YSPH Dean Megan Ranney Urges Public Health Approach to Gun Violence

The statistics about firearm injury in the U.S. are so bleak, they threaten to become numbing. With that opening comment – and warning – a discussion at the Aspen Institute in Washington, D.C. began, focusing on a public health approach to the nation’s gun violence epidemic.

The panelists taking part in the April 29 discussion were Yale School of Public Health Dean Megan L. Ranney; Kathleen Sebelius, former Health and Human Services secretary in the Obama administration and former governor of Kansas; former U.S. Senator Bill Frist, a Republican from Tennessee; and White House Gun Violence Prevention Office Deputy Director Gregory Jackson.

Firearm injury prevention is a key priority for Ranney, who is also an emergency medicine physician. She has advocated for innovative approaches to the problem, including recognizing that gun violence is a public health issue that can be addressed, and led, by the health community.

Sebelius and Frist agreed that a public health approach appeals to people who own guns and those who don’t own guns. Both said they were troubled that firearm injury has become the number one cause of death for children and teenagers in the U.S. That statistic alone “makes it a public health issue,” Frist said, adding that “once you frame it as a public health issue, people put partisanship aside.”

A public health approach “has vast community support in Northern and Southern states,” Sebelius added.

A public health approach to gun violence requires a four-step process, Ranney explained.

“First, you measure how common the problem is … injuries, death, and the consequences,” Ranney began. The second step is to identify both risk and protective factors. “What puts someone at higher risk of gun violence, and what protects them,” she explained. The third step is to use the information about risk factors to develop interventions. And finally, “once you figure out what works, scale it up,” she said.

Following the four steps is important because acting on the wrong risk or protective factor can result in a policy that does not work, Ranney said. Evidence shows that Stand Your Ground laws increase homicides by up to 11% and do not prevent crime, according to the Brady Center to Prevent Gun Violence. On any given month, approximately 30 to 50 people across the country are killed as a result of Stand Your Ground laws, according to the center. Scared Straight programs are ineffective, and vilifying gun owners is counterproductive, Ranney added.

On the other hand, working collaboratively with gun owners can result in what she called a “coalition of strange bedfellows.” While working with firearm-owning communities, Ranney said she “has found tremendous partnership.”

Approaching gun violence as a public health issue allows for building coalitions with people from different sides of the political spectrum, recognizing that no one wants their child, family members, or people in their community to be harmed by guns, Ranney said.

According to Jackson, the lifting of a two-decade ban on federal funding for firearm injury prevention research has “pulled back the veil” on issues about how gun violence impacts communities, which is critical information to have when taking a public health approach to gun violence. Ranney has long been a proponent of studies that examine the causes, consequences, and prevention of gun violence. These studies, she and Jackson said, have guided the implementation of federal, state, and local intervention programs that are having positive impacts across the country.

Research shows that homicide rates are driven by interpersonal violence. “People in crisis with access to guns,” is how Jackson put it. Community intervention programs have been addressing the root causes of why people are in crisis, but recently, the federal government began funding those programs, resulting in a 13% reduction in homicides in 2023, the sharpest decline in homicides in U.S. history, Jackson said. The decline in the homicide rate has mostly impacted urban neighborhoods, with Black and Brown communities seeing the steepest declines, “the result of our investing in those most impacted,” Jackson said.

Access to firearms in the U.S. is “an extraordinary problem,” Jackson said. With 400 million guns in our country, “guns are very readily available,” said Jackson, a gun violence survivor who was shot by a stray bullet in 2013.

According to the first analysis of gun trafficking in 20 years, many guns are sold by unlicensed private gun sellers. In 2022, the Bipartisan Safer Communities Act broadened the category of gun sellers required to have a license to sell firearms and who must conduct background checks before making a sale.

Implementing a public health approach to gun violence with community-based programs and federal policies is the change that is needed, Ranney, Jackson, Frist, and Sebelius agreed.

Watch the Aspen Institute discussion on gun violence on C-SPAN.