The transition of the firearm epidemics in the mid 1980’s to early 1990s was an alarm for public health attention in the rising injuries and deaths related to firearm violence. However, prior to 1980s, gun violence has been on the rise since 1900s. In Western countries such as the US, gun mortality rose steadily from 5,000 deaths in 1910 to 39,595 deaths in 1993 (15.5 per 100,000) to its “endemic” phase in the mid-1990s (Christofell, 2007). The public health and global concerns of gun-violence trend is that the “Endemic” state will give rise to an epidemic state when appropriate prevention and control measures are ignored. Exacerbating the dangerous situation is that firearm violence will spread to the other part of the world if not already the case, due to the influence exerted to the other part of the world by the Western nations.

The United States of America is the leading producer and exporter of firearms in the world (Christofell, 2007). In the US, firearm violence is the leading domestic problem facing the country. Unfortunately, just when the problem was identified, firearm prevention focus shifted to terrorism after the incidence of September 11th 2001. More troubling is that the factors identified for firearm’s prevention, control and regulation, were opposed by the Republican administration (Christofell, 2007).

Firearm is the second leading cause of death (24%) in the US under the injury category (Schneiderman et al, 2010). In the US, the gravity and opacity of firearm violence is clear when comparing the rate of automobile crash, which is the leading cause of injury related deaths at the rate of 29% (Schneiderman et al., 2010). Gun related deaths in the US is more than 70% of those killed in motor vehicle crash each year (Moeller, 2011). More troubling is that 98% of motor vehicle deaths are unintentional while 97 % of all firearm deaths are intentional acts (Schneiderman et al., 2010). Gun violence mortality among children age 5 to 14 is the 3rd leading cause of death in the US, and the number of children murdered in gun violence is 3 times higher than in non-gun violence, which is slightly exceeded by motor vehicle and cancer related deaths (Moeller, 2011). In the US, firearms accounts for major source of violence accounting to 65% of murder and 60% of suicide (Moeller, 2011). Firearm violence disproportionately affect Blacks, and about 25% of US household owns firearms (Moeller, 2011).

In the US, the largest single rise of gun violence in one year was 7% from 1989 to 1990 (Christofell, 2007). The mortality rate of firearm violence was 30,136 in 2003 and the non-fatal injury of gun violence in 2000 was between 58,000 to 64,000 (20.4 to 21.9 per 100,000) (Christofell, 2007). Unfortunately, it seems that this dangerous trend has been accepted by the America population as routine lifestyle, even within population not victims of gun violence and thus, has reduced the sensitivity and urgency of public health attention to firearm violence (Christofell, 2007). The inner cities and suburban areas are besieged by the temerity of the rising fear and terror trend of firearm violence in the US.

In a typical epidemic or endemic situation, public health services have means and different ways in preventing and controlling infectious disease and one of the ways are administering immunization or vaccine followed by surveillance programs. Firearm violence is no doubt a public health issue and one that should be treated as a disease and should follow the same immunization or vaccine and surveillance concepts. The Haddon diagram can be used as an immunization substitute. Using the Haddon chart, which includes a “Phase” criterion involving pre-event, event and post-event stages and a “Factor” criterion involving the host (human), vector (equipment), and environment (physical and socioeconomic) public health services will minimize the risk of firearm deaths and injuries.

In the pre-event phase, the political aisle must bridge their divide on the ideological theme of firearm violence and the rights to own guns and understand that the society is not a 16th century society. Thus, a stricter firearm control should not be chastised or unwelcomed. In the worst case scenario, if households really want to own guns, firearm manufacturers should design potent tranquilizers guns for household uses and policy makers should recall all deadly bullet guns from household use. If the society continues or chooses to go into the violent path in the 21st century, the event phase could also involve proper safety controls and training for gun owners, but, unfortunately, training and safety control may not solve the issue because 97% of gun related mortality is intentional, which means the shooter really had the intention to kill the victim, which bring the discussion back to implementing the use of rubber bullets or tranquilizer bullets. In the post-event phase for lethal bullets, there should be active public health social networks for the victims and families as palliative measures for recovery from psychological trauma, fear and terror associated with the loss of love ones.

Within the “factor” criterion of the Haddon chart, the issue with gun violence is multifactorial and under the pre-event phase the host (human) intending to own a gun must be screen for alcohol and drug addiction and most importantly psychological test. This test is crucial with the current type of fatal bullet guns available in the public. In addition, the government must make the environment especially the low socioeconomic neighborhood habitable for children by improving proactive neighborhood structural upgrade and social awareness campaign against firearm violence. The factors crucial in the event stage is the implementation of the gun handling training learned in the pre-event phase, and rational assessment of the situation before pulling the trigger. In addition, the damage done by the vector, gun in this case, depend on the type of gun and bullets used.

The ethical concern for policy makers is whether there is reasonable need for lethal firearms in the household. The socioeconomic environment should be redressed with a 21st century social reform identifying firearm violence as cruel, unusual and unethical violence.  Studies have shown that the mere presence of firearms increases aggression, an effect termed “weapons effect” (Bushman, Jamieson,  Weitz, & Romer, 2013). Among the pathological and psychological consequences of firearm violence including abstract reasoning, attention, emotional reactivity etc, the most dangerous outcome is that it creates or will create a pervasive communal violence setting where “…every child has witnessed or expects to witness violence and has been or expected to be violated” (Schneiderman et al., 2010, p. 99).

More importantly, the “factors” defining the post-event “phase” must address proper societal and medical responses to gun violence. In other words, the society should not treat gun violence as an accepted trend or fashion including its promotion in the music lyrics or television. Rather firearm violence should be redressed with strong resilient communal resistance. Firearm violence must be viewed as an offensive characteristic profile. In addition to the environmental cultural shift, increasing the cost and tax associated with gun ownership should be appropriate.

Unfortunately, the burden of gun violence in the US is mind boggling. From 1999 to 2003 there were about 147, 488 gun-related deaths in the US (Christofell, 2007). Comparing the US to other developed countries such as England and Japan. England gun-related death rate in 1999 was 0.3 per 100, 000 population while the US was 9.8 per 100,000 (Christofell, 2007). On the other hand, Japan was 0.1 per 100,000 in 1995 compared to 15.4 per 100,000 in the US in 1993 (Christofell, 2007).

In public health, endemic condition always pose a risk of “epidemic flares” and the endemic injuries or deaths usually exceeds the health outcome observed in many epidemic events. Thus, the psychosocial and societal burden caused by gun violence creates a divide in the society and families, immense grief, and short term loss of income. Anger follows, and the most destructive factor is the fear and terror that inflicts the transfer of fear and terror from one endemic community to another community where the condition may be absent. The impact of the transfer of endemic condition to the non-endemic environment was apparent with the impact of smallpox disease on Native American by the Europeans; thus gun violence is a clear reminder of the imminent danger that can cause more global harm if continued to be ignored.

(Graph data from Christofell, 2007 study adjusted to population.)

References

Bushman, B., Jamieson, P., Weitz, I., Romer, D (2013). Gun violence trends in movies.

Pediatrics, 132(6), 1014-8 Doi:10.1542/peds.2013-1600

Christofell, K. (2007). Firearm injuries: Epidemic then, endemic now. American Journal of Public Health, 97(4), 626–629. doi:  10.2105/AJPH.2005.085340

Moeller, D.  W. (2011). Environmental health (4th ed.). Harvard university press, Cambridge  Massachusetts

Schneiderman, N., Speers, M. A., Silva, J.M., Tomes, H & Gentry, J.H. (2010). Integrating behavioral and social sciences with public health. American Psychological Association, Washington DC