to do. But gun violence is a crisis now. Is there something that could be happening now to address this crisis?

ROSENBERG: I think there are things we can do right now because the odds that they will reduce gun violence without interfering with the rights of law-abiding gun owners are really high. One is universal background checks. That's designed to keep guns out of the hands of people who shouldn't have them. And it's designed to not interfere with the rights of law-abiding gun owners. We have red flag laws. There are people who are at very, very high risk of killing themselves with a gun or killing someone else with a gun. And if we can, through a judicial process, identify those people at very high risk, we can probably save lives. And there is some suggestive evidence that these red flag laws will work.

MARTIN: That was Dr. Mark Rosenberg. He is the founding director of the CDC's National Center for Injury Prevention and Control. Dr. Rosenberg, thank you so much for joining us.

ROSENBERG: Thanks for addressing this really important topic.


MARTIN: If you or someone you know may be considering suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-8255 or the Crisis Text Line by texting home to 741741. Transcript provided by NPR, Copyright NPR.