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.

A 2022 Pew Research Report indicates the rate of gun deaths among Americans reached its highest level – 10.6 per 100,000 people – in 2020. Further, the Kaiser Family Foundation reported in 2022 that firearms are the leading cause of death for U.S. children.

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, heart disease and COVID-19, 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, vice president medical officer for Sanford Children’s Hospital in Sioux Falls, South Dakota, and a longtime specialist in pediatric 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 Centers for Disease Control and Prevention calls gun injuries a “serious public health problem.” CDC reports:

  • There were 45,222 firearm-related deaths in the U.S. in 2020
  • More than half of firearm-related deaths were suicides and more than 4 out of every 10 were firearm homicides
  • Males account for 86% of all victims of firearm death and 87% of nonfatal firearm injuries
  • More than 7 in 10 medically treated firearm injuries are from firearm-related assaults
  • Nearly 2 out of every 10 are from unintentional firearm injuries

Recently, the Emergency Nurses Association released its latest firearm safety related position statement. The group supports the screening of patients for access to firearms, safe storage of firearms, childhood access prevention laws, and laws that prohibit access to firearms by those who have domestic violence restraining orders against them or have been convicted of domestic violence and misdemeanors, and the expansion of background checks.

“The true toll of the gun violence epidemic in this country goes deeper than the headlines we see on a weekly, sometimes daily, basis,” said ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN. “Mass shootings and frequent gun violence in many cities across the country get more attention, but emergency nurses understand firearm injuries and deaths attributed to domestic violence, suicides and accidental discharges are also a devastating part of this public health crisis.”

Reducing fears

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.

“Children can be very susceptible to our own fears,” said Dr. Stefanie Hanisch, the chair of child behavioral health at Sanford Fargo in North Dakota. “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.

Finding gun violence causes

“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.”

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.”

Doing a better job

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.

“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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