Stopping the Gun 'Epidemic': A Prescription From Philly


In 1910, 270 Philadelphians died of typhoid fever. Just over a hundred years later, in 2011, nearly the same number of Philadelphians (264) died of gunshot wounds. While a century-old typhoid epidemic may seem far removed from present-day gun violence, there are lessons to be learned.

Typhoid fever was a pervasive fact of urban life, both endemic (a persistent high level of deaths each year) and epidemic (cycles of particularly high numbers of deaths). Like firearm deaths, epidemic years brought attention to the problem above an existing high level of deaths.

Unlike typhoid deaths, which were beginning to drop dramatically in 1910, firearm-related deaths in Philadelphia are not declining. We seem to be in the midst of another epidemic of violence as summer closes, on track to reach a five year high in homicides and in shootings. Over 75 percent of homicides are by firearm. About 15 percent of total shootings result in deaths.

The causes advanced for this latest epidemic range from the summer heat, and the economic crisis to the lack of jobs for youth. Some observers point to a new generation of vulnerable, high-risk youth; others blame an increased supply of firearms.

A look at the data suggests there is no single right answer. We need to seek ways to disrupt both epidemic and endemic violence.

So what can we learn from Philadelphia's earlier battle with typhoid fever? Here are some lessons worth considering.

Find long-term solutions

While epidemics can raise awareness and mobilize action, we often lose interest or, worse, declare a premature victory as they wane. We should view firearm injury as unacceptably high even in good years with “only” 1,500 shooting victims or 240 firearm deaths.

Effectively regulate the risk

Just as targeted regulation of the water supply has increased access to safe water and reduced the availability of dangerous water, a targeted and practical approach to regulating firearms can improve safe access to firearms—while reducing circumstances when gun access is most dangerous.

Truly responsible gun owners should actively engage in efforts for socially responsible and effective regulation, monitoring and enforcement.

Adapt city-wide prevention strategies

Much typhoid was water-borne. A city-wide effort to protect and treat the water supply dropped the number of deaths tenfold.

Changing the environment to provide clean water city-wide had a much bigger impact than advice on boiling water or the quarantine of carriers. Boiling water at home didn't help when people left for work, shopping or school. Quarantines often had unintended consequences.

Today, as Philadelphia faces a firearm-borne epidemic, we also need a comprehensive, citywide approach. We won't escape this epidemic by moving away, locking everyone up, or staying safely at home.

Invest in the future

Improving Philadelphia's water supply was expensive and controversial, running counter to some political and economic interests. There was significant debate on who was responsible, but eventually this shifted to “who could be effective.”

Action became more important than blame. A broad coalition of citizens came together to push toward a long term plan. Access to clean water was a highly successful investment for the city, reducing not just typhoid and other water-borne diseases, but also improving the quality of life and chances for civic development.

Embed solutions into daily life and existing infrastructures.

There are many promising prevention strategies for violence prevention, some requiring only small changes.

These can be embedded into the daily life in the city and in public and private practices. Identifying the roles that all citizens can play in achieving sustainable change could establish a long-term infrastructure for prevention.

Such roles include: supporting healthy brain development, improving coping skills, improving the physical and social environment for young parents and for youth, and reducing weapon carrying among young people. Private and public entities could optimize their operations to reduce the chronic causes of distress, and promote resilience, safety and well-being

Change the impact of violence

The impact of violence goes beyond shooting deaths and gunshot injuries. New brain science is beginning to show us how violence affects healthy physical, emotional, social, and civic development.

This impact can be intergenerational. It spreads through communities and affects individuals, providers and systems.

There are some hospital-community partnerships currently seeking to address this. Expanding this trauma-informed model further is not just a promising approach to the gun epidemic in Philadelphia and elsewhere: it's a practical one.

Rose Cheney is Adjunct Assistant Professor of Surgery and Executive Director of the Firearm & Injury Center at Penn (FICAP) at the University of Pennsylvania. She welcomes comments from readers.

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