“No single law—no set of laws can eliminate evil from the world, or prevent every senseless act of violence in our society. But that can’t be an excuse for inaction. Surely, we can do better than this.”

These were President Obama’s words to the people of Newtown, Connecticut, where last week 20 children and six adults were slaughtered in one of the worst mass shootings in U.S. history.

When I first arrived in the USA, from the UK, nearly four months ago, the country had suffered another tragic shooting, in Aurora, Colorado, where a lone gunman killed 12 people in a movie theatre at midnight. Even as I write, the news tells me a man with a gun has fatally shot two volunteer fire fighters in upstate New York.

Immediately after the Newtown shootings, the media waxed lyrical about strengthening security and training, reporting “aberrant behaviour” and improving mental health services. Major news channels—Fox, CNN—brought in psychologists to advise people on how to handle their emotions. I heard no uproar, no outcry, no holding the Government to account about guns. Then came an outpouring of liberal opinion on gun control, mostly from predictable sources—students, academics, left-leaning newspapers, New York City’s Mayor Bloomberg. Now, I detect a subtle but discernible shift in the wider political discourse. The president’s most recent speech in Newtown alludes to this, as do increasing public protests, Conservative curveballs, and calls for a debate on gun control.

“The only thing that stops a bad guy with a gun is a good guy with a gun.”

This, unfortunately, is the other perspective, from Wayne LaPierre, Vice President of the powerful lobby group, the National Rifle Association (NRA). Coming from a country with such strict gun control laws, to me the issue is a no-brainer and invokes the same incredulity as LaPierre’s words. But not only do tragedies like the 2010 Cumbria shootings make it difficult for me to be too complacent but, importantly, I am discovering certain unique aspects of American culture that should be understood to help contextualise the issue.

According to Seymour Martin Lipset, a leading theorist of American exceptionalism, five “core pillars” of the American creed account for its “exceptional” status: liberty, egalitarianism, individualism, populism, and laissez-faire. [1] Mixed with a religiosity that most modern Britons would find difficult to comprehend, these core values are reflected in many aspects of American public life and politics.

For example, I am only beginning to realise just how much the concept of individual liberty, enshrined in the Bill of Rights (amendments to the U.S. Constitution), means to people here. The historic right to keep and bear arms, supported by a thoroughly modern arms lobby, has become, in the eyes of many, inviolable. During Obama’s election campaign, the gun issue was barely mentioned, even though most of the high profile shootings have been linked to military-style assault weapons that should not be in general circulation.

Even Newtown’s official response was to send in “every possible asset,” including a SWAT team, canines, the State police and troopers, “to protect life and property,” as Lt. Paul Vance put it during a TV interview. Many voices, including those of the NRA, have called for increased armed security in schools. To me, there is something deeply saddening about a society where violence begets violence and a primary school becomes an arsenal.

I am mired in confusion. My mind is awash with more questions than answers. How does a convicted felon, such as the New York gunman, obtain firearms? How can a 20 year old buy guns, but need ID to be served alcohol? Are individuals capable of discriminating between a real and perceived threat? If so, what is a proportionate response? In the heat of the moment, where is the fine line between self-defence and aggression? Have we as a society become so fixated on the supremacy of individual autonomy that we cannot let it be transgressed for a greater good?

Gun control is a public health issue

Clearly, if death and injuries are outcomes then, at the most simplistic level, gun control is a health issue. If these health outcomes are preventable by population-level interventions, then there is indeed a role for public health. Even if we don’t believe that gun crimes are a product of dysfunctional societies—that they are, as many claim, sporadic, and aberrant acts of individual evil or madness—their effects on society can be devastating. According to David Hemenway, a professor of health policy at the Harvard School of Public Health, whose book Private Guns, Public Health has recently propelled him into the media spotlight, a child in the US is 13 times more likely to die in gun homicide compared to children in other developed countries. If societies and health are inextricably intertwined, then whatever ruptures the fabric of society must be a concern for public health.

Regulation in the US is not easy. There are intrinsic difficulties in passing federal legislation over state regulation, for example, and sometimes vice versa. Repeatedly, the First Amendment to the Constitution (freedom of speech) is invoked, for example by the tobacco industry to suppress tobacco control measures. Even a car licence plate in New Hampshire reads “Live Free or Die.”

Yes, gun control alone is not a panacea. Yes, we need specifics. Yes, changing the mindset of a heterogeneous and polarised society with entrenched interests and attitudes is no easy task. But the alternative is worse. As time elapses after every such shooting, the issue will quietly disappear from the public eye and more people will die.

On the radio I heard the palpable despair of a man from Chicago whose neighbourhood has turned into a gun playground but for whom “nothing will ever get done.” I fear that, beneath the apparent groundswell of public opinion lies that same sense of futility—that things will never change. Let’s capture the moment and have a sensible and sustained conversation on gun control, for sure, but let’s also truly believe that ‘we can do better than this.”

Suchita Shah is a general practitioner in Oxford, UK, but is currently living in Boston and is a student at the Harvard School of Public Health, Boston.

1.    Lipset SM. American Exceptionalism: A Double-Edged Sword. Norton; 1997:352.