What is the role of Public Health? Reflections following the Newtown Tragedy

By Sonja Ausen-Anifrani

Following the tragedy in Newtown, Connecticut on 14 December 2012 much has been discussed and debated surrounding the need and efficacy of stricter gun control laws. Worth discussion, certainly, given the magnitude of loss – all preventable.  Proposals have begun to surface across the nation and they will most definitely make appearances in both state and national legislative discussions.  These kinds of catastrophes compel us to propose (and defend) immediate solutions with righteous fervor. The complexity of these kinds of events also demands that we think critically – and strategically –  about the far reaching implications of any new policy effort and the contributing factors that must be considered in order to achieve the most comprehensive solution possible.  This blog by Heidi Ombisa of the Center for Advanced Studies in Child Welfare raises an important point that can encourage us to temper our response:

I do not have an answer on whether the policy discussion should begin immediately or wait. But I do think it is important for policymakers and advocates to be mindful of potential negative outcomes as they begin crafting legislation meant to prevent such acts of violence from occurring. Putting prevention legislation on the fast track in order to appease the public outcry is never a good idea.

What is the role of public health during crisis like this? Certainly, discussion surrounding gun control and gun violence as an important public health issue is important.  The United States, as we’ve all recently been made well aware, has the highest level gun ownership and startling levels of gun violence.   Public health practice offers a framework and support science to address and shift the social norms, change how the roles of professionals are defined,  help us understand the role media plays in violence and how to better use media to change the paradigm around gun ownership and violence, and provide an organizing structure for the implementation of population-level interventions.  We would be remiss not to consider the important role that assuring mental health has in preventing tragedies like those we’ve seen recently. How we prevent, treat and discuss mental health – and mental illness – in this country is as essential to this discussion as is considering a renewal of the ban on semi-automatic assault weapons.  How we respond to this trauma and others like it, will have a lasting impact. It is our role as public health practitioners – across our respective fields – to consider how we may best respond across our spheres of influence to mitigate this impact while considering other evidence-based prevention and  intervention strategies that hold promise for reducing the frequency, severity and traumatic impact of catastrophic acts of preventable violence. How do we build our capacity for recovery – for restoring our collective wellbeing and healing through such events? What is our personal or professional responsibility?

As if this story isn’t already enough to reflect on, there is a seemingly never-ending list of disastrous events with huge public health implications. Women and children Syrian refugees.  Sexual violence, water, and food concerns in the Democratic Republic of Congo. Chronic disease epidemics related to obesity.  Impacts of climate change.   Violence against immunization health workers in Pakistan. Lack of reproductive health access and high maternal mortality rates in developing countries.  By the time my mind has scrolled through this litany of current events, my morale has dropped and my heart sinks as I consider these health-related tragedies and traumatic experiences that impact individuals each day.  While garnering less media coverage, these  circumstances are just as tragic and each of them requires our attention. What, possibly, are the strategies that can begin to piece together appropriate and successful solutions to these challenges?

I pause to further consider the indisputable and essential role that public health practice offers amidst these events—prevention, policy, and passion that meld together to begin to initiate changes. Mark Bittman alludes to the “public health cliff” in his recent New York Times article; increasing awareness of and lessening the degree of this cliff envelopes our task as public health workers and is the driver of these changes.  More than ever, this work matters; therefore, despite the immensity of the challenges, we must continue to be advocates for health justice and, most importantly, we must continue to care and to be aware of public health plights the world over.

The writer of the above referenced blog post asks readers in response to gun control policy: “If you were (or if you will be) a part of the policy discussion, what policy solution(s) would you raise?”  I propose taking this important question a step further in order to incorporate public health:  Whilst considering the vast array of health related tragedy, how do we formulate wise and effective public health policy that tempers our emotional response to devastation and gives us the courage to move forward in addressing seemingly impossible problems?

Sonja Ausen-Anifrani is an MPH graduate student in the Maternal and Child Public Health program at the University of Minnesota.