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Lawmakers contemplate loosening some of North Carolina’s gun laws, even as public health experts are seeking ways to reduce gun violence.
By Rose Hoban
This week, lawmakers in Raleigh may consider a bill that would make sweeping changes to North Carolina’s laws around firearm permitting, background checks and places where concealed weapons could be carried.
The bill has fired up debate between advocates for gun rights and gun control and caused tension within the Republican caucus. Presumably, the bill has posed difficulties for Speaker Tim Moore, who has had to delay a vote on the bill several times. Monday night, he sent the bill back to committee.
Gov. Pat McCrory signaled reluctance to sign the bill if it passes in its current form; he sent his legislative liaison, Ryan Minto, to a committee meeting on the bill last week to say as much to lawmakers.
Opponents of the bill expressed some relief at the removal of earlier provisions in HB 562 that would prohibit physicians from questioning their patients about guns in their homes. Doctors, in particular pediatricians and psychiatrists, worried the measure would have prohibited them from talking to their patients about safety measures to protect children or people experiencing mental health issues.
But the physician-counseling provision is not the only way the gun issue intersects with health care.
Public health issues
“Gun violence is a public health problem because so many people die of it,” said Phil Cook, an economist from Duke University’s Sanford School of Public Policy who has done firearms research for some four decades.
Cook has irritated people on both sides of the issue, including Grass Roots North Carolina head Paul Valone, who maintained in a recent interview that Cook is an advocate who has been “cooking the books for years on gun research.”
But Cook said he’s also angered gun-control advocates who wish he’d not publish things like an analysis finding there was little evidence the 1994 Assault Weapons Ban saved lives. And he agrees with Valone that law enforcement officials probably don’t hear about all the instances in which an intruder is scared off by someone in a household with a gun.
Nonetheless, Cook, and others, are increasingly embracing a public health approach when they talk about guns. That approach emphasizes prevention of gun injuries, and researchers have started to work at preventing gun deaths in ways similar to the way they think about other epidemics.
“When you think of the research and investment in traffic safety, there’s no comparison between that effort and the effort around gun violence and gun safety,” Cook said. “It’s the orphan in the trauma world.”
One epidemic Cook noted was that of suicide.
According to CDC statistics, in 2013 21,175 people committed suicide using a firearm, while another 19,974 committed suicide by other means.
Those are numbers that concern many public health experts who study injury prevention, such as epidemiologist Steve Marshall, who leads the Injury Prevention Research Center at UNC-Chapel Hill’s Gillings School of Global Public Health.
Marshall pointed out that for every homicide in the U.S., there are more than two suicides. In the 2013 data, suicides with a firearm far outstripped the number of homicides, which totaled 16,121.
The North Carolina data are similar. According to the state’s Violent Death Reporting System, in 2012 there were 1,941 violent deaths; of those, 1,277 were suicides. In that year, deaths from suicide almost doubled the number of unintentional narcotic-overdose deaths.
“Suicide is highly preventable,” he said. “If you remove the mechanisms by which the person is seeking to kill themselves, they live.”
But Marshall said the data show that in households with guns, having lethal means close at hand makes it easier for someone to commit suicide “successfully.”
“Suicide is a mix of planning, and is also highly impulsive,” he said. “If you remove the means, the lethal force, oftentimes a suicide can be prevented. And assuming you can provide the appropriate care and services, you don’t have people making another attempt.”
More than half those suicides were by people using a firearm, with men killing themselves at more than twice the rate of females in almost every age group. Women were more likely to have had a previous attempt at suicide, something Marshall noted is probably related to the fact that women are less likely to use a firearm to attempt suicide.
But with a firearm, one attempt is plenty.
Researchers from the Harvard School of Public Health compared successful suicide rates of people in states with high gun ownership to those with low gun ownership and found the high gun-ownership states had four times as many gun suicides.
And North Carolina is a state where many people own guns.
“I’m not saying that people shouldn’t have guns, but that guns can be dangerous in ways that people don’t anticipate,” UNC’s Marshall said.
Success reducing homicides
According to state data, in 2012 there were at least 547 homicides in North Carolina, with firearms used in 389 of those deaths.
Reduction in homicides is the goal of violence-prevention initatives such as the one pioneered by Chicago physician and epidemiologist Gary Slutkin.
Slutkin developed the Cure Violence initiative after doing AIDS work in Africa. His idea was to reduce violence using the same behavior-change and disease-control methods used for controlling outbreaks of diseases such as malaria and Ebola. His approach is credited with reducing gun violence in some of Chicago’s most violent neighborhoods.
An initiative based on Slutkin’s work was implemented in Philadelphia in 2012 and documented by Jim MacMillan, who used to run the Gun Crisis Reporting Project, a news organization that reported on the gun problem in the city and the solutions being developed.
“In the 22nd Police District, the district with the most violence for many years, they had a 27 percent year-to-year reduction in gun violence in the first year,” MacMillan said.
Other such programs are starting to pop up around the country, such as “focused-deterrence” programs that require close police work with those at risk for committing felonies with guns. People at risk of committing crimes, and their family members, are told that police will refrain from prosecuting them if they’ll participate in helping reduce crime in their areas. The idea is that peer pressure will help keep people on the straight and narrow.
A focused-deterrence initiative in High Point that’s been running for about a decade has dropped the crime rate in that city, with sustained results.
On the strength of these programs and others, eight medical societies, from the American Public Health Association to the American College of Surgeons, recently joined with the American Bar Association to call for better background checks, better reporting laws and more research on how to prevent gun violence.
Reducing gun violence will likely anger gun-rights advocates, but Steve Marshall said it doesn’t make sense not to work to make guns safer.
“Guns are part of American culture the way cars are, and we’ve done a lot of things to make cars safer, but not guns,” he said.