Gun Violence as a Public Health Issue and the Second Amendment

In the United States, there is a gun for every citizen with approximately 300 million firearms held by citizens in their homes. As the beacon of democracy for the world, American’s hold their right to keep and bear arms guaranteed by the second amendment sacred. While this right is considered fundamental, healthcare professionals are observing an alarming rate of death and injury based on gun violence. Further analysis of the data shows that young people are several times more likely to be killed by a firearm in the United States than in any other industrialized country. The prevalence of these incidences are not new, they are continuing. In this paper, the phenomenon of the death and injury rate of citizens and young people is examined concluding that gun violence is a public health concern. Healthcare professionals are the custodians of the community’s faith and trust and therefore has a professional moral obligation to advocate on behalf of victims and patients. On this particular issue, the second amendment is a barrier to the role of government but perpetuates the NRA influence. However, it is not insurmountable as more than two centuries of court cases have paved a way for balance between the right to bear arms and the health and safety of the community. This paper presents gun violence as a public health issue. Outlines the scope of the second amendment and public health advocacy issues regarding gun violence. Discusses civil rights concerns for the use of privileged health care information regarding the mental health of patients in centralized databases.

Gun ownership by citizens in the United States is much greater than in other industrialized countries. Although the United States is home to just 5% of the world’s population, it is also home to an estimated 250-300 million guns owned by civilians, nearly one per person. Statistics show that “On average 88 Americans died every day from firearm violence in 2011, and another 202, were seriously injured” (Witenmute 397). Extrapolating Witenmute’s statistic, the United States is losing 32,120 American’s to gun violence, and another 73,730 are injured each year. This rate of death and injury has continued and remained steady. “In 2005, in this country, 30,694 people died from gunshot wounds; 17,002 cases were suicides, 12,352 were homicides, and 1340 were accidental, police-related, or of undetermined intent” (Witenmute 1421). The economic impact of those surviving gun violence is costly, “Gunshot wounds in the United States in 1994 cost an estimated $2.3 billion in lifetime medical costs or, on average, ∼$17 000 per injury (Eber et al. 1686). This data shows that a small to medium-sized town is lost every year to domestic gun ownership. Not only economically costly, data shows that young people are particularly affected by gun violence. 

Evaluating the impact of gun violence on young people, Kathleen Reich’s study presented a shocking finding for the effects of gun violence on young people. Of gun-related deaths, “20,000 children and youth under age 20 are killed or injured by firearms” (Reich et al., 5) “An estimated 58% of firearm deaths among children and youth under age 20 in 1998 were homicides” (Reich et al. 8). More than half of the young are shot by other people. “Suicide is the second leading cause of firearm-related deaths among children and youth, accounting for 33% of these deaths in 1998.” (Reich et al. 8). Firearms are considered to be an efficient way to commit suicide. Most people are successful in their suicides when they use a gun. This rate is much higher than those who attempt suicide by overdose. The survivability of a suicide attempt from an attempted overdose is greater because there is more time for healthcare to intervene. Regardless of this, 1 in 5 young people involved in a shooting will die, while 4 are injured (Reich et al. 9). It is generally illegal for juveniles to own handguns. If they come into possession of one it is usually a gift, a theft, or happens to be present in the household. 

Households with guns are exponentially more likely to experience gun violence and death. “Living in a home where there are guns increases the risk of homicide by 40 to 170% and the risk of suicide by 90 to 460%. Young people who commit suicide with a gun usually use a weapon kept at home” (Witenmute 1422). Having a gun in the house increases the likelihood that it will be used. This is logical, however, the reported intent for individuals owning guns is self-defense and protection. Research disputes this and shows that the gun is more likely to be used in an unintended way. 

These data support that gun violence is a public health problem in as much as it is indeed affecting the health of the community but it is largely preventable. Healthcare has an obligation to identify things that are damaging to public health. Healthcare advocates for the use of helmets for motorcyclists, antismoking campaigns, and other public health issues because the observations of healthcare show that there is a problem and that these problems can be fixed with certain legal changes. Gun violence is presenting itself to be a significant social issue at this time and this is a ripe opportunity for healthcare to present its findings. 

Considering these facts, healthcare is in a critical social role in advocating the responsible regulation of gun ownership from a public health perspective. Because of healthcare’s training and expertise, they are obligated to advocate with policymakers on behalf of victims and for the integrity of the healthcare system. The statistics for the effect of gun violence on public health present a clear problem affecting the health of young people in the United States. As the data outlined here shows, the deleterious effects of gun violence have been present in the United States for quite some time. This problem has existed preceding the tragedy of Newtown. However, the tragedy at Newtown is a powerful focusing event on reevaluating gun regulation in this country. One unique barrier to making policy in this area is the limitation on Congress' authority to regulate gun ownership because of the Second Amendment. However, since its inception in 1789, a rich legal history has surrounded the government's actions to protect the second amendments’ right to bear arms while working toward public safety. 

Gun ownership is a civil right that has undergone substantial court scrutiny over the years. Laws limiting gun ownership often wind up in the courts to determine constitutionality. These laws are required to pass a judicial test whereby the statute limiting gun ownership must be substantially related to a legitimate governmental interest. In the area of gun ownership, the legitimate public interest is safety. “Most gun control laws to date have satisfied the requirement that they be substantially related to government’s objective of enhancing of public safety” (Rosenthal & Winkler 6). In these cases, the government is required to defend their statute and specifically articulate the nexus between their actions and their interests. In court, the government must present a clear and convincing causal link to the legislative or regulatory action enforced, and a legitimate government end. This is the justification of the use of governmental power in a certain policy area. “The Second Amendment leaves Congress and the state and local governments significant regulatory power...with substantial justification” (Rosenthal & Winkler, 6). In the area of establishing justification for government’s regulation of firearms, healthcare is able to provide evidence of the effect of firearm prevalence and in some cases provide evidence that regulations are working. 

Following the ban of firearms in the District of Columbia, a significant drop in homicides and suicides was observed. “Careful analysis linked them [firearms bans] to reductions of 25% in gun homicide and 23% in gun suicide” (Witenmute 1423). It stands to reason that with an overall reduction in gun violence, there would also be a significant reduction in gun violence affecting young people. However, bans on guns may not be the only effective regulatory scheme to help address the public health problem of gun violence. 

Jon Vernick and Stephen Teret suggest that the government should adopt a consumer regulatory model for the manufacturing of guns available in this country. They argue that the government imposes strict quality and safety standards on automobiles and other consumer goods, but that guns are not held to the same strict standards. They suggest that innovations in firearm design would help reduce the unintended use of weapons. This includes personalized firearms where only the proper owner may fire the weapon. “Personalized guns might prevent at least some of these deaths caused by unauthorized users such as juveniles” (Vernick & Teret  1204). The proposed regulatory scheme would designate an agency of the federal government to ensure certain safety standards are met by gun manufacturers. Additionally, a regulatory scheme would include the ability to bring tort actions against gun manufacturers when they do not comply with safety standards. This holds the gun manufactures to the same type of responsibility as car manufacturers when there is a public safety concern with the deficient product. 

The second amendment was written in a time when the country had just won the revolutionary war based largely on the involvement of citizen-soldiers who brought their own guns to the battles. At the time, most firearms were muskets, slow to load, and almost as likely to blow up in the face of the shooter as properly work. The philosophical intent of the amendment was to ensure that the people should always have the ability to defend themselves in the event their property is threatened either by the government itself or other citizens. The right to defend individual property is sacred. Nevertheless, times have changed, weapons are more deadly and highly efficient. As this paper showed, so many incidents of gun violence are accidental and tragically affect the youth in disproportionate ways. 

It is very difficult to keep up with exactly what is happening in the United States Congress and in state legislatures in the wake of the Newtown shooting. It’s necessary to remember that this was one of many incidences of public displays of gun violence. The public argument for and against government intervention is fanned by the public grief and panic incited by displays of gun violence. Some recommendations include regulating the type of weapons and there is a great debate on the size of a magazine. At the end of the day, the right to bear arms will endure with most likely more background checks and greater scrutiny on who should have guns. This includes an important role for healthcare in the area determining who may be mentally ill and should possess a gun. 

Healthcare professionals determine who is mentally ill or not, however, this information is part of a legally protected medical record. The privacy of medical records, especially those dealing with psychological issues is a sacred tenet of healthcare ethics. However, the Tarasoff case has made it clear that healthcare professionals who have a credible belief that a patient presents harm to themselves or others are expressly obligated to report that concern to the police.  In these instances, lives can be saved, and that is the ultimate role of healthcare, to do no harm, and to help. However, there is a great deal of concern that patient privacy will be violated if each contact with a mental healthcare provider is to be reported to some government database. How this information is protected is a very real concern for healthcare providers as confidentiality, especially in areas of mental health is sacred. In areas of public health, healthcare professionals are obligated to push for policy changes to the benefit of the community of patients while ensuring their ability to properly care for their patients. 

Its been clearly articulated that gun violence has been and continues to be a public health issue. The effects of gun violence are expensive to the healthcare system and costly emotionally and materially to society at large. Data shows that households with guns are disproportionately more likely to have an unintended discharge of the firearm resulting in death or physical and mental injury for all involved. The numbers do not lie, it is the obligation of healthcare to present these data to policymakers. Regarding gun violence, the issue of regulation of firearms balancing the civil rights afforded in the US Constitution against the health and safety of the community are policy issues for lawmakers, courts, and lawyers to handle. 

This paper discussed the data of the preponderance of gun violence-related death and injury as a public health phenomenon. The data were further examined to identify the effects on young people. Healthcare is obligated to advocate on behalf of victims on issues of public health to policymakers. Further, it was discussed in this paper the effect of the second amendment and how the government currently regulates firearms. As this issue ripens while the social wounds of Newtown and other tragedies begin to heal, it is with the hope that lawmakers take their obligation to protect the community as seriously as healthcare professionals do in caring for their patients.  Presented here was a regulatory scheme that balances the “right” to have a gun, with reasonable technological protections to ensure the right person with the right gun is using it.   

Works Cited

Eber, Gabriel, Joseph Annest, James Mercy, and George Ryan. "Nonfatal and Fatal Firearm-Related Injuries Among Children Aged 14 Years and Younger: United States, 1993–2000." Pediatrics 113.6 (2004): 1686-1692. www.pediatrics.org. Web. 21 Mar. 2013.

Reich, Kathleen , Patti Culross, and Richard Behrman. "Children, Youth, and Gun Violence: Analysis and Recommendations." The Future of Children 12.2 (2002): 4-23. www.jstor.org. Web. 21 Mar. 2013.

Rosenthal, Lawrence, and Adam  Winkler. "The Scope of Regulatory Authority Under the Second Amendment." Legal Studies Research Paper Series 13.1 (2012): 1-10. http://ssrn.com/abstract=2205520. Web. 21 Mar. 2013.

Vernick, Jon, and Stephen Teret. "A Public Health Approach to Regulating Firearms as Consumer Products." The University of Pennsylvania Law Review 148.4 (2000): 1193-1211. www.jstor.org. Web. 21 Mar. 2013.

Wintemute, Garen. "Gun's Fear, the Constitution, and the Public's Health ." The New England Journal of Medicine 358.1 (2008): 1421-1424. http://www.nejm.org. Web. 21 Mar. 2013.

Wintemute, Garen. "Tragedy's Legacy." The New England Journal of Medicine 368.5 (2013): 397-399. http://www.nejm.org. Web. 22 Mar. 2013.