How and why did doctors get into the argument about gun violence?  They got into it because the World Health Organization (WHO) says that violence, defined as hurting oneself or someone else, is a threat to health. And since a health threat can be measured by the number of times that someone is treated at a medical facility for something which, left untreated, could make that person feel unwell, I guess that 125,000+ such treatments each year constitutes a threat to health.

             But a threat to someone’s health is not the same thing as a threat to public health. The latter is usually defined as a proactive, medical response that seeks to combine scientific evidence with public policies to protect the entire community from a health threat, be that community a small village, a neighborhood within that village, a group of families within that neighborhood, or maybe the total population of an entire nation-state. In other words, first we figure out why someone gets sick, then we figure out how the illness moves from one person to another, then we figure out what we need to do to confine the illness to as small a number as possible. If people get sick because they all drink water from the same contaminated well – clean up the well. If a deadly virus is transmitted through unprotected sex, educate everyone to engage in protected sex.

Unfortunately, it turns out that many illnesses cannot be eradicated or even controlled just by figuring out how the pathogen moves through the air from Victim A to Victim B. This is because many illnesses are caused not by a virus, but by the way we behave. Drive your car at an unsafe speed and sooner or later you’ll smack into someone else. Plug a home appliance into the wall while you’re taking a bath and – zap! – you’re on the way to the morgue. In 2016, more than 230,000 Americans died because they accidentally injured themselves or someone else; another 32 million needed some degree of medical attention because they were injured but weren’t killed.

Next to those numbers, 35,000 deaths and 90,000+ non-fatal gun injuries doesn’t seem like such a big deal, except for one little difference between how and why gun injuries occur. Because if public health researchers discover that excessive speed causes automotive accidents, we lower the speed limits; if research shows that tobacco causes cancer, we can pass laws which prevent kids from starting to smoke. But how do you make someone use a gun safely when the only reason to use a gun is to inflict injury on yourself or someone else?

Now one can argue that if you injure someone else with a gun in the process of protecting yourself from that person’s attempt to injure you, then the gun has served a positive purpose and that such behavior should not only be respected but encouraged as well. But at least 100,000 gun injuries occur each year because someone consciously used a gun to hurt themselves or someone else without the slightest self-defense rationale at all.

If public health researchers want to bring the number of intentional gun injuries down, they need to figure out why only a small percentage of people who own guns use them in a violent way, and more important, why even most people who engage in violent behavior choose not to use a gun.  Last year physicians treated more than 2 million victims who were injured because someone else wanted to hurt them real bad. But less than 5% of the attackers were armed with guns, and it’s not like the other 95% couldn’t get their hands on one.

Rand Paul is totally wrong when he says that gun injuries aren’t a concern for public health. But his argument will stand until and unless researchers figure out why some people make a deliberate choice to commit an assault with a gun. If a gun is the pathogen which leads to gun violence, why don’t we have 300 million gun injuries every year?