Social Epidemiology: Public Health + Social Movements | Future of Health Summit 2023

Global and US Life Expectancy Trends

• Global life expectancy rose from an average of 31 years in 1900 to over 70 years today due to biomedical advances.
• Conversely, life expectancy in the United States has declined for the first time, eroded by social determinants of health.

Gun Violence: The Crisis and Movement

• The US gun murder rate is approximately 27 times higher than that of any other developed country.
• External observers express shock that US children are trained to react to active shooters as early as age five.
• The "Manchin-Toomey" gun safety bill failed after Sandy Hook despite bipartisan co-sponsorship, highlighting that political astuteness alone cannot shift hearts and minds without a vocal movement.
• The grassroots merger of Everytown with "Moms Demand Action" (now one of the largest US grassroots organizations) helped shift the political calculus.
• In the summer of 2023, Congress passed the first gun safety bill in 26 years, supported by 15 Republicans and all Democrats against NRA objections.
• The gun industry benefits from a "fortress" of legal protections, including blanket civil immunity granted by Congress in 2005 and a ban on federal gun violence research.
• Strategies to pierce this fortress include litigation (Everytown employs a 22-person law firm) and stigmatizing specific manufacturers, particularly Glock, which is disproportionately linked to crime scenes.
• Corporate levers are being utilized: Citi prohibits certain gun purchases, and Amex, Visa, and MasterCard recently established a specific merchant code for gun sales, a first in US history.
• Dick's Sporting Goods and Walmart have exited the gun business, setting a precedent for corporate responsibility.

Tobacco Control: Successes and Health Disparities

• Teen cigarette use has dropped from 23% in 2000 to approximately 2–3% today, driven by public education, tax increases, and denormalization campaigns.
• Despite progress, "Tobacco Nation" persists in the South and Midwest (e.g., Michigan to Louisiana, North Carolina to Oklahoma), where smoking rates rival those in China, Indonesia, and the Philippines.
• The tobacco industry has historically targeted vulnerable populations: 85% of Black smokers use menthol due to targeted free distribution, and LGBTQ+ communities face higher smoking rates due to industry targeting of social events.
• The industry now targets youth for vaping, with new campaigns linking nicotine use to worsening mental health ("Depression Stick," "Breath of Stress Air") and dating prospects ("Left Swipe That").
• A strategic shift is emerging from "tobacco control" to a "tobacco end game," aiming to eliminate the industry's social license rather than just regulate it.
• New Zealand is pioneering legislation to ban tobacco sales for anyone born after a specific cutoff date.

HIV/AIDS: Stigma and Health Equity

• Despite medical advances, 15,000 HIV-related deaths and 35,000 new transmissions occur annually in the US.
• Of the 1.2 million people living with HIV in the US, only 50% have achieved viral suppression.
• The epidemic has become increasingly concentrated among Black and Brown populations and those in the South, requiring a focus on health equity.
• Stigma remains a critical barrier; personal stories and allyship are necessary to break the silence, as seen in cases where patients hide diagnoses from families for years.
• Corporate adoption of domestic partnership benefits in the 1990s and early 2000s was instrumental in advancing the HIV and LGBTQ+ social movements.
• The passage of the Respect for Marriage Act is attributed in part to the groundwork laid by corporate advocacy and social movements.

Strategic Levers and Future Outlook

• Grassroots to Legislative Pipeline: Policymakers often ignore issues until grassroots movements make them politically unavoidable (e.g., marriage equality, gun safety).
• State-by-State Strategy: Following federal failure on the Manchin-Toomey bill, the gun movement shifted to state-level victories, mirroring the strategy that eventually led to marriage equality.
• Product Safety Innovation: The panel proposes "safe gun" technology (e.g., biometric firing pins) similar to auto safety features, aiming to render stolen or negligently stored guns unusable in the black market.
• Commercial Determinants: Private sector entities play a critical role in "commercial determinants of health," with potential to either exacerbate disparities (via targeting) or solve them (via cessation support and investment pressure).
• Social Media Responsibility: Social media platforms are identified as key players that either enable violence by hosting "breadcrumbs of violence" or could prevent it through data intervention.
• Taxation Challenges: Implementing price controls for guns faces higher legal hurdles than tobacco due to constitutional challenges regarding the Second Amendment, which the panel notes is less of an obstacle for tobacco.
• Corporate Investment: Pension funds and equity shareholders have leverage to influence corporate behavior regarding social issues and profit motives.