Within the span of one week, my state of Kansas was
headlined in two pieces in the New York
Times, unusual for a small state. Unfortunately, neither was meant to be
complimentary. “What’s
the matter with Kansas Schools?” by David Sciarra and Wade Henderson
appeared as an op-ed on January 8, 2014, and “Keeping
Public Buildings Free of Guns Proves Too Costly for Kansas Towns”, by Steve
Yaccino, was a news article (middle of the main section but top of the web
page!) on January 12. Both are political and social issues; for example, the
thrust of the “guns” article is that Kansas municipalities (like Wichita) that
want to keep guns out of public buildings (like the library) are financially
stymied by the cost of the security requirements the legislature has put in
place in areas where carrying guns is not permitted. Like abortion (and neither
of these pieces addresses Kansas’ virulent anti-abortion laws), guns are a very
hot-button issue that inflames deep-seated passion in places like Kansas, and
so is (sometimes) education. I will, however, focus my comments on the health
impacts of these laws.
First, guns. Guns are, very simply, bad for people’s health.
(Obviously, even when used as “intended”, for hunting, they are bad for some animals’ health, but this is not my
focus.) Having guns around increases the risk of death or injury from them. Having
guns intended for hunting stored locked and unloaded is the safest, but this
doesn’t work for guns intended for self-defense since that renders them less
available for that purpose. Carrying guns on your person, in your car, in
public, on the street, and into businesses, public buildings, schools, and
health care settings increases the risk. This is not what gun advocates, and
concealed-carry advocates believe. Their idea is that there are bad guys out
there carrying guns, either criminals who might want to rob you or crazy people
who might want to shoot up your school or post office, and that carrying a gun
allows one to protect oneself, and possibly others, by shooting down the perpetrator
before more damage can be done. Thus, it protects your health, and that of
others.
Nice idea, but completely unsupported by the facts. Guns kill lots of people, injure many more,
and virtually never save lives. This is the case even when used by police, and
even more true when use of guns by police officers is excluded. It is true despite
the widely-publicized, often repeated on the internet, and frequently invented
stories about a virtuous homeowner shooting an armed robber. I have no doubt that
such cases occur, but with such rarity as to be smaller than rounding error on
the number of deaths and serious injuries inflicted by guns. Suicides and homicides are among the leading
causes of death in the US, most are caused by guns, and almost none of the
homicides are “justifiable manslaughter” from a person protecting him/herself
from an armed invader. The mere presence of easy-to-access guns in the
environment increases dramatically the risk of successful suicide (see my blog,
Suicide:
What can we say?, December 12, 2013, with data from David Hemenway’s
“Private Guns, Public Health”[1]).
In addition, the number of “accidental” deaths (where someone other than the
intended victim was shot, or someone was shot when the intent was “just” to
threaten or show off, or by complete accident, sometimes when an unintended
user – say a child – gets hold of a loaded gun) from guns is way ahead of any
other method of harm (knives, bats, etc.)
When we go beyond having
guns to carrying guns in public
places, the data is less well collected. However, the trope of the heroic
law-abiding, gun-carrying citizen drawing down on the evildoer in a public
place, like say a movie theater or the waiting room of your clinic, is a
terrifying thought. First of all, almost none of them are Bat Masterson or
Wyatt Earp or Annie Oakley (except maybe in their own minds) and the idea that
they will hit who they are aiming at is wishful thinking; the rest of the folks
are caught in a gunfight. It is scary enough when this involves police
officers, but if half the waiting room pulls out pieces, the results will be,
um, chaotic. Harmful. Not to mention what happens when the police show and
don’t know who to shoot at (maybe if you are a gun-toting good guy you can wear
a white hat…).
So, having guns around, and the more easily they are
available, is absolutely harmful to the health of the population, and generally
you as an individual. If people, including legislators, and Kansas legislators
in particular, want to encourage gun carrying for other reasons, they should at
least be aware of and acknowledge the health risks. But what about education?
The cuts in state education will, quite likely, harm the education of children
(or if, as the article notes, the state Supreme Court forces the legislature to
fund K-12, the education of young adults since the money will likely come from
higher education), but what about health?
There is a remarkable relationship. More education leads to
better health. Better educated people are healthier. The relationship is
undoubtedly complex, because better educated people also have better jobs and
higher incomes, which is also associated with health. This is addressed with
great force in a recent policy brief “Education:
It Matters More to Health than Ever Before”, by the Virginia Commonwealth
University Center for Society and Health sponsored by the Robert Wood Johnson
Foundation; for example, while lifespan overall in the US continues to
increase, for white women with less than 12 years of education, it is currently
decreasing! The RWJ site also includes
an
important interview with Steven Woolf, MD MPH, Director of the Center. “I don’t think most Americans know that
children with less education are destined to live sicker and die sooner,”
Dr. Woolf says. He discusses both the “downstream” benefits of education: “getting good jobs, jobs that have better
benefits including health insurance coverage, and higher earnings that allow
people to afford a healthier lifestyle and to live in healthier neighborhood,”
and the “upstream” issues, “factors
before children ever reach school age, which may be important root causes for the
relationship between education and health. Imagine a child growing up in a
stressful environment,” that increase the risk of unhealthy habits, poor
coping skills and violent injuries.
In several previous blogs I have cited
earlier work by Dr. Woolf, one of the nation’s most important researchers on
society and health, notably in "Health
in All" policies to eliminate health disparities are a real answer, August
18, 2011. I included this graph, in which the small blue bars indicate the deaths
averted by medical advances (liberally interpreted) and the purple bars
represent the potential deaths that could be averted if all Americans had the
death rates of the most educated. I also included a link to the incredible County
Health Calculator (http://chc.humanneeds.vcu.edu)
which allows you to look at any state or county, find out how the education or
income level compares to others, and use an interactive slider to find out how
mortality and other health indicators would change if the income or education
level were higher or lower.
In the US, the quality of one’s education is very much tied
to the neighborhood you live in, since much of school funding is from local tax
districts and wealthier communities have, simply, better schools. (This last is
completely obvious to Americans, but not necessarily to foreigners. A friend
from Taiwan was looking at houses and was told by the realtor that a particular
house was a good value because it was in a good school district. She called us
an asked what that meant; “In Taiwan, all
schools are the same; they are funded by the government. No one would choose
where to live based on the school.”) This difference could be partially
compensated for by state funding for education, which is why cuts in this area
are particularly harmful, including to our people’s health. In fact the most
effective investment that a society can make in the health of its people is in
the education of its young.
An educated population is healthier. Wide availability and
carrying of guns decreases a population’s health. Unfortunately, the public’s
health seems to carry little weight in these political decisions.
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