MISSING PIECES - Inter-Parliamentary Union

MISSING PIECES
PUBLIC HEALTH AND THE SMALL ARMS ISSUE
Violence is a learned behaviour. It can be unlearned, as can many
public health problems . . . 8
Public health provides a useful schema for understanding the types and
timing of prevention approaches. This is relevant for policy development
and preparedness to care for and rehabilitate survivors of gun violence,
including:
1. Primary prevention, which seeks to prevent a problem from occurring
in the first place by building resilience in the populations and communities
at large.
2. Secondary prevention, which focuses on groups and individuals particularly
likely to commit violence and aims to “keep these individuals from
engaging in violent activity.” 9 Focus populations for secondary prevention
might include, for example, young men in particularly violent settings. 10
3. Tertiary prevention, which involves care of the disease or injury, and
aims to minimise the worst aspects of the problem. For those surviving
gun violence this often includes access to rehabilitation services, psychosocial
support and trauma counselling, and access to employment.
THE PHYSICAL AND MENTAL IMPACTS OF A GUN INJURY
The severity of the injury—and the likelihood of permanent disability—
are affected by the technical specifications of the ammunition used, for
example, the bullet size, the type of tip (e.g. hollow-tipped, round nose),
material (e.g. fragmenting), velocity and ‘flight pattern’. These factors influence
bullet trajectory through the body and the subsequent damage to
tissue, organs and bones. Bullets produce damage through laceration and
crushing of tissue and bones in the direct path of the projectile, and via
cavitation. When a bullet enters the body, a temporary vacuum is opened
for a few thousandths of a second behind it, much like the vacuum created
by a torpedo travelling under water. The greater the speed of the bullet,
the larger the initial cavity: a large cavity may be 30 to 40 times the diameter
of the bullet. After the bullet has gone through, a lasting cavity—or
wound track—will remain. The pressure applied by the temporary cavity
on surrounding tissues and organs provokes injuries far from the bullet
path and therefore hard to detect, particularly to soft organs. It is also
capable of fracturing bones several centimetres from the bullet track. 11
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