Bioethics Forum Essay
Public Health Officials and Gun Rights Advocates Must Work Together
In rural Virginia, where I live, there is strong support for the right to own and carry guns. For more than a decade, I have shared public health, mental health, and other scientific findings with the leadership of a statewide Second Amendment rights advocacy group, especially regarding the leading number of deaths by firearms: suicide. We do not agree on what firearms laws and policies might be or do to prevent suicides, but we have sustained our conversations and respectfully learned from each other’s point of view. Such conversations are hard to have.
Following each mass shooting—of which there were 11 on July 4th alone—and the Supreme Court’s decision striking down New York State’s concealed-carry law, supporters of stronger gun control and supporters of Second Amendment rights talk past each other, restating their familiar views. We need better skills for respectfully listening to different points of view if we are to make effective progress to reduce the public health problem of firearms violence.
From many years of volunteering–with queer youth, in support of survivors of partner and sexual violence, and during the HIV/AIDS pandemic–the personal, family, and community devastation of self-harm and suicide are horribly familiar to me. In addition to advocating for prevention strategies, such as improving mental health resources, I took an unusual step about 10 years ago by attending a talk given by a leader of the Virginia Citizens Defense League, a group “dedicated to the right to bear arms as guaranteed by the Second Amendment.” I recall the tension in the room when I began to share data and ask questions about the group’s statements on a legal gun owner’s autonomy: that some people might own a firearm to be able to quickly end their live (which, for them, might mean preserving their dignity). I observed that suicide is not actually a solitary act, since others are changed by the suicide, and that there are occasions of murder-suicide and suicide-by-cop that we should, without question, prevent. I also brought up the necessity of safe firearms use and storage that can prevent some suicides.
I have continued talking with this group by regularly commenting on its public announcements and sharing public health data on firearms violence and well-argued scientifically grounded policy papers on preventing firearms violence. I have also given insights and recommendations from my experience and my values that I thought might affect their policy positions.
The group’s foundational view–that the Second Amendment guarantees the right of citizens to protect themselves and their family, property, and others with guns—has not changed. But the group has made some changes. It has given more public attention to firearms safety. For example, it has offered training and support, including to racial, LGBTQ+, and other groups vulnerable to violence, who want to lawfully and safely own, carry, and store firearms for their protection. The group has begun to identify and discuss connections between adequate community mental health services and prevention of violence (including through self-harm and suicide).
In our continuing conversations, I have sometimes noted biases in how Second Amendment rights advocates interpret data. And VCDL leadership has identified biases in studies supporting gun control that fail to account for different cultural expectations around firearms, self-defense, and public safety. We have also discussed flaws in research and policies on gun violence, such as the lack of rural cohorts in research studies and policy analyses that make no distinctions among rural and urban jurisdictions. Rural-urban differences are widely recognized to be significant for public health interventions – and yet are poorly studied in much of the public policy literature.
The Second Amendment rights advocates I talk with question the purpose of gun control laws if they are not enforced. A recent example is the Illinois “red flag” law, which failed to stop the suspect in the July 4th shooting in Highland Park. The advocates also criticize firearms violence prevention laws that do not fund and ensure effective mental health services and do not equitably fund and ensure these services across rural America when we know that the suicide rate is higher in rural than in urban areas and that rural areas have mental health and behavioral health provider shortages. The Bipartisan Safer Communities Act, signed into law by President Biden last month, may help change some of these rural-urban disparities by reducing administrative burdens on small and rural agencies. Nonetheless, because much of the act’s support goes to telehealth services, rural communities will be disproportionately left out because they face barriers to telehealth.
People from diverse groups must come together, listen to one another, and build trust to make progress against the public health problem of gun violence. This will take law enforcement agencies, mental health services providers, civic, faith, and other community organizations, and the general public. The most effective and ethical practices of building trust in public health require intentional sustained engagement, rather than stereotyping and stigmatizing.
The public health community should get to know and work with Second Amendment rights advocates. In the state of Virginia alone, advocates have built a well-organized grassroots movement that has mobilized tens of thousands of people to public meetings with local government officials. Public health needs to reach out to these people to find common interests and achieve some common goals. How about a shared interest in supporting locally accessible, affordable mental and behavioral health services (including for alcohol, opioid, and other addictions)? In helping families in distress? In suicide prevention, especially for those most vulnerable to suicide, such as veterans, rural residents, people who identify as sexual and gender minorities, and people in tribal communities? How about a shared interest in adequately funded systems of public defenders and legal aid, including for poorly served working class and rural communities?
But this engagement would only be possible from foundations of trustworthiness that includes making it obvious that public health respects and wants to serve all community members, with their many different cultures, faiths, and practical points of view, privileging none and empowering all for their own and their community’s health, safety, and well-being.
Edward Strickler, Jr., MPH, is a member of the Ethics Section of the American Public Health Association and a retired programs coordinator for the Institute of Law, Psychiatry and Public Policy at the University of Virginia School of Medicine.