Charles Branas Finds Public Health Solutions for Gun Violence

Bridget O'Brian
April 02, 2018

At first glance, abandoned spaces in cities and gun violence would appear to have little in common. Charles Branas, who joined the Mailman School of Public Health over a year ago as chair of its Department of Epidemiology, has made the connection, and it is offering large returns for cities and the country at a time when solutions to gun violence are not easy to come by.

“I had worked on more traditional approaches to gun violence—conflict-resolution programs, testing new laws, etc.—but we met with little success and a lot of political opposition,” he said. “When these ideas did work, they often couldn’t be sustained.”

About a decade ago, Branas and colleagues, whose expertise ranged from epidemiology to criminology to anthropology, began asking communities in different cities what they would do. “Everyone had a lot of ideas, but the one that kept coming up from different neighbors and local groups was how vacant and abandoned spaces scared them,” he said. “People were seeing all sorts of violence and dangerous activity in and around these spaces that they felt was out of their control.”

He and his research teams began a number of studies and in one of the most recent, in 2016, they looked into whether programs that cleaned up abandoned buildings and vacant lots in Philadelphia had any effect on gun violence. Sure enough, they did—remediating the abandoned buildings reduced firearm violence by nearly 40 percent.

A further study from Branas and his team, published in the February issue of the Proceedings of the National Academy of Sciences, confirmed those findings in a major citywide experiment showing that when vacant lots were rehabbed in poor neighborhoods, significant and sustained reductions in gun violence and nuisance crimes of as much as 30 percent resulted. What’s more, neighbors felt significantly safer and went outside more.

Branas, a former paramedic, has spent most of his career studying who is at risk of gun violence —“given that we have one-gun-per-person in the U.S., the answer is everyone,” he says. He has studied trauma centers and their role in the decline of U.S. gun death rates, and looked into the connection between substance abuse and gun violence.

His research was cited in Justice Stephen Breyer’s vigorous dissent to the 2008 U.S. Supreme Court District of Columbia v. Heller decision, which found that the Second Amendment supports an individual’s right to possess a firearm under certain circumstances. Branas makes a forceful case that firearm violence is not only a law enforcement issue.

“It is also a public health crisis, but we need to keep asking what can public health and medicine uniquely offer in terms of solutions?” he said. He offers comparisons to public health successes of the past such as with cholera, tobacco, or car crashes. “Bold, systemwide changes were made to our water, our roadways, and our ability to publicly embrace the notion that certain consumer products, cigarettes for instance, may be bad for your health,” he said. “We now need to do something similar for gun violence.”

Q. What does your research tell you about mass shootings?

A. Mass shootings are the tragic tip of a much larger iceberg of gun violence in the U.S. We should not lose sight of the fact that on an average day, almost 300 Americans are shot, 90 fatally, according to the U.S. Centers for Disease Control and Prevention—a mortality rate that dwarfs traditional public health threats like AIDS or food poisoning. Put another way, there are roughly 100,000 shootings in the U.S. every year, in small towns and cities alike, and more than 1 million firearm injuries every decade. This is a staggering number that even eclipses U.S. military casualties in times of war.

Q. What are some solutions?

A. Think about what happens when someone is shot—yes, there is a police response, but a shooting victim who survives will be taken to a hospital by paramedics, and if not a medical examiner somewhere will be involved. These are all actors in a larger public health system. At some level, U.S. homicides have declined because our health care system has improved. But we also need to prevent these deaths before anyone even pulls the trigger. We tend to forget that not all shootings result in death. For every gun homicide, there are four other people who are shot, who may be living with a lifetime of disability and poor health. All these different forms of gun violence, and its ripple effects beyond just the victims themselves, deserve vigorous new thinking into solutions and prevention.

Q. What do you think of the idea that a good guy with a gun can deter a bad guy with a gun?

A. In the first major National Institutes of Health-funded study of gun violence that our research team undertook over a decade ago, we tested whether possession of a firearm was protective in terms of avoiding being shot. We found no such protective effect. Since then, multiple meta-analyses and other “studies-of-studies” have labelled ours as best in class, and in line with the findings from a series of similar, but independent studies. But we need more well-funded research to better unpack this finding. It may be that having a gun changes what you choose to do or where you choose to go. People with guns may be more likely to overreact or become entangled in dangerous situations. In short, shootings are highly chaotic situations, and the chances of successfully defending yourself with a gun may not be as high as many people think. Yet we still allow people to purchase guns with little if any training requirements compared, for instance, to what is required for driving a car.

Q. Should we give teachers guns?

A. We know little if anything about the effectiveness of arming teachers in terms of stopping gun violence in our schools. The science just isn’t there. We give uniformed police officers firearms under the expectation that they have been appropriately trained to protect us in a crisis. For teachers, there are no evidence-based guidelines available that can help in developing the training needed to be ready when a crisis strikes and no indication that this is a reasonable policy to pursue. At this point, we should be debating whether a new profession, that combines the responsibilities of a law enforcement officer and a teacher, is even feasible. Teachers are already burdened enough with their classroom duties so it’s unclear how this could work.

Q. You have been widely quoted on your view that gun suicides are a greater problem than gun homicides. Can you elaborate?

A. Statistics show that nine out of 10 successful attempts of suicide are made with a firearm. And while both gun homicide and gun suicide result in tragic deaths, the gap between the two is growing. And counter-intuitively to anyone who thinks of gun violence as a uniquely urban problem, the risk of being fatally shot is actually greater in rural areas; it’s really just a matter of who pulls the trigger. A study we did decades ago showed this and was used to support discussions at the Supreme Court as well as the idea that death from firearms in the U.S. is everyone’s problem, regardless of where you live.

Q. What effect does gun violence have on a neighborhood?

A. Shootings certainly affect the person who is shot, but they also affect that person’s family, their neighborhood, and the city or town that has to contend with the fallout of these tragic events. People don’t typically move off their block if someone dies of cancer. But if someone gets shot on their street corner it’s likely that neighbors will move out. Billions of dollars are spent not just in legal proceedings and the medical system to deal with our gun violence crisis, but also with the downstream economic implications and the pain and suffering that tangentially affects so many other lives.

Q. How did you go about studying whether improving blighted neighborhoods can reduce gun violence?

A. In our most recent experiment, we randomly selected over 500 vacant lots in Philadelphia and then randomly assigned some to receive a cleaning and greening restoration and others to be control sites where nothing was changed. Residents who lived near the restored land reported a significantly reduced perception of crime and vandalism, 37 percent less—as well as increased feelings of safety. They were also more apt to use outside spaces for socializing. Police reports matched these perceptions. Overall crime—including gun violence—was also significantly reduced. It’s an inexpensive intervention that can be replicated in many places. Given a city like Philadelphia’s prior experience, the 29 percent reduction in gun violence reported in this citywide experiment could translate into hundreds of fewer shootings each year for this particular city.

Q. Is this applicable to other cities?

A. There are hundreds of other large and mid-sized cities across the U.S. with similar or even larger gun violence problems on a per capita basis. If you add up all the vacant and abandoned land in these cities, it’s an area the size of Switzerland. We see this as a major opportunity to change gun violence for the nation if we could get cities, and funders, to also make the connection between blighted spaces and gun violence. We’re hoping that the scientific evidence that’s now accumulated on just how effective and, frankly, inexpensive these programs are will be a big carrot in getting them to support implementation on a wide scale.

Q. What kind of research have you done that is specific to guns?

A. We’ve also run laboratory trials where we gave people firearms and put them under different conditions. We used a large video-immersion shooting simulator, just like the one the FBI and various police agencies use, with real guns programmed to fire harmless laser bullets, to see how people perform under different levels of alcohol consumption. There are few states where laws exist pertaining to the intersection of guns and alcohol. We’ve spent billions as a nation on the scientific study and creation of policies pertaining to alcohol and the use of motor vehicles, including a large series of driving simulation studies. There’s no reason to think that we shouldn’t do likewise for alcohol and guns.

Q. Have the number of major grants to study firearm violence changed recently?

A. The level of funding for gun violence research does not even come close to other issues. Each year, there are about 100,000 new cases of gun violence in the U.S. and about 1.5 million new cases of cancer. If the National Cancer Institute receives about $5.5 billion annually for research, then gun violence should get 1/15 of that, or about $350 to $400 million each year. But again, we’re nowhere near the level of scientific funding of other issues when you consider that there has been the equivalent of only one major NIH research grant for every 1 million cases of firearm injury per decade. I do believe things will change, though, and that this will be more of a priority going forward. Maybe then we can start to shrink the iceberg of gun violence that the U.S. has been under all these decades.