You were surprised by Trump’s con job? Seriously?

President Elect Donald J. Trump

President Elect Donald J. Trump and his famous hat.

Everyone must stop saying they are “stunned” and “shocked.” What you mean to say is that you were in a bubble and weren’t paying attention to your fellow Americans and their despair. YEARS of being neglected by both parties, the anger and the need for revenge against the system only grew. Along came a TV star they liked whose plan was to destroy both parties and tell them all “You’re fired!” Trump’s victory is no surprise. He was never a joke. Treating him as one only strengthened him. He is both a creature and a creation of the media and the media will never own that.

Michael Moore’s Facebook Post, Nov. 9, 2016

A lie is an allurement, a fabrication, that can be embellished into a fantasy. … Truth is cold, sober fact, not so comfortable to absorb. A lie is more palatable. … I found it far more interesting and profitable to romance than to tell the truth.

Joseph Weil, aka “The Yellow Kid” (Professional Con Artist), Robert Greene, 48 Laws of Power

To those who expressed shock and awe the day after GOP presidential candidate Donald J. Trump won the Electoral College but not the popular vote on Nov. 8, 2016, I say, what freaking country have you been living in for the last 25 years?

If you were born any time before 1980, exactly what forms of dystopian thinking had overwhelmed your senses as you observed events unfold in your country and home town–year … after year … after year?

The outcome that brought smiles in the Kremlin and so wildly alarmed the much of the world, America’s progressive coalition, and the Democratic establishment was paved decades ago by the Republican Party and its supporters.

The GOP has unabashedly and shamelessly advanced a far-right agenda that makes the United States an extreme outlier in nearly every category compared to “advanced democracies.” And now the Democratic and progressive establishment say they are shocked by the election? Are you kidding me?

So, am I outraged that Trump lost the popular vote and was still elected? Absolutely. Shocked? Hell no, and not even remotely.

The GOP Establishment Primed the Nation for Trump

Adolph Hitler, one of history's most infamous demagogues

Adolph Hitler is one of history’s most infamous demagogues and the dictator who seduced Germany as he turned it into a totalitarian state that organized mass murder and global war.

Rather than an aberration, Trump was a pre-ordained messiah who walked through the giant blast hole the GOP created in our democracy over the last three decades. He also proved to be an adept and capable con artist, clever enough to employ all of the proven stratagems used by dictators throughout history, in nearly every civilization.

Anyone who has read anything about history or who has read writer Robert Greene’s 48 Laws of Power, could recognize how Trump mastered the trade craft of power in the purest Machiavellian sense. But the real-estate mogul and reality TV star also exploited an exceedingly well-fertilized landscape, plowed for a generation by his GOP predecessors and moistened by the flood of unregulated money in American politics.

Trump’s performance as a titillating, transcendent messenger was similar to demagogues of the last century. He offered racial and economic salvation, while restoring “law and order,” deporting millions of non-citizens, building a wall with Mexico, and giving hate speech wide latitude to an increasingly agitated and well-armed white and right political base.

Even the right-wing publication The Weekly Standard—a foe of Trump—predicted Trump’s meteoric success perfectly in an August 2015 article, by Jim Swift. Swift described prophetically how Trump was using all the 48 tactics of past strong men of history: “Law 27 — Play on People’s Need to Believe to Create a Cultlike Following: As Greene writes: ‘People have an overwhelming desire to believe in something. Become the focal point of such desire by offering them a cause, a new faith to follow.’ How about ‘Make America Great Again?’”

Sadly, I correctly predicted the outcome myself in the spring of 2016, when I bet a good friend a beer that Trump would defeat his likely rival, Democrat Hillary Clinton. (I have yet to drink that beer, and it will be the worst brew of my life.)

I knew he would win the “shocker” by the time he had won the South Carolina primary, where he repudiated the military legacy of the last GOP president, George W. Bush, and called the Iraq war a failure without any political consequences among evangelicals or traditional conservative voters. Here was a new creature who defied the rules–a characteristic of successful demagogues in history.

Rep. Tim Ryan (D-Youngstown) of Ohio’s industrial heartland, who is now challenging House Minority Leader Nancy Pelosi (D-San Francisco) for her job and pledging to reconnect with disaffected blue collar white voters, also predicted a dire outcome a month before the election. Ryan warned union members to not fall for Trump’s song and dance. “He will gut you, and he will walk over your cold dead body, and he won’t even flinch,” Ryan told a crowd of union members in Ohio in October 2016. “He’ll climb over your cold dead body and get on his helicopter.” And many of them did not listen.

Other wise people who saw this coming were filmmaker Michael Moore and commentator Van Jones—because it was so bloody obvious. They too were ignored.

In two key policy areas—guns, health care—Trump mostly used tested messages. Those soundbites and their political outcomes were already extreme before Trump became what Moore called a “human Molotov cocktail.” However, he was unexpected in several key ways.

Trump broke from the GOP orthodoxy on jobs and trade. He saw an opportunity to resonate with the disaffected working class in the industrial Midwest. He also proved to be a far better salesman than anyone in the GOP establishment. Lastly, he had a keener understanding of psychology than most of the highly respected, well-paid, and powerful individuals of the Democratic and Republican parties and the broadcast media, most of whom professed not to see the Trump tsunami coming.

Walmart is the largest commercial retailer of guns in the United States, including semi-automatic rifles commonly used now in mass shootings.

Wal-Mart is the largest commercial retailer of guns in the United States, including semi-automatic rifles commonly used now in mass shootings.

Trump and Guns, Nothing New

Consider the domestic militarization of the United States since the early 1990s. GOP members of Congress and in state legislatures have worked lock step with the National Rifle Association since the passage of the The Brady Handgun Violence Prevention Act in 1993.

Mores Guns Than PeopleAmerica now has a virtually unregulated market of guns and semi-automatic weapons that are now considered inalienable rights of the majority of Republican-voting and mostly white Americans. There are now more guns than people in these United States of America. This powerful segment of the American electorate had turned their fringe ideas into mainstream GOP policy long before they voted for Trump.

These armed citizens who form the rank and file of a well-armed citizenry for years have muzzled lawmakers who might otherwise approve gun measures that put modest restrictions on the sale of weapons that kill about 33,000 Americans a year. During the campaign candidate Trump implicitly threatened to call these Americans into action against his Democratic opponent: “By the way, and if she gets the pick—if she gets the pick of her judges, nothing you can do, folks. Although the Second Amendment people, maybe there is, I dunno.”

Trump merely echoed the GOP lines that had become accepted public discourse since the Columbine mass shooting in 1999. He was able to say it publicly without much rebuke because it was already normal to threaten gun violence against elected officials, putting them in “cross-hairs.” Immediately after the election, the NRA unsurprisingly announced an even more radical agenda it has been pushing, to allow concealed handgun permits to be accepted in every state and to legalize silencers—yes, silencers.

Trump’s Health Care Vision Advances the Decades-Long Agenda of the Republican Establishment

The GOP has fought doggedly for more than six decades to prevent the United States from adopting a national health care system or even insurance plan. As a result, the country is the most expensive and least efficient health provider at the population level among most developed nations.

The Affordable Care Act that squeaked through under President Barack Obama’s slim majority in Congress in 2009 was not true health reform—it was mostly an expansion of health insurance to nearly 50 million uninsured Americans—50 million!—and a first step to change the broken health insurance market. It was never meant to be the start of a national health system, like Canada’s or France’s.

OECD Health SpendingBut this mattered little to the nearly half of the American electorate in November, many who were lower-income and who supported a billionaire who boasted of not paying U.S. income taxes. Trump knew that. He knew facts did not matter, the same way the GOP was able to defend the monopolistic and dysfunctional health system for years while health insurance middlemen were gobbling up the nation’s economic resources. Trump simply reflected all that was said repeatedly before, like a mirror.

Throughout the campaign, Trump pledged to dismantle the act and remove more than 20 million Americans from having even lousy coverage. However, the GOP in Congress voted to repeal it more than 60 times by February 2016 and tried to shut down the government in 2013 to protest legislation promoting health insurance for all Americans. Trump repeated common political discourse that never wandered into real facts.

Jobs and Manufacturing—Who Needs Facts?

What about Trump’s promise to “make America great again,” and bring back those shuttered factories in depressed Midwest towns and coal production in Appalachia. Here is where Trump broke ranks with the GOP, seeing his golden opportunity. Trump had been paying attention. He and Democratic presidential candidate Sen. Bernie Sanders of Vermont were sharply aware of millions of lost manufacturing jobs and closed factories and mills since well before 1994. The establishment of both parties were not.

For the last 20 years, America has seen its manufacturing base shrink while factory jobs fled across the border to our NAFTA partners, Canada and Mexico, or overseas to China and Asia. FiveThirtyEight reports the United States “has lost more than 4.5 million manufacturing jobs since NAFTA took effect in 1994.”

Not many care what happened to Midwest cities over the last two decades in Washington, DC.

Who really cares about ailing Midwest industrial cities in the post-NAFTA era? Many there thought no one did and just swung an election to a billionaire who had nothing in common with those who live there.

That pain is visible in nearly every crumbling Midwestern city, which have repeatedly been ignored and long deemed unworthy of saving. No one, not even the Democrats, really cares about the devastated community that is now Detroit, except Detroiters, even though candidates Trump and Clinton both used it as their prop to talk about their vision for the economy. For that matter, few in Washington and less in the GOP really have cared about Youngstown, St. Louis, Akron, Cleveland, Toledo, Flint, or other industrial cities that slid into oblivion since the passage of NAFTA. The GOP, until the Trump tornado, had promoted outsourcing and trade policies that sped up the loss of manufacturing.

While Both Clinton and Trump campaigned for votes in Detroit and Michigan, as well as Ohio, Wisconsin, and Pennsylvania, Trump’s message about feeling the overwhelmingly visible dislocation seen everywhere in the Midwest resonated. The angry, white, dislocated Midwest blue-collar worker became a larger than life meta symbol of the Trump constituency and the key voting bloc that gave him victory.

Flint native and left-leaning independent filmmaker Michael Moore predicted the vote outcome in every single Midwestern state and national election perfectly three weeks before the election in his must-see film Michael Moore in Trumpland.

moore-screen-snapshotAlways the savvy cultural observer, Moore described why those angry and almost all white voters would revolt and go for Trump on election day: “On November 8, you Joe Blow, Steve Blow, Bob Blow, Billy Blow, all the Blows get to go and blow up the whole goddamn system because it’s your right! Trump’s election is going to be the biggest ‘fuck you’ ever recorded in human history. And it will feel good. For a day. Eh, maybe a week, possibly a month.” Then, a few months later, they would realize they were conned, and, as he said, “It will be too late to do anything about it.” Because Moore is a Joe Blow himself, he and more importantly his insights were ignored or sidelined by the pundits and the Democratic National Committee, who had been missing the warning signs that had been festering all election, but really for the decades before.

Reality Sets in, and the Threats to American Democracy Are Real

Now that the election is over, we are all beginning to see the likely devastating outcomes. Hate crime activity is rising. White nationalists, the Klan, neo-Nazis, and others feel legitimized to speak openly of promoting fascist and extremist views.

hitler-and-hindenberg

Adolph Hitler with President Paul von Hindenburg of the Weimar Republic, after the 1932 election that saw the Nazis win more seats to the Reichstag than any other party, but not a majority of the posts. Two years after the election, Hindenburg would die in office, ushering in the dictatorship of Chancellor Hitler, who took power first through the ballot box.

Public officials who support Trump are even now actively talking of creating a national registry for Muslims and frankly discussing the policy of Japanese American internment camps from the 1940s. These are all echoes of Germany, after Adolf Hitler and the National Socialist German Workers’ Party, or Nazi Party. It won less than a full majority of seats in the German Reichstag in 1932, and the party under Hitler and his circle managed to turn Germany into a totalitarian state that murdered at least 11 million in camps, on top of tens of other millions killed in war.

Between Nov. 9 and 14 alone, the Southern Poverty Law Center collected 437 reports of hateful intimidation and harassment. Many cases involved references to the Trump campaign or its slogans. Many had taken place at schools, where bullies and racists are feeling emboldened by the new openness in hate discourse.

I remain profoundly worried what will happen to my nation and its most vulnerable members. Many challenges lie ahead. But I completely agree with Moore’s top two action items he laid down the day after Americans woke up in a bed the GOP had been making for decades. For my part, I will, as Moore argues, support that take over of the Democratic Party and its return to the people. They have, as Moore wrote so clearly, “failed us miserably.”

It will be up to the party itself to see if it takes action on item No. 2 on Moore’s list—so far, they have not. If you have not read that list, here it that item: “Fire all pundits, predictors, pollsters and anyone else in the media who had a narrative they wouldn’t let go of and refused to listen to or acknowledge what was really going on. Those same bloviators will now tell us we must ‘heal the divide’ and ‘come together.’ They will pull more hooey like that out of their ass in the days to come. Turn them off.”

And what is next? Many from President Barack Obama down to the thousands of street protesters after the election see the next four years as a real fight for democracy that is now very, very much in peril. The GOP has never had more power in state capitals and Congress. A true charismatic demagogue just took power, without winning a popular vote, the way it happened in Germany in 1932. The fight has begun, and it will be bitter and costly. The stakes have never been higher since the country successfully came together and helped defeat the Axis Powers in World War II. But the fight will be for the soul and future of the country. History will judge how successful we are.

How the 10 essential public health services handicap a weakened profession

Public health, as a profession and system to improve population health, continues to fall short in the United States.

Since the start of the Great Recession, nearly a quarter of all employees working for local health jurisdictions have been downsized or laid off because of funding cuts to already meager budgets. The National Association of County and City Health Officials pegs the attrition at nearly 44,000 workers–a fact reported on this blog before.

Proportional changes in inflation adjusted spending for public health (CDC) versus health care spending in the United States.

Proportional changes in inflation adjusted spending for public health (CDC) versus health care spending in the United States.

Today, most Americans have little idea what public health does, why it matters, and why its funding is critical to improving health outcomes at the population level. For that matter, half of all Americans cannot even identify what the core elements of health insurance plans are. 

From its start as a profession in the United States in the early 1900s, public health was deemed to have a political-activist function. In fact, noted public health pioneer C.E.A. Winslow, Yale’s first chair of public health, promoted universal medical care in the 1920s as a principle of sound public health policy, backed later by other public health practitioners in the next two decades who unsuccessfully called for a form of universal health care.

Winslow’s often-quoted definition of public health called for the “development of the social machinery which will insure to every individual in the community a standard of living adequate for the maintenance of health.” Such efforts were overt and unashamed calls for political action and advocacy, the likes of which are mostly not heard today from the profession.

10 essential public health services: a recipe for political impotence?

Since 1994, the U.S. Centers of Disease Control has pushed the “10 essential public health services” model as the gold standard for defining public health’s realm of practice. As far back as 1999, the CDC claimed, “The overall goal for public health’s infrastructure is to have every health department fully prepared with capacity to fulfill the Ten Essential Public Health Services and every community better protected by an efficacious public health system.”

The 10 essential public health services is the U.S. model, not a global model, for defining the profession.

The 10 essential public health services is the U.S. model, not a global model, for defining the public health profession’s realm of practice.

This model has rippled outward to every public health agency, every school of public health, and all professionals in the field as the benchmark to measure quality and effectiveness. Logic models have been developed to see how well health departments were doing according to this standard.  Anyone who works in the field is told that these services define who we are and what we do.

All the while, public health budgets have been slashed nationally, and at the state and local level, workers have fled or were pushed out of the profession. Still the field of public health continues to push its competent but still toothless model for what is considered a best practice—the 10 essential services.

While evidence-based and certainly valid, this 10-step model is also a self-defeating set of quasi-religious commandments that fails to address the harsh political realities related to developing legislation and orchestrating fights over budget appropriations. It also fails to call for advocacy and political activity, which can and have pushed public health efforts far greater than these prescribed activities.

Politics, money, and real power

For-profit entities working in the health sector thrive because advocacy and political engagement are fundamental to their business models and bottom lines, unlike the model of inefficacy promoted for the public health profession.

For instance, pharmaceutical powerhouse Pfizer unabashedly states, “We believe that public policy engagement is an important and appropriate role for companies in open societies, when conducted in a legal and transparent manner. … The Pfizer Political Action Committee makes contributions to candidates for federal office, and fully discloses its contributions on a regular basis to the Federal Election Commission.”

Pfizer, multinational pharmaceutical firm, published its political spending activities in the United States for the first half of 2013.

Pfizer, the multinational pharmaceutical firm, published its political spending activities in the United States for the first half of 2013.

While for-profit health interests march forward, with ever more dollars and clout, public health continues to retreat. The President’s budget request in 2014 for the CDC, the agency charged with protecting America’s health, is a measly $6.6 billion (for its program level expenditures)—a drop of $270 million over 2012.

This dip likely reflects pushback by GOP lawmakers in the current Congress, who view CDC’s public health activities as synonymous with overt advocacy. Language in funding measures, in the current session of Congress, has attempted to limit federal dollars for grassroots efforts by public health practitioners to lobby on behalf of specific legislation, particularly on efforts to address chronic disease and obesity.

Generally, public health advocacy is not lobbying, which is prohibited when it involves federal or earmarked funds. Exceptions include study or research and discussions of broad social problems.

So it is not surprising that government-funded public health bodies have been generally shy, and in the case of firearms legislation, nearly totally muzzled, from discussing firearms deaths since congressional language banned funding of firearms research starting in 1996. (In my opinion there has been a failure of leadership in public health when such leadership was needed on the issue of firearms violence, which is a legitimate public health concern.)

But should bans on using public funds for lobbying mute the profession from pushing for advocacy approaches and political engagement?

Daniel Callahan and Bruce Jennings’ 2002 article in the American Journal of Public Health examined the ethics of public health advocacy. They noted, “Politics is a necessary component of public health, moreover, precisely in order to achieve public health policies and practices consistent with American traditions and values. Politics is the messy arena in which ultimate questions of the public good are worked out.”

Public health’s failures in the political mosh pit

A perfect example of what happens when public health was not fighting tooth and nail was President Obama’s Affordable Care Act of 2009, which ultimately squashed efforts for a single payer system—the long-held dream of public health advocates from the 20th century—and advanced a health insurance industry, market-based model for “health care” reform.

All told, advocacy groups in 2009 spent $3.47 billion for D.C.-based lobbyists to parse out issues, according to left-leaning Center for Responsive Politics. Not surprisingly, the lion’s share of that spending went to fight the health reform battle. Businesses and organizations that lobbied on “health reform” spent more than $1.2 billion on their overall advocacy efforts.

APHA lobbying 2013

Source: The Center for Responsive Politics

For its part, the American Public Health Association (APHA) spent less than $500,000 annually on lobbying at last count in 2013. (See spending chart for lobbying expenditures by APHA from 1998 to 2013.)

The good news is that this marked a jump of more than 300 percent from what APHA spent in 2012. It would appear that some in the field are waking up to the realities of fighting for public health where the most meaningful impacts can be achieved – through policy and legislation.

By comparison, just one big pharma company, Pfizer, spent more than $800,000 in the first six months of 2013, from local to congressional candidates and political parties nationwide (see chart above).

What is most discouraging is that future leaders entering the profession continue to be shortchanged by graduate programs that do not know how to prepare practitioners to win in the bruising political environment known as “upstream.” This is my general assessment of not just my graduate MPH program, but of the field that I still see through its obsessive and yet parochial obsession with the 10 essential public health services.

The CDC's 10 essential public health services.

The CDC’s 10 essential public health services.

A very smart resource guide developed by the California Endowment sharply noted: “… many public health faculty do not possess the skills or experience to teach advocacy effectively. Faculty surveys show, for example, that despite advocacy for health being recognized as an ethical responsibility and required competency of health educators, many health education faculty do not see themselves as competent for teaching advocacy and lack instructional materials to do so. Degree-granting programs in public health need to provide systematic training in social advocacy. In the absence of formal training in social change, public health graduates must learn this information and develop these skills on a catch-as-catch-can basis. Working in this way means that some will be less effective than they otherwise could be in advancing the health of the public.”

America’s cultural zeitgeist and the emerging Don Corleone of public health

This has been one of the wildest weeks exposing the extremes of America’s cultural zeitgeist I can remember. What could be more American than gay marriage moving to the mainstream of American life and semi-automatic weapons readily available at a Walmart  near you, right?

Need a weapon of war to feel safe? Just drive to the nearest Walmart near you and select from their popular product lines.

Need a weapon of war to feel safe? Just drive to the nearest Walmart near you and select from their popular product lines.

On one hand, you have the U.S. Supreme Court hearing two landmarks cases, one on the legality of a voter approved ban on same sex marriage and another on the constitutionality of the federal Defense of Marriage Act, which aligns hundreds of federal benefits to promote that only a man can legally marry a woman.

Meanwhile, a full-court press was taking place in Congress to advance legislation that would require criminal background checks on all gun purchases and that would close the so-called gun-show loophole, which allows for up to 40% of all firearms sales to evade any scrutiny at all. However, efforts to include Sen. Dianne Feinstein’s amendment to restrict the sale of semiautomatic, military style assault rifles —the kind used to slaughter 26 civilians at Newtown—were dashed when Sen. Majority Leader Harry Reid (D-Nev.), on March 20, pulled it from the current gun legislation in the U.S. Senate. GOP members of Congress are already promising to filibuster the bill.

Will Ferrell, actor, comedian, and cultural clairvoyant, seemed to sum up the obvious best.

Will Ferrell, actor, comedian, and cultural clairvoyant, seemed to sum up the obvious best.

Will Ferrell’s now much repeated tweet seemed to put the pulse of the nation best: “I feel so blessed that the government protects my wife and me from the dangers of gay marriage so we can safely go buy some assault weapons.”

And, as we have so often seen in our country, sometimes tasteless, but also very popular, comedians can best summarize the seemingly craziness of political reality, where serious-minded commentators fall flat. Perhaps only through comedy can we see the absolutely surreality of our current reality.

Bloomberg takes on the NRA: no quarter asked, and none given

This week also saw the launch of Mayor Michael Bloomberg’s $12 million campaign in 10 states to promote federal gun legislation, through his national coalition of big city mayors called Mayors Against Illegal Guns. “I don’t think there’s ever been an issue where the public has spoken so clearly, where Congress hasn’t eventually understood and done the right thing,” said the multi-billionaire leader of a national political movement to restrict the proliferation of weapons that claim more than 31,000 lives annually.

Bloomberg’s newly created super PAC, Independence USA PAC, infused millions in the last federal election cycle, helping elect four of seven candidates who promoted legislation to reduce gun violence in the United States, a major public health threat that only now is getting the attention of public health  officials nationally after years of self-imposed silence.

Wayne LaPierre went head to head with Michael Bloomberg on the talk shows.

Wayne LaPierre went head to head with Michael Bloomberg on the talk shows.

Likely fearing the emergence of a national political movement, the National Rifle association (NRA) launched a counter-strike against Bloomberg’s media campaign. NRA head Wayne LaPierre sparred with Bloomberg on Meet the Press on March 24, framing Bloomberg as a plutocratic, public health-minded uber-nanny who threatened America’s freedoms, including the alleged right to own guns and the right to eat unhealthy food:

“And he can’t spend enough of his $27 billion to try to impose his will on the American public,” said LaPierre, the national face for the most powerful gun industry lobby.”They don’t want him in their restaurants, they don’t want him in their homes. They don’t want him telling them what food to eat; they sure don’t want him telling them what self-defense firearms to own. And he can’t buy America.”

Which multi-billionaire do you want to champion public health, Gates or Bloomberg?

Bloomberg’s efforts to limit the size of sugary drinks in New York City was recently struck down by the courts. But Bloomberg remains determined to preserve his emerging national status as the Don Corleone of public health.

From pushing upstream interventions to tackle obesity to funding multiple efforts to reframe the national dialogue on guns and America, Bloomberg appears to be everywhere at once these days. In many ways, the bolder, tougher, more confrontational face for public health and the national voice for legislative action on clear public health threats is the 71-year-old Boston native.

By force of will and deep pockets, Bloomberg is emerging as a rival brand for plutocratic public health warrior to reigning champion Bill Gates, whose Microsoft-based wealth helped fund the biggest non-governmental player in public health, the Bill and Melinda Gates Foundation. With $34 billion in assets it is the largest openly run private foundation on the planet.

Which Don Corleone do you want to promote public health, Bill Gates or Michael Bloomberg?

Which Don Corleone do you want to promote public health, Bill Gates or Michael Bloomberg?

Multi-billionaire Gates carefully has chosen non-confrontational public health initiatives that many limited-government and conservative minded leaders can champion, such as poverty reduction programs, education programs, and promoting technological efforts such as genetically modified crops.  Bloomberg’s approach is a much more in-your-face, New York style. He has proven very effective on the bully pulpit by staking out public positions and articulating views that few in the field of public health or even elected office have championed since the assault weapons ban was passed in 1994 as part of a major cops bill under the Clinton White House.

One thing is clear. Leadership, in the wake of repeated gun-fueled tragedies, like the Sandyhook Elementary School mass murders, is making a difference. And for a change, it appears that the NRA’s seeming unshakable momentum to promote the ever-expanding sales of firearms and legislation that allows for the deadly use of force has been called into check.

This also has rippled down to the public health departments, which are now showing greater resolve and passing measures calling firearms-related deaths a threat to public health and totally preventable. Maybe Bloomberg’s moxie is rubbing off. Such symbolic efforts by public health departments clearly are not a true fix, but they are a long-awaited and long-overdue baby step forward.

Rally to ban assault weapons lays out strategy for Washington State activists

I attended a rally today (Jan. 13, 2013) in Seattle that included a march through downtown to the Seattle Center. The event called for an immediate ban on assault weapons and better laws to require background checks on all weapons sales. The march was organized by the non-profit called Washington Ceasefire, a state-based group founded in 1983 and dedicated to reducing violence from guns in the United States. (See my photo essay below.)

The event attracted somewhat lukewarm media coverage as of this evening, with stories picked up by most of Seattle’s major broadcast media, including the major TV news stations. The event was competing with the story that mattered most to Seattle–the playoff game that saw the Seattle Seahawks fall in a heart-breaker to the Atlanta Falcons. Still, approximately 400-500 participants attended the rally that marched about a half mile from Westlake Center to the Seattle Center.

The event began with a speech by mayoral candidate and current City Councilman Tim Burgess, a former Seattle police officer who called for attendees to focus their advocacy on immediate actions that could be taken by the Washington State Legislature. No specific state-level legislation or bills were identified, and Burgess’ rallying cry noticeably did not call for any specific federal action, perhaps because such proposals are still being formulated by the Obama White House.

Nor were any of the state’s congressional members referenced in public remarks or acknowledged in any event promotional material I am aware of. (Note I left the rally before it ended.) To my knowledge, no member of the state’s congressional delegation officially participated in the speaking activities, nor did their staff. I found that omission intentional and noteworthy. I am sure many attending noticed this also.

Washington Ceasefire President Ralph Fascitelli specifically called on an outright ban on assault weapons and sensible gun legislation. The web site created to promote the event quoted the group’s executive director, Beth Flynn: “We want to send a clear message to our legislators that we want to ban semi-automatic assault weapons.”

It was refreshing to me, as a public health professional, to hear Councilman Burgess make reference to the public health threat posed by firearms in his remarks. I spotted at least one retired University of Washington School of Public Health faculty member in attendance and holding a sign, which was very encouraging. I also met other public health professionals in the audience. Again, nice to see.

A list of the dignitaries who were invited to speak can be found here. I spied Seattle Mayor Mike McGinn, Councilman Nick Lacata, Councilmember Jean GoddenState Rep. Reuven Carlyle (D-Seattle), and other civic and religious leaders on the Mural Amphitheater stage at the Seattle Center, where remarks were made.

Also noteworthy was the presence of gun-rights activists. I saw two men wearing handguns in their holsters at the Westlake Center. So, I took their photographs. No doubt groups opposed to firearms legislation were monitoring the event and were mixing with the crowd. I observed very peaceful exchanges between those for greater legislation and those opposed to it. I included a photograph of the two men who were armed below to highlight how they communicated their views–at least through a visible display of their guns for the TV cameras and for those seeking legislation to control firearms violence.

Photographs of the StandUp Washington rally, January 13, 2013 (click on each thumbnail for a larger image)

How research on gun violence is muffled, and who refuses to shut up

On the first day in the new year, I read one of what will become thousands of similar stories that will be published this year in the United States about how firearms were involved in completely senseless and preventable violence.

To understand why we have so many shootings, one may wish to buy this book: Armed America: Portraits of Gun Owners in Their Homes by Kyle Cassidy. Go to http://www.armedamerica.org/. The cover photo provides a shockingly good insight into the national crisis over gun related violence.

To understand why the United States has so many shootings, one may wish to buy this book, Armed America: Portraits of Gun Owners in Their Homes, by Kyle Cassidy. Go to http://www.armedamerica.org/. This book cover photo offers one perspective on the national crisis over the nation’s gun-related violence.

In this particular instance, a 54-year-old woman reportedly shot a  24-year-old man in the thigh over a dispute that he was shooting fireworks at her property in rural Lake Stevens, Wash. No, I am not making this up.

While no one died in this New Year’s eve confrontation, the story barely received three paragraphs of news coverage, as it lacked the dramatic horror that the media exploit when mass homicides occur involving often-legally purchased weapons. There were no dead children or mentally deranged men in military gear loaded with weaponry. Were this story to occur in Canada, or say Japan, it would have received much different coverage.

While we may assume this seemingly “bland” shooting will be counted in national data, that is not guaranteed. It likely could be ignored.

In response to uncertainty over national data, Slate Magazine, on Jan. 1, 2013,  published a story called How Many People Have Been Killed by Guns Since Newtown?. The article alleges guns statistics are “surprisingly hard to come by.” Slate claims it will track the toll of gun related killings with an an anonymous publisher with the Twitter feed @GunsDeath to create an interactive tracking feature. The articles asks readers  who know about gun deaths in their community that are not counted on its interactive map  to tweet @GunDeaths with a citation, and it will be added to the feed.

brady center stat count

The Brady Center keeps a daily tab on gun violence–go to the right corner of the center’s home page for the shooting count, based on CDC data.

The Brady Center, the best known nonprofit that is working to pass legislative fixes to issues such as the sale of semi-automatic weapons and closing loopholes that allow for guns sales without background checks, uses data from the Centers for Disease Control (CDC) (2008-09 estimates). It then makes an estimate of the number of killings a day that may not correspond to the most recent trends. The source data is captured by the CDC National Center for Injury Prevention and Control, reported and accessible through the web-based Injury Statistics Query and Reporting System.

A lesson in how to silence public health researchers, and yes it is about the money

Slate’s professed shock at the lack of poor tracking of gun-related fatalities should actually surprise no one who has monitored the muzzling of research on gun-related violence since the 1990s by the National Rifle Association (NRA), the gun industry’s lobby, and its allies in Congress.

According to a newly published article by Dr. Arthur L. Kellermann and Dr. Frederick P. Rivara (both of whom have MPH degrees), in the Dec. 21, 2012, edition of the Journal of the American Medical Association, gun research at research universities that is funded by the federal government has been systematically quieted by pro-gun forces since a ban was enacted on the CDC in 1996, mainly through budget language. Pulling funding, in effect, silenced the nation’s public health agency on a critical public health issue.

The budget language, which remains in effect today, stated “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” While it is not clear why individual CDC officials or even highly paid medical and public health professionals have not more publicly risked their professional standing to challenge this language, the authors of the study note, “Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.”

Rivara and Kellermann further state that the language restricting such research was expanded after a 2009 study that was federally funded, this time by the National Institute on Alcohol Abuse and Alcoholism, if a gun increases or reduces the risk of firearm assault. Congress, in 2011, during the Obama administration and amid the Tea Party insurgency of 2010, “extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.”

The two authors highlight other efforts taking place national to stifle medical professionals from speaking out, such as Florida’s law (HB 155), which put health care practitioners at risk of penalties, including the loss of their licenses, “‘if they discuss or record information about firearm safety that a medical board later determines was not ‘relevant’ or was ‘unnecessarily harassing.'”

How silencing plays out at research universities, quietly and likely without intent

This blog has reported that the silence within the research community can be found at major public health research programs, such as the University of Washington School of Public Health, which  I attended from 2010 to 2012. I was unable to find any faculty actively teaching future public health leaders–my classmates–about firearms safety research or gun violence in the school’s public health curricula.

It should be noted Dr. Rivara is an adjunct faculty member of the UW School of Public Health, and Dr. Kellermann and he are also graduates of the same school (for their MPH degrees). Dr. Kellerman was in fact my graduation commencement speaker, and proved to be a passionate scientist and advocate to all of us. However, my review of courses did not reveal any classes focussing on gun violence as a public health issue; this does not mean Dr. Rivara and other faculty did not cover this topic in their classes. (It should also be noted that a keyword search for “guns” on the UW SPH web site today, Jan. 2, 2013, yielded only three pages, one focussing on Dr. Rivara and another focussing on Dr. Kellerman.)

During my studies there, I repeatedly raised this anomaly to my professors and during seminars in front of as many faculty as possible–often to the point of becoming an annoyance to those who had heard me ask the same questions repeatedly. But short of actually sitting in on faculty strategy sessions or having any survey data, it is impossible for me to know the reasons why my former school choose not to include this topic in its curricula. There were and remain classes on issues that do receive federal funding: tobacco cessation, obesity and nutrition, maternal and child health, and much more. All are worthy topics, but these were the winners, guns was a loser.

My guess remains it was purely a matter of funding, or lack of funding, and the intense internal pressure on junior faculty to pursue research dollars highly coveted by all departments that were not tied to this pariah topic. Thus the silencing of research continued, without any alarm bells raised from a larger community of researchers, who should be the most active and who should have been leaders, locally and nationally. That is how it works.

Dr. Rivara’s primary role is as a faculty member at the UW School of Medicine, Department of Pediatrics. To his credit, he has shown continued national leadership on gun violence. He and Dr. Kellerman deserve great praise for their lifelong service and work on this topic. Hopefully their article also will shame and embarrass their distinguished academic peers–locally and nationally–into either creating endowed teaching positions or a campaign drive to fund research that can shed light on this national public health crisis that has seized the nation’s attention since the massacre of 20 children and six faculty in a public school in Newtown, Conn. in December. MPH students also can lobby for change too, despite the hazards of confronting faculty who grade and often employ them as assistants.

Given that many faculty at these institutions can earn salaries well above $200,000 annually, some may be reluctant to jeopardize their professional careers or positions in the name of public-minded research on a topic that is at the center of one of the nation’s greatest moral debates since the Civil Rights movement and perhaps since the violent ending of slavery during the Civil War.

Gun researchers who have not been silenced by budget threats

Researchers not blocked by the ban on the CDC and NIH have shown that a prized policy goal of the NRA and gun makers, expanding “standing your ground laws,” have lead to more homicides.Researchers have found that states with a stand your ground law record more homicides than states without such laws.

Data from the study by Hoestra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).

Data from the study by Hoekstra and Cheng, as published on the NPR.org web site (Jan. 2, 2013).

Two economics researchers at Texas A&M University, Mark Hoekstra and Cheng Cheng, found that the laws “do not deter burglary, robbery, or aggravated assault. In contrast, they lead to a statistically significant 8 percent net increase in the number of reported murders and non-negligent manslaughters.” The findings run counter to the argument of the primary proponent of such legislation, the NRA.

On average, there are about 500-700 more homicides a year among the 23 states with stand your ground laws because of these laws: “One possibility for the increase in homicide is that perhaps [in cases where] there would have been a fistfight … now, because of stand your ground laws, it’s possible that those escalate into something much more violent and lethal,” says Hoekstra.

The Newtown massacre and musings on guns, morality, and public health

The brutal massacre of 20 young children and six public school employees in Newtown, Conn., on Dec. 14, brought to mind one of the greatest speeches in U.S. history, President Abraham Lincoln’s Second Inaugural Address. On March 4, 1865, well into the fifth year of the bloodiest U.S. conflict, to resolve the criminal institution of slavery, Lincoln evoked unusually strong biblical and moral language that he normally avoided.

This FaceBook Post generated comments that said, this is why this country is so great and also why it is is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)

This facebook post generated comments that said, this is why this country is so great and also why it is so “f’d up” (https://www.facebook.com/photo.php?fbid=314047015290064&set=o.113895238664965&type=1&theater)

He first stated that the continuing expansion of slavery was the goal of the South. “All knew that [slavery] was, somehow, the cause of the war. To strengthen, perpetuate, and extend this interest was the object for which the insurgents would rend the Union … .” Then Lincoln, in language well understood by his countrymen, further noted the sins and injustice of slavery had brought the wrath of an Old Testament God upon the nation: “Fondly do we hope–fervently do we pray–that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue, until all the wealth piled by the bondsman’s two hundred and fifty years of unrequited toil shall be sunk, and until every drop of blood drawn with the lash, shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said the judgments of the Lord, are true and righteous altogether.”

A moral issue?

In short, Lincoln held his country morally accountable for that “peculiar institution.” He used moral language, much the way Dr. Martin Luther King, Jr., a century later, used similar language to address the injustices of discrimination and racism in the Jim Crow South and throughout the country. Such language by elected officials, however, has been mostly absent from the national debate over firearms violence that is involved in the death of more than 11,000 U.S. residents annually (homicides alone).

But the debate over the regulation or expansion of guns and automatic weaponry on the open market may have turned a page with Newtown shooter Adam Lanza’s killing spree. He used at least three guns (Glock 10 mm and a Sig Sauer 9 mm handguns and a Bushmaster .223-caliber) that were first obtained legally. He stole all of them from his well-to-do mother after killing her.

This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.

This Bushmaster .223, as of Dec. 16, was being advertised for sale on the Internet.

The availability of such lethal weaponry is far from an aberration. The Bushmaster .223 can easily be purchased now. Here’s one ad I found on Dec. 16; the weapon is described as intended for military combat.

In response to this mass murder of mostly kids, Peter Drier, professor of politics and chair of the Urban & Environmental Policy Department at Occidental College, posted a piece on Dec. 15, on the Alternet web site titled “The NRA’s Wayne LaPierre Has Blood on His Hands: The Brady Campaign to Prevent Gun Violence has a 62-page list of mass shootings in America since 2005. It is Wayne LaPierre’s resume.” Drier asserts that “the long list of killings is due in large measure to the political influence of the [National Rifle Association] NRA—and the campaign finance system that allows the gun lobby to exercise so much power.” In short, the NRA, the gun industry it lobbies for,  the NRA’s alleged 4 million members, and officials in elected office are all morally accountable for downstream effects of firearms proliferation.

Who is morally accountable for mass gun shootings like Newtown's? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre,

Who is morally accountable for mass gun shootings like Newtown’s? Just the shooter or weapons industry promoters like NRA CEO Wayne LaPierre.

The NRA’s influence

The NRA, of course, alleges that the Second Amendment to the Bill of Rights gives individual Americans the right to possess guns, even combat weapons designed for the mass killing of people. The NRA also, in my opinion, falsely alleges that regulating gun sales and ownership is an attack on our constitutional freedoms–even our “civil rights.” Such language is devoid of both logic and rationality, and absent any moral foundation. I continue to find “literalist” interpretations of the U.S. Constitution, which also legitimized slavery for decades, as irrelevant to the complexities of a public health crisis that weapons-related violence has become in this country.

But, the NRA is more than a gun lobby. Its annual budget exceeds more than $250 million. It donates generously to political campaigns. It runs a non-profit foundation that boasts having raised $160 million. It runs a multimedia operation to promote its extremist views. It is, at the state level, aggressively promoting gun rights such as “stand your ground” laws. In the U.S. Senate, John Thune (R-S.D.) introduced a measure that would force all states that issue concealed carry permits to recognize the permits from other states. More importantly, the NRA promotes both the culture of weapons proliferation and a social media ecosystem that enables extremist views to proliferate, both inside its ecosystem and in the blogosphere, where many NRA talking points pepper the comments section of news stories on gun violence.

Using a public health lens to debate gun violence

In addition to embracing moral language, the national debate should also use a public health lens and the widely available data at all times to bury the completely false NRA propaganda that “guns don’t kill people, people kill people.” For example, the Harvard School of Public Health’s Injury Injury Control Research Center examined peer-reviewed research and reported three main findings that point to the association between gun proliferation and homicides, including in the United States:

1. Where there are more guns there is more homicide.
2. Across high-income nations, more guns = more homicide.
3. Across states, more guns = more homicide.

A public health approach involves looking at the data, having a population focus (rather than focusing on the motives of a mentally disturbed killer), examining the policies and systems that enable guns to continue impacting the public’s health, and focusing on forces that develop dangerous personal behaviors—even the embracing of ideas that promote harmful activities such as owning guns. The conservative-leaning Seattle Times, which has not called for any legislative action to address firearms violence this past week (following two mass killings), pulled together some data from public sources on Dec. 15, regarding mass murders involving firearms (my comments in italics):

  • Shooting sprees are not rare in the United States.
  • Eleven of the 20 worst mass shootings in the past 50 years took place in the United States.
  • Of the 12 deadliest shootings in the United States, six have happened from 2007 onward.
  • America is an unusually violent country. But we’re not as violent as we used to be. (See the graph below.)
  • The South is the most violent region in the United States.
  • Gun ownership in the United States is declining overall. (However, we have more than 300 million guns in the U.S.–a staggering figure.)
  • States with stricter gun-control laws have fewer deaths from gun-related violence.
  • Gun control, in general, has not been politically popular. (This fact  overlooks how campaign funding impacts local and national races.)
  • But particular policies to control guns often are.
  • Shootings don’t tend to substantially affect views on gun control.
Duke University sociology professor Kieran Healy complied OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how aassults in the U.S. end up with lethal consequences (his data does not distinguish cause of death from say guns to knives.) Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/

Duke University sociology professor Kieran Healy compiled OECD data on violence in developed countries (excluding Estonia and Mexico) and concluded “America is a violent country.” Such data points to both a pathology toward violence and how assaults in the U.S. end up with lethal consequences (his data do not distinguish cause of death from say guns to knives). Go to: http://www.kieranhealy.org/blog/archives/2012/07/20/america-is-a-violent-country/

A 2003 study by EG Richardson and D Hemenway  (called “Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003”) found that he United States has “far higher rates of firearm deaths-firearm homicides, firearm suicides, and unintentional firearm deaths compared with other high-income countries” and that the “United States is an outlier in terms of our overall homicide rate.”

Referencing this study, the Brady Campaign concludes that “the United States has more firearms per capita than the other countries, more handguns per capita, and has the most permissive gun control laws of all the countries.” The Brady Campaign further notes that “of the 23 countries studied, 80% of all firearm deaths occurred in the United States; 86% of women killed by firearms were U.S. women, and 87% of all children aged 0 to 14 killed by firearms were U.S. children.”

More blood from the sword … for the lash?

What remains to be seen is if the preponderance of data and the moral outrage that may have been generated by the Newtown shootings will create change.

President Obama, the day of the shootings, held a press conference and said, “We’re going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics.” Gun control advocate and billionaire New York City Mayor Michael Bloomberg dismissed such talk immediately:  “Not enough,” Bloomberg said. “We have heard all the rhetoric before. What we have not seen is leadership — not from the White House and not from Congress. That must end today.” To date Obama has not used his office to promote any national legislation or even national dialogue on gun policy.

One thing is certain: there will be more mass murders in the United States involving legally obtained and legally sold firearms. And I am left paraphrasing Lincoln and wondering: how much more blood from such gun-related killings will have to be spilled to atone for our nation’s continued shortcomings to control what other developed nations have managed to do, and do for decades?

Bloomberg spends millions on candidates supporting firearms legislation

Democratic U.S. Rep. Joe Baca, of California’s 43rd Congressional District, lost in a race for the redrawn 35th Congressional District to fellow Democrat, state Sen. Gloria Negrete McLeod, thanks mostly to funding by Mayor Michael Bloomberg’s super PAC focussing on gun control issues.

During the November general elections, few candidates running for national office chose to stake out policy positions advocating for legislation attempting to address the proliferation of firearms and the public health risks they pose to the country. But a few did, and their sugar daddy, New York City Mayor Michael Bloomberg, chose to invest some of his small fortune in a handful of political races that put the long-smothered issue into the national spotlight.

One six-term congressional veteran, U.S. Rep. Joe Baca from southern California, lost thanks to campaign spending by the Independence USA PAC, created by Bloomberg late in the fall campaign. According to a Nov. 23, 2012, story on the race by National Public Radio (NPR), Bloomberg’s PAC was looking for “the right race and the right set of circumstances.”

According to the NPR Story, the first thing Bloomberg’s new super PAC wanted was a clear contrast between the candidates on an issue of real concern, such as guns, and Baca, a Blue Dog Democrat, previously had gotten high ratings from the National Rifle Association (NRA). Columnist Dan Bernstein, with The Press-Enterprise newspaper in the “Inland Empire” area east of Los Angeles, said, “There’s probably one man in America, in this campaign, who cared about gun control. And it’s Mayor Bloomberg.”

For reasons still not clear to me, NPR’s report focussed on how super PACs can defeat local candidates, but ignored the bigger issue of why Bloomberg joined the fray–to address the issue of gun violence in the country. NPR continues to be a media outlet that fails to report national statistics on firearms violence, namely easily accessible public health data on murders and suicides linked to guns.

Mayor Michael Bloomberg of New York City is a billionaire who has staked out policy interventions to promote public health, targeting obesity/nutrition and firearms.

Bloomberg’s super PAC made late entry in key races

When Bloomberg made his announcement on Oct. 17, 2012, he stated, “It’s critically important that we have elected officials in Washington, Albany, and around the nation who are willing to work across party lines to achieve real results. I’ve always believed in the need for more independent leadership, and this new effort will support candidates and causes that will help protect Americans from the scourge of gun violence, improve our schools, and advance our freedoms.”

Bloomberg’s decision had an immediate and symbolic impact. The Press Enterprise newspaper noted that Baca lost his re-election bid to a come-from-behind finish by state Sen. Gloria Negrete McLeod, D-Chino, thanks mostly to a last-minute cash infusion from Bloomberg’s PAC. Baca also reportedly blamed Bloomberg’s spending for his loss in the race for the redrawn 35th Congressional District.

Bloomberg’s super PAC came late in the race. The Washington Post only reported the PAC’s existence the day Bloomberg made it public, and all just three weeks before the Nov. 6, general elections. A New York Times blog had initially reported that Bloomberg’s top issues were abortion and gun control before the super PAC was made public.

Bloomberg’s actions were entirely consistent with his statement following the horrific mass murder in Aurora, Colo., on July 20, 2012, when a gunman wounded 59 civilians and killed 12 others at a theater. Bloomberg, after the shooting and the media spectacle that ensued, lambasted Republican presidential candidate Mitt Romney and Democratic President Barack Obama for failing to mention the issue of how unrestricted firearms was a major factor in such mass murders of U.S. citizens.

“Soothing words are nice,” said Bloomberg, “But maybe it’s time the two people who want to be president of the United States stand up and tell us what they’re going to do about it, because this is obviously a problem across the country.” Both candidates failed to discuss any serious policy approach to stemming gun-related violence in the United States, notably during the three presidential debates.

As this blog has reported before, the Centers for Disease Control and Prevention (CDC) reports that the number of firearm homicides in 2010 in the United States was 11,493, while the role of firearms in suicides was nearly twice that rate, or 18,735 persons. All told firearms were linked to 30,228 deaths annually at last count–a fact that Democrats have decided to avoid as they put together their national coalition that includes many center and right of center candidates in the U.S. House of Representatives the U.S. Senate.

Bloomberg’s super PAC picked Pennsylvania race winner

Bloomberg’s PAC also supported Pennsylvania Attorney General Democratic candidate, Kathleen Kane. An ad paid by the super PAC said: “Kathleen Kane: close the [Florida] loophole and keep guns out of the wrong hands. Track stolen guns to choke of supply to criminals. Background checks for all gun sales.” (See the ad here.)

Independence USA, Michael Bloomberg’s new super PAC, ran this issue ad supporting candidate Kathleen Kane prior to the Nov. 6, 2012 election.

Kane, in a rare move for a Democrat running for a state or higher office, publicly came out in favor of legislation favoring firearms control. She said she wanted to close the so-called “Florida loophole,” which lets someone denied a concealed-carry gun permit in Pennsylvania to get one in another state and then transfer that permit to Pennsylvania. Kane went on to win her race handily.

While Kane is a rarity, few if no politicians have the pockets of Bloomberg, an independent who can spend $10 million to $15 million of his own fortune on an issue that has seen no legitimate political discourse at the state or federal level for years, thanks mainly to the work of the NRA, the gun industry lobby.

All told, Bloomberg’s spending was directed at seven races nationally, of which his picks won four races, costing the billionaire roughly $8 million. Public health advocates who champion addressing firearms violence in the country likely will be following how Bloomberg’s super PAC will continue to wade into strategic races and confront the silence over firearms violence, which has become the acceptable new normal in political discourse by both major parties.

Leadership likely will remain with big city mayors, who as managers overseeing jurisdictions that carry out day to day criminal justice activities, see all facets of firearms violence most closely. The Brady Center also will continue to lobby for legislative changes to address the proliferation of firearms in the United States, as well.

The Brady Center featured this image on its web site to advocate for firearms policy reform here: http://bradycenter.com/advocates/women.