Gun Violence: A Public Health Issue

Her text message read: “The school is on lockdown, but don’t worry I’m safe.” It was not the first encounter my wife has had with gun violence in our school system and it will not be the last. The active shooter drills have become little more than a reminder of the threat teachers face each day. Our community is dealing with a public health crisis.

In these days of social media, it’s all too easy to sit at home in an armchair following the news of another gun-related tragedy and simply echo the talking points of one’s favorite political party on Twitter. However, I believe the actuarial profession is above such partisan squabble and is in a prime position to affect real change in order to benefit our community. We have to do more than simply acknowledge the issue. We need to take action to curb the spread of this public health crisis. Our community’s health is at stake.

Is This A Public Health Issue?

In 2017Axene Health Partners published a series on Accountability in the Healthcare System and defined Public Health as:

“Public health fundamentally promotes and protects the health of people and their communities. The three primary ways in which public health systems influence our lives are (1) through the development of community programs, (2) through advocating for health- and safety-promoting policies, and (3) through dissemination of evidence-based information.”¹

One of the key take-aways from the article suggests most healthcare money is spent on treatment rather than prevention. And an even smaller percentage is spent on public health. Our community could benefit from policymakers and other key stakeholders in the healthcare industry taking action to expand public health focused programs in an effort to curb long-term healthcare costs related to gun violence.

Real Costs

While gun-related suicides and homicides are increasing year after year², death from gun violence is only one factor related to healthcare costs. According to the CDC’s Web-based Injury Statistics Query, for every death there are two to three injuries. Add in injuries from accidental discharges, ongoing behavioral health treatment for PTSD and counseling for survivors and we begin to see the growing cost impact.  Never mind that gunshot wounds are significantly more expensive to treat than other non-fatal injuries. It is clear gun violence results in real costs to the healthcare system which eventually get passed through to the rest of us through higher insurance premiums.

Accountability

As members of the community and the healthcare space, we need to be doing everything we can to address this issue. Public health is an important part of the solution to rising healthcare costs and gun violence is an issue continuously in the spotlight. If we want to have Total Accountability as defined in the AHP accountability series, there are some questions we need to ask ourselves based on the public health definition:

• Are we developing community programs to curb gun violence?
• Are we advocating for safe communities by researching and lobbying for programs and policies that reduce gun violence?³
• Do we hold our representatives accountable for enacting legislation?
• What evidence-based information could we disseminate related to this issue?

It is this last question where the actuarial profession has ample opportunity to improve public health. In fact, it is a moral and ethical responsibility.

Responsibility

Actuaries have and can access information not readily available to the wider community. With the detailed claims data available to actuaries, one can envision using that data to study the impact of gun-related injuries and deaths on healthcare costs. Much like the recent Rand Corporation study of how gun policies affect outcomes. Actuaries are in a position to benefit the public by performing such studies and should be held accountable for doing so.

As members of the community, actuaries have taken on other public health issues. Actuaries have partnered with key stakeholders to develop tools to address Climate Change. Joint research ventures have provided data and analysis for battling the Opioid Crisis. We have the same responsibility with the public health issue of gun violence. What might an analysis of gunshot wounds’ impact on cost of care show? Could a comparison be made between the cost of care in a state with stricter gun laws and a state without such regulation? What might that reveal? These are just basic examples of what insight actuaries can deliver. Answers to these types of questions could provide actionable data to key decision makers and legislators.

Conclusion

We are in the midst of a national public health crisis due to gun violence. Taking action on gun violence often faces challenges from oppositional political forces that undermine what is best for public health. If we agree that public health is about creating conditions to make people healthy, then Dr. Sandro Galea is correct when stating “public health has a moral imperative to engage with efforts to shift the cultural forces” at work behind the spread of gun violence.⁴ Actuaries and those consulting in the healthcare space have the tools, experience, connections and policy expertise to make a significant impact addressing gun violence as a public health issue. This is the time to stop making excuses, move beyond merely acknowledging reality and take direct action.

^1,3 https://axenehp.com/accountability-inspire-series-public-health/

²Centers for disease Control and Prevention, Web-based Injury Statistics Query 2014

⁴https://www.bu.edu/sph/2015/11/29/secondosis-a-case-study-in-stymied-disease-prevention/

Lonnie Campbell is the Director of Marketing for Axene Health Partners, LLC and is based in AHP’s Temecula, CA office.