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A scholar of gun policy says his field has gotten it wrong

A longtime advocate of the public health approach to stemming gun violence says it has had disastrous unintended consequences.

Police tape blocked off a Waffle House restaurant in Nashville, Tenn., after a gunman opened fire at the restaurant on April 22, 2018.Mark Humphrey/Associated Press

It went according to a now too familiar script: On Sunday, April 22, 2018, a white man with a history of mental illness and previous run-ins with law enforcement drove into a Waffle House restaurant southeast of Nashville, Tenn., and opened fire with his AR-15-style rifle, killing four and injuring several others. Grieving family members, activists, public health experts, and the city’s mayor called for gun reform. Instead, six and a half months later, Tennesseans elected a pro-gun governor who overturned already lax gun regulations, making it possible for almost anyone to carry guns in public places, including in bars and near schools.

That outcome may seem like a paradox, but it is the logic of our gun politics, says Jonathan Metzl, a psychiatrist and sociologist who directs the department of medicine, health, and society at Vanderbilt University in Nashville. In his new book, “What We’ve Become: Living and Dying in a Country of Arms,” Metzl, long a vocal supporter of public health policies aimed at reducing gun violence, writes that those who view guns as vectors of disease curable only through the enactment of public health policies are missing a crucial political piece. Blue state liberals seeking to curb gun violence have pathologized by association all American gun owners. Framing gun violence as a public health epidemic has failed, Metzl says.


My interview with Metzl has been edited and condensed.

Can you explain what a public health framework on gun violence has meant?

There’s a long and proud history of public health scholars, doctors, and activists taking a health framework to consumer products that kill people. That playbook worked well with cigarettes or faulty seat belts in cars or asbestos insulation. The idea was that if you could show the negative health effects of a product, that would lead to corporate accountability and bring about regulations and health policies that improve health. The health framework has been very effective.


Starting in the 1980s and 1990s, we began applying it to guns. We began tracking the health toll that guns take on our nation: how many injuries and deaths there are, soaring rates of gun suicides, gun homicides, accidental shootings. The idea was that those injuries and deaths could be dealt with the same way we dealt with cigarettes and seat belts, which is to highlight the health effects, create health policies, and bring about corporate accountability and government oversight.

Jonathan Metzl, author ofHamilton Matthew Masters

This public health approach to gun violence has had disastrous consequences, you write. How so?

Part of the issue is not recognizing that guns are very political, which seems obvious now but wasn’t quite as obvious in the 1990s and early 2000s. We thought that of course people are going to do what the government says. But we didn’t realize that gun ownership intersects with the histories of race and gender and geography in America in important ways, and our models didn’t account for that. The other part is that gun rights advocates have been saying that gun control is biased against them. I’m an advocate of public health. I’m a doctor. But when I began tracking this history, I started noticing the assumptions about gun owners that were sewn into the public health model. I think public health hasn’t recognized its own politics. In other words, from the beginning, the framing was this: Public health was common sense and gun owners were seen as lacking common sense, irrational.


One example: We built all our policies in the aftermath of mass shootings, and so a lot of gun owners felt like they were being conflated with the mass shooters.

There are also profound assumptions about race that are part of different public health policies. For example, red flag laws require that relatives call the police to come remove firearms from family members, but gun owners of color I talked to mistrusted the police and didn’t want to invite authorities to assess their own relatives.

Do most mass shooters suffer from mental illness?

I spend a lot of time unpacking the mental health narrative, and I hope my book shows why it’s based as much in myth and stereotype as in reality. Yes, many mass shooters suffer from psychiatric symptoms — but that’s very different from saying that mental illness caused them to commit murder. This stereotype covers over the many other factors — bad gun laws, substance use, misogyny, previous history of violence, access to guns, and others — that are more central causal factors pretty much in every shooting, even when shooters are also mentally ill.

The 1996 Dickey Amendment prevented the Centers for Disease Control and Prevention from using its funding “to advocate or promote gun control.” This effectively shut down data gathering about gun violence in the United States, and you write that it created a divide between researchers and conservative gun owners. How so?


It reinforced the divide between red state gun owners and blue state researchers. A lot of the universities that could fund gun research were in blue states. A lot of people who wanted to do gun research were people like me, who were liberals. A lot of gun owners didn’t see gun research as representing their interests and were hostile to a lot of things people in public health were proposing. It created a structural divide, where blue state researchers and liberal researchers were creating policies that people who had guns, who were conservative red state people, would then have to follow. It was a very paternalistic assumption that was not obvious to many people. I was part of this. It’s different from cigarettes, for example, where everybody knows somebody who smokes. There wasn’t this geographical and ideological divide in other public health campaigns.

Gun politics is also racial politics. You note that our cultural scripts code white gun owners as patriots and Black gun owners as threats. The gun industry is attuned to this and exploits it for profit by pushing different messages to different groups. Is there a way to intervene in this profit-motivated escalation of fear-driven gun ownership?

After the police killing of George Floyd, gun companies were directly advertising to Black Americans, telling them that the police were not going to protect them. And then they would advertise to white people and say, look, these Black people are buying all the guns, you better get more guns. It’s a circuit. In the Sandy Hook case, gun manufacturers got in trouble for advertising. [Editor’s note: The families of the slain sued Remington for marketing their AR-15 rifle in ways that appealed to troubled men, in violation of Connecticut’s consumer protection laws.] So there’s some promise with regulating advertising. But there also needs to be a counternarrative. Every time some group is under attack, the gun industry narrative is: Go get guns because you need them to protect yourself. It’s such an effective, powerful narrative. There needs to be a counternarrative that speaks to the importance of community cohesion. The answer is not background checks or red flag laws. The answer is to build communities that are safe across divides. I argue for the importance of championing a broader agenda that joins public health with structural support for the safety of public spaces and democratic institutions.


So how do you do that? Both gun reform advocates and gun owners care about public safety and protection. The problem is that they do not have a shared understanding of what public safety means.

In my ideal world, we don’t have to argue about this. There are ways to build consensus.

The Supreme Court has been chipping away at gun laws in blue states and cities. The Bruen decision, which ruled that the ability to carry a pistol in public is a constitutional right guaranteed by the Second Amendment, has had repercussions for Boston and the surrounding area, where police used to have broad discretion over issuing licenses to carry — but not anymore. If we are so divided, how can we agree on gun policies that would be acceptable nationally?

I think we have to overturn Bruen and we have to overturn these ridiculous public carry laws that are permissive to the point of absurdity. But I don’t think we’re going to do it by building a coalition around background checks and red flag laws. Over the five years that I was writing this book, 27, now 28, states have passed open carry legislation, we’ve surpassed 500 million guns owned, and then the Bruen case happened. This shows that our coalition for this issue is not as big as it seems. And it’s concentrated in places that are already going to vote to support gun restrictions. I’m trying to imagine how we can build a broader coalition of people who see that gun safety is in their self-interest.

Ieva Jusionyte is an associate professor at Brown University and author of the forthcoming book “Exit Wounds: How America’s Guns Fuel Violence Across the Border.”

Jonathan Metzl will be discussing his new book tonight at Harvard Book Store in Cambridge, at 7 p.m.