aamc.org does not support this web browser.
  • AAMCNews

    At the crossroads: Addressing gun violence as a public health crisis

    The problem of gun violence is multifaceted and complex, but the lessons learned from COVID-19 may help us understand and identify effective solutions. Everyone has a role to play.

    Stethoscope with pistol-shaped rubber tubes

    In the fall of 2019, after 41 people had been murdered in mass shootings over the course of several weeks, I used the platform afforded by my organization, the Association of American Medical Colleges, to make the case that gun violence in this country is a public health crisis and, as such, demands an urgent, multifaceted, nonpartisan response.

    Gun-related suicides, gun-related accidents, and other gun-related acts of unspeakable horror constitute a deadly daily reality for America’s EMTs and emergency physicians, as well as the trauma specialists who try to help heal the shattered lives of survivors and of families who have lost loved ones.

    The idea that the scourge of shootings is a public health crisis is, increasingly, widely recognized among medical professionals. But over the past three years while the crisis has intensified, our collective response — including that of Congress — has not, whether measured by social services, gun safety, or other legislation.

    Today, however, I hold out hope that more Americans might be able to see the epidemic of gun violence as a public health challenge. Our national experience with another public health challenge — COVID-19 — may help us find a way forward.

    This might seem counterintuitive. The COVID-19 pandemic and the spread of gun violence in the United States are, of course, vastly different problems requiring different solutions. There is no vaccine, no pill that can reduce the spread or severity of gun violence.

    At the same time, the pandemic has taught us certain ways of thinking that could have a broader application in the way we tackle other societal problems. Whether you’re a parent, a small business owner, a teacher, or a student, COVID-19, for all it has taken from us, has also given us more knowledge about public health crises than we’ve ever had. We have a better-informed vocabulary about public health issues, new, hard-earned knowledge about the capacity of as well as the strains on health systems, and a clearer sense that we are all bound together.

    For example, the COVID-19 pandemic has made clear that research is indispensable. Public health crises are complex; they have many contributors, many determinants, and it takes dedicated work to identify and disentangle them. Early in the pandemic, we didn’t yet understand how exactly the novel coronavirus spread, why it affected different people differently, or how certain risk factors influenced its course. Some of these things are still being studied.

    Yet we also understood, from the start, that we had to take action even as researchers conducted their careful work. We simply could not afford to wait. Based on what we already knew, we took steps — social distancing, mask-wearing — that made a difference. Then, as our research generated new insights, our efforts became better targeted, and ineffective practices (such as cleaning home deliveries with sanitizing wipes) fell aside.

    Even the best research, conducted over decades, won’t find the perfect solution to gun violence. But evidence shows that violence prevention programs, suicide hotlines, assault weapons bans, better education about safe gun ownership, and other approaches can decrease risks. So while more research is needed to understand the contributors to gun violence, including its social determinants, those questions shouldn’t stand between us and action at this moment.

    Our experience with COVID-19 has also taught us that even the most massive problems can be broken down into smaller, more manageable components. A global pandemic is, by definition, as vast as a public health problem can get. Its ripple effects — from mass unemployment to an acute mental health crisis to an upheaval in the education system — have made it even bigger and more intimidating. Yet by approaching these different elements of the challenge from different angles, we have made progress on many.

    My years of tackling problems this way — in my role at the AAMC and, before that, as the Secretary of the Smithsonian Institution and as a university president — leave me convinced that the problem of gun violence can and must be addressed piece by piece. Each piece suggests its own specific intervention: the availability of guns to people with a history of violence requires universal background checks; the role of firearms in domestic terrorism demands a more vigilant monitoring of online communities that foster hate and encourage violence.

    The scale and complexity of the challenge cannot be understated. Yet I believe it is not insurmountable if we each do our part to address whatever aspects are within our reach. For some, that will mean building stronger civic organizations. For others, it will mean maintaining the pressure on elected officials to enact common-sense gun laws. And for those of us who work in health care, we can work to advance research on gun violence, and do more to educate clinicians and others about how to encourage patients to store their guns safely, how to seek mental health care when needed, and how to address other aspects of prevention.

    Where we’ve succeeded in mitigating COVID-19, it is because of this mindset. Where we have failed, it is because we have failed to apply it — have failed to follow the facts where they lead, allowed ourselves to feel overwhelmed, and refused to embrace our individual roles, however small, in combating a collective challenge.

    These are times for grief, but we cannot afford the paralysis of despair. I, for one — and I know I am not alone — still see cause for hope that progress can be made against this epidemic of violence. If the pandemic has taught us anything, it is that a public health crisis will not yield to fighting or preaching or finger-pointing, but to common resolve, and to treating one another with compassion and care.