Gun Violence in Maine, and Beyond
Dan Onion, MD, MPH
Mt. Vernon/Vienna Health Officer
I am writing this on March 25, the day after huge marches to demand action to reduce gun violence were held locally and all over the country, along with some counter marches. Those marches and a recent dialog I had with Mt. Vernon's most prominent sportsman, George Smith, (see his Bangor Daily News blog) lead me to want to expand the discussion of gun violence to other related and alarmingly bad public health transformations we seem to be suffering.
In our published dialog, I said to George: " Gun violence is on the rise, as school and other mass shootings are becoming more and more commonplace. Several instances have been thankfully prevented recently in Maine. Domestic violence against women and children in Maine has been and continues to be a perennial cause of injury and death, the latter often perpetrated with guns (over 12 each year, half of all Maine homicides, and half are children under 13). And finally, suicide by guns (half of all Maine suicides) is also a major risk and increasing here in Maine. All three examples are especially impacting teenagers and young adults, and thus dramatically increase the 'years of potential life lost,' as the 'public healthies' like me use to measure the payoff of a public health issue intervention."
The mass shootings have prompted outrage and demonstrations. They have increased dramatically after the 1994 ban on assault weapons was reversed in 2004. Fixing or moderating such high-risk gun use needs doing. I've hunted all my life, as have most rural people; but these aren't hunting guns we are talking about. Access to any weapon that carries significant risks to others is no more a right than is driving on the wrong side of the road or drunk!
But it ain't just guns that are playing an increasing role in premature deaths here in Maine and the nation. So too are other deaths now classified as "unintentional deaths," like the rising number of narcotic overdoses, car crashes, falls and other accidents often associated with alcohol use, as well as diseases like hepatitis (from needle transmitted hepatitis, alcohol, and/or diabetes), and lung cancer and emphysema from smoking. Unlike mass shootings, these deaths, as well as clear suicides, seem to be rapidly increasing most in rural areas, disproportionately afflicting the white households with lower incomes and education levels, to the point that their overall age-adjusted mortalities are worsening or at least not improving overall unlike the other segments of our US population, as illustrated in sub-groups in the graphs below,. I urge you to go to the Washington Post reference #2 below, which allows you to look at those subgroups in various combinations, like urban vs rural, males vs females, White/Black/Hispanic, region of the country, and by 5-year age groups.
Most of these potential causes seem likely caused by increasing risky behaviors in the subgroups, perhaps related to the increasing income disparities in the US among segments of the population over the past 50 years, even though all have improved over their historical averages. Perhaps what matters more than one's own situation compared to that of one's parents, is how one now compares to one's peers and neighbors. When social safety nets are trimmed or dismantled, like the Affordable Care Act, MaineCare , and food stamps, we see more illness and downright despair and thus suicide, murder, accidental overdoses of opiates, and death through recklessness and/or depression.
Other research, like ours I frequently cite done in Franklin County Maine over the past 50 years, shows that community-wide engagement in preventive activities like education and social pressure can counteract some of these bad outcomes, despite socio-economic impediments. The ability to initiate and maintain community interventions seems to hinge on how much "Social Capital" the community has or can muster. In other words, can and does the community exhibit altruistic interactions and programs open to all.
Demonstrators are now demanding more gun controls since mass shootings have become commonplace. It may be that such shootings have now extended such unintentional harms from the poorest, least politically powerful of our society, into the middle classes. Our schools especially are melting pots of all classes. Their unfortunate vulnerability now may increase the likelihood of real change in gun laws and perhaps eventually even some of the income disparities, which may be causal. I certainly hope so!
Still, I think we need concerted efforts to develop and sustain local community-wide programs to reduce the despair and risk-taking among those most at risk, and to provide compassionate outreach, and evidence-based interventions to turn this nearly two-decade-long spiral of worsening mortality in our populations. Mt. Vernon and Vienna do a lot of that already through volunteers who organize community center and church dinners, Neighbors Driving Neighbors, the Grange, our churches, the food bank, the Mt. Vernon Community Partnership, and our library, and probably more I am forgetting, in addition to the many individual acts of human kindness and support we see here every day. We need to keep it up and recruit even more to participate. Kindness and caring not only enrich a community, but also save lives.