The Epidemiologic Triangle: Changing the Conversation about Gun Violence
Public health practitioners use a tool called the “Epidemiologic Triangle” to identify the causes and transmission of an epidemic, and to identify points of intervention:
- How do we end gun violence?
The points of the triangle are the Environment, Host, and Agent. How can we use this concept, this vocabulary, to talk about gun violence?
Understanding the Triangle:
Take malaria for example: The Agent is a parasite. Mosquitoes are the Vector–they transmit malaria to the Host. The Host? Humans. And the Environment brings them all together.
Malaria can be addressed by changing the Environment (percolating water, mosquito dunks), cutting down on the Vector by reducing the mosquito population, and by improving the Host’s (human’s) resistance through medication.
To be effective, all must be done.
Applying the Triangle: Smoking-Related Diseases
In tobacco prevention, multiple strategies are used to effect change:
- Improve the Environment: pass smoke-free workplaces laws
- Limit the Agent: reduce access to cigarettes (no sales to minors, taxes) Note:despite the diagram THERE IS NO SAFE CIGARETTE, and FILTERS DON’T WORK!
- Limit the Vector, otherwise known as Big Tobacco: stop them from marketing to children (remember Joe Camel)
- Build resistance in the Host: Quit Lines, quit-smoking medications, education, school programs
So how can we apply this to gun violence?
If we are committed to change, we must address all of these factors.Here is my simplistic first pass at it:
Semi-automatic assault weapons, are the common factor in these shootings. They are designed to kill people, not for hunting or “sport” or defending yourself against an intruder. They kill many people, quickly. Many gun owners support getting military-style weapons off the streets.
Vector: shooters, often mentally ill or criminal… or just children who are playing with a household gun.
We need to have a robust mental health system, including support for people with mental illness and other disorders. We need to do everything we can to prevent child abuse and school bullying. We need to make sure the community has plenty of activities to engage our children.
Host: the victims
Short of issuing bullet-proof vests, I’m at a loss here. A school security guard with a hand-gun isn’t going to be able to defend a class full of children from a shooter.
Environment: a culture that makes guns easy to get.
The United States has the highest rate of per-capita gun ownership: 88.8 guns per 100 people. The next two closest countries, Serbia and Yemen, have gun ownership rates around 58 and 54 percent.
We have the 12th highest rate of gun deaths of any nation, around 9 deaths per 100,000 people. Our gun death rates far outstretch any industrialized nation, which have about 1 death per 100,000 or less. People are dying from gunshots at a rate similar to South Africa and Montegro, not European countries or Canada.
So what do we do? What are your ideas?
How do we come together to change ALL parts of this triangle?