One of the greatest triumphs in health over the past century has been the dramatic decrease in childhood mortality. And yet, children still die, and that suggests that we should be looking carefully at what kills our children, and asking what we can do about it.
The firearm, obesity, and opioid epidemics are among the most important public health crises of our time. Each epidemic has a complex etiology that challenges efforts at mitigation. From this, a central question arises for researchers, clinicians, and policymakers: How can we identify what matters most within a broad range of causal factors in these epidemics, and can we draw cross-epidemic inferences that will help inform our thinking?
The principles of population health science can shed light on the fundamental forces that drive each epidemic. Because population health science is a relatively new field, we do not yet have substantial agreement on a set of axioms to guide our work.1 Two years ago, building on the work of Geoffrey Rose,2 a colleague and I proposed 9 principles to guide the science of population health.3 These principles, presented in the box, offer a framework that can inform research on the drivers of population health. I focus here on 2 of these principles to illustrate how they can apply to—and help set priorities for—these 3 wide-ranging epidemics.
Suicide is one of the very few causes of death that have remained stubbornly steady over nearly the past century. A recent CDC report showed that suicide rates have risen about 30% in the United States since 1999. This report revealed an increase among all sexes, racial/ethnic groups, and all ages; in 2016 there were nearly 45,000 suicides in the US. With the recent increase adding fuel to our concern, suicide is now the tenth leading cause of death in the country.
Next weekend, Americans will wear orange to mark Gun Violence Awareness Day and advocate for changes to our laws that could help stem the tide of firearm violence in this country. The recent shooting at Santa Fe High School in Texas, which killed 10 people, underscored the need for reform, as did the many shootings that came before it, as will the many shootings that will follow if we persist in our collective inaction. With this in mind, we today rerun a modified version of a Dean’s Note on guns and public health. It is no accident that the original version of this note was one of the first I wrote when I became dean of the School of Public Health in 2015. I have come to believe that gun violence is among the preeminent public health challenges of our time, a belief shared by many in our field, and, hearteningly, an increasing number of people outside of it. The growing acknowledgement that gun violence is indeed a public health problem opens the door to public health solutions, and a commonsense, data-informed approach to this challenge, as the gun debate continues to unfold.
The February 14 shooting in the Stoneman Douglas High School in Parkland, Florida, reminded us once again about the horrific toll of gun violence on the United States. This was the 18th school shooting in the US this year; in Parkland, 17 students were killed and about as many were injured. The shooter used an AR-15 semi-automatic rifle, the same weapon used in many other high-profile mass shootings, including Sandy Hook. These guns have been widely available in the United States ever since Congress allowed the federal assault weapons ban to expire in 2004.
It seems that not a week passes without a new report of a mass shootingin the United States.
The gun epidemic, long simmering, has in the past few weeks seemed to reach a new phase in the public discourse. The shootings in San Bernardino, California occasioned a nearly unprecedented front-page editorial in The New York Times, the country’s “paper of record,” together with comments, once again, from the president, urging congress to act on regulating firearms and firearm violence.