Some of the deadliest mass shootings in U.S. history, including lone gunmen killing 26 people at the First Baptist Church in Sutherland Springs, Texas, and 17 students and staff at Marjory Stoneman Douglas High School in Parkland, Florida, have occurred in the past 2 years.
These tragedies were preventable, says Garen Wintemute, an emergency medicine physician at the University of California (UC), Davis, Medical Center, and the director of UC Davis’s Violence Prevention Research Program. Wintemute has studied gun violence for more than 30 years and is one of the few researchers to approach the matter as an issue of public health. He has gone undercover at gun shows to document illegal activity and worked with California lawmakers to establish gun policies.
Wintemute writes about his solutions to gun violence in an opinion piece published this week in The New England Journal of Medicine. Science chatted with him about the unique factors behind mass shootings and which policy interventions are most effective. This interview has been edited for clarity and length.
Q: What does it mean to approach gun violence from a public health perspective?
A: Firearm violence has been seen traditionally as a crime problem. But gun violence is one of our leading causes of death and injury, and the implications of this violence are huge in terms of the safety and health of our overall population. So, we treat it as we would any other major health problem. We ask: Where does it come from? How does it get amplified? Who is at risk for developing this problem? Can we learn enough to create a treatment or prevention strategy?
Q: How are mass shootings different from other acts of gun violence?
A: They are rare, accounting for maybe 1% of deaths from firearm violence. But they are also unique. They are the one form of violence about which no one can tell a story that leaves themselves out. It could happen to me. It could happen to my children. It could happen to my grandchildren. What public mass shootings have sadly done is, for the first time in history, made this everyone’s problem. The specific role of my article is to point out that there are some very specific things that we can do to help make these events a lot less likely to happen.
Q: The first way you say we can stop mass shootings is through better background checks. How do we improve them?
A: Twenty-two percent of all firearm transfers in the country do not involve a background check. These take place over the internet, at gun shows, or a brokered through “friend of a friend” exchanges. Some states require a background check for all transfers of firearms, but most states do not, and the federal government does not. Comprehensive, well-designed background checks, as well as regular reporting by agencies of incidents that would prohibit someone from purchasing a gun would let us see the full effectiveness of this policy.
Q: Your second recommendation is for gun violence restraining orders. What do these involve?
A: If a person is credibly believed to be at high and imminent risk of doing harm and has access to firearms, these laws allow law enforcement or family members to go to a judge and present the evidence just as they would in any other court proceeding. The judge can then issue an order that authorizes law enforcement to recover firearms from this individual for a defined period of time, typically just 2 or 3 weeks.
These orders, if properly used, would not just prevent individual tragedies but could probably drop rates of violence altogether because it’s so common that a future shooter puts out unmistakable signals of intent to do harm. This can mean telling hospital staff, friends, or family that they’re planning on hurting themselves or others. It can mean unusual patterns of purchasing weapons, like purchasing several firearms in a short time span. Here in California, I am aware of two mass shootings that did not occur because the intended shooters said things like, “I’m going to shoot up a school,” which came to the attention of law enforcement.
Q: Do you ever encounter resistance to your work because of the political debate around gun control?
A: There’s always controversy with this sort of work, but to me the common ground far outweighs it. One of the policy proposals that is widely seen as highly controversial is to require a background check for all purchases of firearms. More than 90% of the population supports that measure, but so do more than 80% of gun owners and more than 70% of self-identified members of the National Rifle Association.
A mistake that is often made—it’s made by the public, it’s made by the media—is to pay attention to the extremes and ignore the fact that the country has basically made up its mind on this one. We just need our leadership to represent the opinions of the people and not the opinions of the extremes.
Q: What are you going to study next?
A: We’re conducting a true randomized trial of an intervention here in California that identifies people who legally purchased firearms in the past but have just become prohibited from owning firearms. They’ve just been convicted of a violent crime, or they've just been served with a domestic violence restraining order, or they’ve just been hospitalized for a psychiatric emergency related to dangerousness to self or others. The intervention in California identifies those people, then puts law enforcement officers at the front door to recover the firearms. Intuitively, it sounds like a good idea, but no one knows whether that process is effective in reducing rates in violence. We are collaborating with enforcement agencies on a randomized trial that involves almost the entire state. This is the same process used throughout medical research to test how effective a given treatment is—only this time the treatment is a firearm policy.