If you think about big public health challenges of our day — the Ebola virus in Africa, the rising rates of suicide among the middle-aged in the United States, the HIV epidemic everywhere — religions are playing a role. When I speak, I ask audiences, “What was the first thing you heard about the Ebola crisis?”, and they always say “The missionaries who got it were taken to Emory.” “That makes my point,” I say. “You didn’t know anything about it up until that moment, but they did.” Those missionaries, and the faith-based organizations they worked for (Samaritan’s Purse and Serving in Mission) were already there on the ground along with other faith-based organizations, volunteering their time, putting their lives in danger, and providing valuable resources of equipment, supplies, and knowledgeable helping hands to try to contain the outbreak.
In another challenge, the crisis of rising suicides among US veterans and Baby Boomers, religion’s role is more in the background, but no less important. Since sociologist Emile Durkheim first studied the subject in late 19th century France, researchers have consistently found that individuals with more social ties – particularly to religious groups — are more protected from suicide. Religious ties provide caring, support, warmth, and intimacy — the “carrots” of social interaction. They also provide rules for living and guidance for behavior that often require individuals to sacrifice their self-interest for the good of the group. These are the “sticks” of social interaction, which Durkheim argued were just as necessary as the “carrots” in keeping individuals from taking their own lives. So here are two quite different roles that religions play in public health: first in the foreground, deploying resources and religious social capital as partners with public health authorities in countries around the world, and also in the background, providing the sustenance of social integration and regulation that prevents the tailspin of suicide.
But religions are complicated, and in the HIV epidemic we have seen faith traditions playing all of these roles and other less helpful ones as well. One positive thing that religions do — very effectively through religious ritual and practice — is to give individuals a sense of belonging to something larger than themselves; they bestow a social identity that marks individuals as valued members of a group, with all of that group’s rights, privileges, and responsibilities. But group membership by its very nature implies that there are other individuals and groups — outsiders — who are not members, who may be less valued. This is an obvious source of conflict around the world and can lead to violence on a small or large scale. This too, sad to say, is an instance of religions taking a role in determining the health of populations, but not in a good way. And at a less extreme level, if an individual violates the norms of the group, or breaks its rules, it can lead to sanctions, punishment, or even being cast out from membership. So in the HIV epidemic, individuals who were victimized by the disease first, in many cases experienced a secondary victimization of being stigmatized by religious groups who perceived that the disease was a sign of forbidden behaviors, and therefore a just punishment.
Public health organizations and religious organizations are both looking to promote the well-being of their communities. In many cases those interests are perfectly aligned and the two institutions function, implicitly or explicitly, as partners. When they do not, it makes sense that two powerful forces should identify all of the ways in which they can work together, finding a way around the contentious issues to leverage each other’s constructive responses. Religion, along with income inequality, education, and political structures, is one of the social determinants of public health in countries around the world, despite its usual exclusion from the public health paradigm.
Headline image credit: The fight against Ebola in West Africa. ©EC/ECHO/Jean-Louis Mosser. CC BY-ND 2.0 via European Commission DG ECHO, EU Humanitarian Aid and Civil Protection Flickr.
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By Philip J. Cook and Kristin A. Goss
The debate over gun control generates more heat than light. But no matter how vigorously the claims and counterclaims are asserted, the basic facts are not just a matter of personal opinion. Here are our conclusions about some of the factual issues that are at the heart of the gun debate.
- Keeping a handgun to guard against intruders is now a Constitutional right. In Heller vs. District of Columbia (2008) and McDonald vs. Chicago (2010) the US Supreme Court ruled by a 5-4 majority that the Second Amendment provides a personal right to keep guns in the home. States and cities are hence not allowed to prohibit the private possession of handguns. However, the Court made it clear in these decisions that the Second Amendment does not rule out reasonable regulations of gun possession and use.
- Half of gun owners indicate that the primary reason they own a gun is self-defense. In practice, however, guns are only used in about 3% of cases where an intruder breaks into an occupied home, or about 30,000 times per year. That compares with over 42 million households with guns. One way to understand just how rare gun use is in self-defense of the home is to look at it this way: on average, a gun-owning household will use a gun to defend against an intruder once every 1,500 years.
- As many Americans die of gunshot wounds as in motor-vehicle crashes (around 33,000). In the last 30 years, over 1 million Americans have died in civilian shootings — more than all American combat deaths in all wars in the last century.
Non violence sculpture by Carl Fredrik Reutersward, Malmo, Sweden. Photo by Francois Polito. CC-BY-SA-3.0 via Wikimedia Commons.
- Most gun deaths in the United States are suicides. There are 20,000 gun suicides per year, compared with 11,000 gun homicides and 600 fatal accidents. While there are hundreds of thousands of serious suicide attempts each year, mostly with drugs and cutting instruments, half of the successful suicides are with guns. The difference is in lethality — the case-fatality rate with guns is 90%, far higher than for the other common means. Availability influences choice of weapon; states with the highest prevalence of gun ownership have four times the gun suicide rate as the states with the lowest prevalence.
- The homicide rate today is half of what it was in 1991. That is part of the good news in the United States — violent crime rates of all kinds have plunged since the early 1990s, and violent crime with guns has declined in proportion. (Two thirds of all homicides are committed with guns.) Still, homicide remains a serious problem — homicide is the second leading cause of death for American youths. Our homicide rates remain far higher than those of Canada, the UK, Australia, France, Israel, and other wealthy countries. We are not an exceptionally violent nation, but criminal violence in America is much more likely to involve guns and hence be fatal.
- The widespread availability of guns in America does not cause violence, nor does it prevent violence. Generally speaking there is little statistical relationship between the prevalence of gun ownership in a jurisdiction and the overall rate of robbery, rape, domestic violence, or aggravated assault. But where gun ownership is common, the violence is more likely to involve guns and hence be more deadly than in jurisdictions where guns are scarcer. In place of the old bumper strip, we’d say: “Guns don’t kill people, they just make it real easy.”
- The primary goal of gun regulation is to save lives by separating guns and violence. Federal and state laws regulate who is allowed to possess them, the circumstances under which they can be carried and discharged in public, certain design features, the record-keeping required when they are transferred, and the penalties for criminal use. The goal is to make it less likely that criminal assailants will use a gun. The evidence is clear that some of these regulations are effective and do save lives.
- Gun violence can also be reduced by reducing overall violence rates. Gun violence represents the intersection of guns and violence. Effective action to strengthen our mental health, education, and criminal justice systems would reduce intentional violence rates across the board, including gun violence (both suicide and criminal assault). But there is no sense in the assertion that we should combat the causes of violence instead of regulating guns. The two approaches are quite distinct and both important.
Kristin A. Goss is Associate Professor of Public Policy and Political Science at Duke University. She is the author of Disarmed: The Missing Movement for Gun Control in America. Philip J. Cook is ITT/Terry Sanford Professor of Public Policy and Professor of Economics and Sociology at Duke University. He is the co-author (with Jens Ludwig) of Gun Violence: The Real Costs. Kristen A. Goss and Philip J. Cook are co-authors of The Gun Debate: What Everyone Needs to Know®.
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