The mass shooting Thursday at Umpqua Community College in Oregon is heartbreaking—especially for the students and families directly affected. But it is tragic in a different way for those of us in public health who have followed the trajectory of gun violence in the U.S. and tried to sound a call for change.

Firearm deaths are a preventable epidemic.

There is no other cause of death that we know how to prevent so readily—and that, time and time again, we do nothing about.

Early last summer, seeking to combat an unprecedented crisis of opioid abuse, Gov. Charlie Baker asked the Legislature for $28 million in extra state spending on treatment and prevention. That initiative is the latest example of Massachusetts’ progressive approach to tackling public health issues. I propose that the state — with that same laser focus and commitment — undertake 10 additional reforms that would dramatically improve our residents’ public health.

Ambitious programs to improve the U.S. health care system typically include improving population health in their objectives. For example, that is one of the Institute for Healthcare Improvement’s “Triple Aims” (along with improving the patient experience and lowering the per capita cost of care). Similarly, the Affordable Care Act (ACA) is designed to improve population health in multiple ways, the most obvious being improved access to care. But the ACA also aims to improve the quality of care, enhance prevention, and promote health through the implementation of affordable care organizations (ACOs) and the establishment of a new Prevention and Public Health Fund.

While European leaders publicly fret about installing quotas over the influx of migrants seeking asylum into Greece, Italy and other European Union nations, very little has been done to make sure that those who are given asylum are well received in the countries to which they attempt to migrate.

Discussion about meeting the refugees’ complex health needs, especially their long-term needs, has been particularly lacking.

Ten years ago this month, Hurricane Katrina made landfall along the Gulf Coast, claiming more than 1,800 lives and damaging more than $100 billion in property in a mass tragedy that captured the attention of the world.

But long after the news crews left New Orleans, the consequences of Katrina continued to play out — not just in the well being of area residents, but in the larger understanding of the impact that disasters have on population health. It has become increasingly clear in the last decade that community-building supports and long-term mental health assistance improve resilience after mass disasters.

In ruling that the 14th Amendment requires states to issue marriage licenses to same-sex couples and recognize same-sex marriages performed in other states, the U.S. Supreme Court, in Obergefell vs. Hodges, not only addressed a fundamental issue of equality, but may have unwittingly contributed to improved public health.

Consider the research devoted to the health of LGBT (lesbian, gay, bisexual and transgender) populations. A growing body of work shows that their health is worse on multiple levels than the health of comparable majority populations. This work reflects a key foundation of public health that I have discussed previously: Context plays an ineluctable role in shaping the health of populations.

The world has enjoyed tremendous improvements in health over the past century.  We have gained almost 20 years in life expectancy globally over the past 50 years. Just to give one example, children in Chile now can expect to live to age 79, while in 1950 they could expect to live to 55.   Much of this improvement in the health of populations comes from changes in the world around us, structural efforts that create the conditions that enable population health.  Some of these core changes in the past century were improvements in food supplies, sanitation, cleaner air, and declining birth rates.

To the Editor: 

It is unfortunate that Nina Teicholz throws out the methodological baby with the policy bathwater.

She is right that we have not been served well by policy making that has been enamored of compelling but probably unsound dietary advice. But epidemiologic data is not the culprit. Observational studies can yield insights that guide causal inference as much as experimental studies can.