Reducing Gun Violence

Even raising the topic could be viewed as a transparent attempt to compromise or infringe on the Second Amendment. It is not.

The evidence and justification for taking decisive action is indisputable even prior to the horrific shootings in Uvalde, Texas, Buffalo, N.Y., and other parts of the country.

• According to a June 16, 2021 report issued by the U.S. Government Accountability Office, “In 2019, close to 40,000 people died from a gun injury in the U.S., and about twice that number suffered nonfatal injuries.” This report also noted hospital costs for initial gun injury care, representing about 30,000 hospital stays and 50,000 emergency room visits, were just over $1 billion a year, based on data from 2016 and 2017 (the latest available at that time).
• After reviewing data from recent years in National Vital Statistics Reports from the Centers for Disease Control and Prevention, researchers at the Westchester Medical Center in Valhalla, N.Y., reported on February 22, 2022 that firearms were the leading cause of trauma-related deaths in the U.S., overtaking motor vehicle crashes as the top cause of years of potential life lost. In the decade that researchers reviewed, firearms accounted for 12.6 million years of potential life lost.
• A March 23, 2022 New York Times article indicated the Centers for Disease Control and Prevention reported that the rate of gun deaths of children 14 and younger rose by roughly 50% from the end of 2019 to the end of 2020.

The Need for Effective Action Plans

A number of health care organizations have taken initiatives to address this ongoing national tragedy, but active engagement is needed by more health systems and hospitals already committed to improving community health status.

The following are three specific steps for consideration.

1. Replicate the actions of the University of Maryland Medical Center violence prevention program that demonstrates how these steps brought participants’ reinjury rates as low as 5%. This program was initiated in recognition that those with a history of violent injury are usually 45% more likely to be readmitted with another such injury within five years. The services provided by the violence prevention program at Shock Trauma include peer support groups, individual counseling and advocacy, GED diploma assistance, job readiness and training, parole and probation service, connections to community resources, and protective/peace order filing assistance. According to a UMMC spokesperson, “The mission of VPP is to prevent violent personal injury among Baltimore’s most at-risk populations through research into the root causes of violence and the development of evidence-based programs targeting those root causes.”
2. Consider the actions taken by Temple University Hospital, which treated more than 850 shooting victims in 2021, the highest number of any Level I trauma center in Pennsylvania. According to Scott Charles, the hospital’s trauma outreach manager, “Our efforts to address gun violence, which is the leading cause of death for a significant cross-section of our community, is consistent with our hospital’s mission to provide the highest quality of health care in both academic and community settings.” He added, “As a trauma department that prides itself on community service, we feel a moral obligation to utilize a public health approach to confronting the epidemic of gun violence.” Among the initiatives taken were the following:
   1. Used its Fighting Chance program to teach community members how to provide basic first aid to victims of gunshot wounds.
   2. Developed a plan focused on at-risk youth to help break the cycle of gun violence.
   3. Instituted “The Turning Point” intervention program to take advantage of teachable moments that exist during the post-injury/pre-discharge period for survivors of violence.
   4. Created the Safe Bet Program to prevent unintentional childhood shooting. To date, Safe Bet had provided more than 8,000-gun locks to Philadelphia families.
3. Review the extensive literature on gun violence prevention programs at health systems and hospitals to determine which components can be instituted in your organization.

Concluding Comments

The need to reduce gun violence is unrelated to the fact that the number of guns exceed the country’s total population or that U.S. gun production has tripled since 2000 fueled by handgun purchases. However, it is relevant that this nation’s gun death rate, as highlighted in a February 3, 2022 report from the Pew Research Center, was 10.6 per 100,000 people in 2016, the most recent year for which data was available, compared to countries such as Canada (2.1 per 100,000), Australia (1.0), France (2.7), Germany (0.9) and Spain (0.6).

From the perspective of health care providers, the most critical issue is what more can be done to lower the daily carnage felt most at the local level. A logical first step is to become a member, if your organization has not already done so, of the Health Alliance for Violence Intervention. Established in 1994, the Alliance “supports an intervention community of violence intervention specialist, doctors, health administrators and researchers providing resources to enhance new and existing network programs.” Perhaps most importantly, these are programs advancing comprehensive models of care that address the intersectional nature of trauma, social determinants of health and violence.

Paul B. Hofmann, DrPH, LFACHE, is president of the Hofmann Healthcare Group, Moraga, Calif., and co-editor of Managing Healthcare Ethically: An Executive’s Guide, published by Health Administration Press, and Management Mistakes in Healthcare, published by Cambridge University Press. Please note that the views of author does not always reflect the views of the AHA.