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“This society has chosen to live with guns,” Dr. William Schwab was saying in July, as he stood before a roomful of reporters in a Penn Law classroom. “There are over 220 million guns in circulation in the United States of America. There is nothing that’s going to take those guns away.”

Schwab, a professor of surgery and the chief of traumatology and surgical critical care at the University of Pennsylvania Health System, is intimate with the consequences of that number. Over the past decade, he and his surgical team have treated over 3,000 gunshot wounds—and that’s only a fraction of Philadelphia’s total.

“This city in the last year has had 2,000 people admitted to its trauma centers for gunshot wounds,” he went on. “What’s interesting is that if you do the numbers and you believe the FBI, only 11 percent of bullets ever strike the person they’re aimed at … Just do the multiplier there, and you’ll say that we had people shooting at each other 20,000 times this year. This is a phenomenal epidemic and something that has to be dealt with.”

If that sounds like the wind-up for a proposal to gut the Second Amendment, get ready for a curveball. Because Schwab isn’t really interested in “gun control,” which, after all, is right up there with abortion and gay marriage atop the list of issues that most polarize the American electorate. What he wants is to reduce gun violence and the impact it has on its victims. And like the other half-dozen panelists at this media seminar, Schwab has concluded that talking about firearm bans is a dead end in that quest.

“The issues all become politicized and then you can’t talk about it,” said Dr. Donald Kettl, director of the Fels Institute of Government and the panel’s moderator. The question is, he continued, “Can you reframe the issue to find a safe way to talk about it?”

The answer, panelists contended, is yes—by shifting the focus toward a public health model of violence. Comparing gun violence to a malaria epidemic, Schwab said, “This involves an environment, a host, and a vector. It’s very similar to an infectious disease.”

“The environment could be anywhere,” he added, “the hosts are the people involved—the person who was shot—and then the vector, in fact, is the bullet.”

Of course, the environments in which most gun homicides take place are typically urban and poor. A high proportion of the young men in such neighborhoods are unemployed, giving them ample leisure time to become involved in contests of honor and personal disputes. And there is evidence to suggest that gun ownership is attractive even to law-abiding citizens in such areas, who may reason that police protection is an insufficient guarantor of their safety. It doesn’t take much imagination to see how this feedback loop can take on the contour of an arms race.

High gun density is a good predictor of elevated gun violence, according to Dr. Lawrence Sherman, director of the Jerry Lee Center of Criminology and professor of sociology at Penn. But there’s also a substantial level of spontaneity in gun-mediated arguments, he added, and the large majority of disputes don’t last long enough to allow someone without a firearm to go home and fetch one.

“The rule seems to be that if you don’t have the gun at the point of time you’re confronting somebody and you’re angry at them, you’re much less likely to end up killing them,” Sherman said.

One challenge, therefore, is finding a way to reduce the level of gun-carrying in public, where most of these homicides happen.

This idea played a role in Philadelphia’s Democratic mayoral primary campaign, during which eventual winner Michael Nutter W’79 proposed expanding the police’s ability to stop and frisk people on the streets. Sherman presented several experimental studies indicating that such a policy can be very effective at reducing gun violence—even, somewhat surprisingly, if there’s no increase in the number of guns seized.

“There’s kind of two different models,” he said. The first is “the idea of a ‘take-away’ model, where the more guns seized, the less guns are carried. But I think what’s really working is a ‘keep-away’ model. That is, if you are deterred from carrying your gun into an area where police might take it away from you, you don’t want lose it, even for the week or two it takes to replace it, because somebody might hear that the cops took your gun, and they might come after you because you’re unarmed.”

In other words, a policing tactic that has stood up to Supreme Court scrutiny in the past, if applied without racial bias, might work without changing the laws regulating gun ownership. In a sense, the goal would be to bring city streets closer in line with airports and courtrooms, from which guns have been successfully excluded.

On the other side of the equation, there’s the host. Many victims of gunshot wounds survive, and some emerge with the motivation to exact vengeance. (Similarly, some perpetrators of gun violence are themselves victims of other traumas, such as child abuse.)

“A growing body of evidence is that trauma is a predictor and a treatable cause—a preventable cause—of homicide,” said Sherman.

Dr. Therese Richmond, an associate professor in the School of Nursing and director of the Firearm and Injury Center at Penn (FICAP), detailed a laundry list of consequences for gunshot injury victims. “The psychological consequences are profound,” she said. Depression is common. Families of victims are often wracked with anguish. Some survivors find it difficult or impossible to leave their homes because of fear.

Unfortunately, Richmond and others said, the federal government has crippled the ability of researchers to get funding for studies treating gun violence as a public health issue. In 1996, Congress effectively gagged the Centers for Disease Control from pursuing any injury-prevention research that might conceivably give gun-control advocates rhetorical ammunition.

The National Institutes of Health haven’t been much better, according to FICAP. Despite the more than 3 million shootings that took place between 1973 and 2002, the NIH awarded only two grants for prevention research during that stretch.

“To this day,” Schwab said, “the CDC or any other agency cannot fund researchers if any of that research can be used, or might even be thought to be used, to control guns. And again, the researchers in this business … don’t want to use this about gun control. What we want to do is look at this as any other pubic health problem.”

Whether that means reducing gun density on city streets, helping victims overcome the mental and physical trauma that impedes them from being productive in society, or using counseling in an effort to break cycles of violence, the panelists were trying to drive media debate in a particular direction. Setting up an analogy to one of the great public health successes of the last century, Dr. Richmond observed that automobile death and injury rates have dropped significantly over the past few decades in America, despite the fact that we have “way more cars, way more people, way more miles driven.”

“We didn’t say, Get rid of cars,” Richmond said. “What we did say is, How can we make the interaction of cars, the environment, and people safer?”—and answered by introducing graduated driving licenses, seatbelts, airbags, tougher laws against drunk driving, and the like. Having chosen to live with guns, she said, the challenge is to do so as safely as we can.

“This is a public health problem,” said Schwab, her colleague at FICAP. “This is a public health nightmare.”


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