Gun violence drawing attention as a public health crisis

Health care providers support more research, offer prevention tips to families

Gun violence drawing attention as a public health crisis

Amid recent mass shootings, doctors have intensified the call to treat gun violence as a national health crisis.

In a span of less than 24 hours on the weekend of Aug. 3-4, mass shootings took the lives of 31 people in separate incidents in El Paso, Texas, and Dayton, Ohio. The killings are the latest in a series that have society looking for answers in addressing the problem of gun violence.

Increasingly, it’s an issue identified as worthy of the same medical scrutiny devoted to other sources of injury and trauma, and treated with similar models for gathering information that could contribute to possible solutions.

It is far from the first time those in medicine have contributed to help minimize the damage done midst national epidemics. Doctors worked with the auto industry to make cars and roads safer in the 1950s and ’60s. They also spearheaded a campaign to make the public aware of the dangers of tobacco in the 1960s and ’70s.

On other societal health issues involving the opioid crisis, obesity and heart disease, medicine continues to direct and lead significant efforts at prevention. Should gun violence get the same treatment?

Using a scientific model

“If there was a disease that struck people randomly, without prior conditions, and with increasing frequency — I believe we would address it as a health crisis,” said Dr. Joseph Segeleon, a Sanford Health pediatrician specializing in critical care.

“The American Academy of Pediatrics has come out with various stances on reasonable gun control but I think what you can do as an individual — and the American Academy of Pediatrics does recommend it — is that pediatricians discuss safe gun storage and gun safety for children who live in homes that contain firearms.”

The number of people killed in mass shootings (an attacker who shoots three or more people) represents only a small percentage of the overall number of victims of gun violence in the United States. In 2016, the Centers for Disease Control and Prevention reported:

  • 38,658 who died as the result of firearms
  • Of those, 22,938 were suicides and 14,415 were homicides
  • Homicides included 71 victims of mass shootings
  • 1,305 other deaths included accidental deaths and war casualties

According to Time magazine, 62 people have died in mass shootings (at least three people shot and killed in a public place) in 2019 as of Aug. 5. Media attention devoted to these events, especially those involving schools and young people, provide a challenge to parents who want safety for their children, but also peace.

Reducing fears

“Children can be very susceptible to our own fears,” said Dr. Stefanie Hanisch, the chair of child behavioral health at Sanford Fargo. “As adults we need to set an example. We need to react to these things with empathy and concern and talk about these things, using them as a teaching tool.”

That would include conversations about gun safety and making sure firearms do not get into the wrong hands.

“I’m not suggesting people shouldn’t have firearms if they so choose, but make sure they are secured,” Dr. Hanisch said. “And try to keep it in perspective. Children should not have to worry about being safe at school, in their communities and even in their own homes. Society has a responsibility towards its children to safeguard both their physical and emotional safety as much as possible. There is a fine line between common sense safety precautions and sending a message that we are constantly at risk and in danger.”

Common sense will always play the most important role in the prevention of gun violence. It applies to all people in being sensitive to conditions in the home or outside it, but it also applies to how those involved in health care approach the challenge of prevention.

“In diseases we look at research and we look for commonalities — we look for common causes,” Dr. Segeleon said. “Then we would go about seeing if there is any way to eradicate or reduce the cause. And also to mitigate its consequences. Applying disease models would at least be a place to start for the scientific community.”

Ancillary damage, while difficult to quantify, also plays a role in assessing the damage that comes with gun violence. Evidence exists that exposure to violence early in life can lead to both psychological and physical problems in adulthood.

Childhood trauma can have devastating effects on both emotional and physical well being,” Dr. Hanisch said. “Being exposed to trauma increases the risk of developing serious emotional difficulties including depression, anxiety and behavioral problems, as well as a variety of serious medical conditions later in life. If children are exposed to trauma that appears to be affecting them negatively, it is important to seek treatment for this. There are good evidence-based treatments available at Sanford to treat the psychological effects of trauma.”

Finding gun violence causes

Identifying gun violence as a health issue would help determine causation but also help discount some factors considered likely contributors that may in reality have little to do with the epidemic.

“People will ask me about video games — are they the cause of this phenomenon?” Dr. Segeleon said. “My response is that as a pediatrician I am unaware of data linking video games to mass shootings. Moreover, there are video games in every country in the world and yet the United States seems to be somewhat unique regarding the frequency of mass shooting.”

As a scientific approach gains speed with the promise of potential information-fueled policy adjustments, there are and will continue to be everyday practices that can play a role in preventing more of the same.

Doing a better job

“We could do a much better job in talking to families and parents about gun safety and making sure that if there are firearms in the home that they are safely stored away, locked up outside the reach of kids,” Dr. Hanisch said. “We do a lot of work as it pertains to suicide screening and mental health screenings but I think this is an area that we need to be working harder at. It should be a routine question to ask: Are there any firearms in the home and are they locked away?”

Many providers see it as much more of an obligation than an inclination to bring science and medicine to the forefront in addressing a national problem.

“We’ll often ask about seat belt use and helmet use for cycling,” Dr. Hanisch said. “As child psychiatrists, as a profession as a whole, we need to make it part of our screening and our education for how important it is to make sure that tragic accidents don’t happen.”

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