Our recent report, produced in collaboration with Boston Consulting Group, draws attention to the impact of gun violence and how, to one extent or another, very few of us are spared. Whether through direct or indirect medical costs or indirect costs to society, the ripple effects of gun violence reach into many aspects of our everyday life.
My personal story is no exception. As a pediatrician in training 30 years ago, I vividly remember taking care of an adolescent patient in the intensive care unit who had attempted suicide with a handgun. She was biracial, went to one of the most elite schools in Washington, D.C., and was visited daily by her pastor. She didn’t survive, but her memory stays with me still. There were countless other patients who were victims of gun violence whom I helped take care of while a medical student in Newark.
During my training, one of my fellow residents was going through a rough personal time and through the course of our conversation confided in me that she was thinking of hurting herself. Because of my personal history—my father died by suicide with a handgun when I was nine—I asked her if she had a gun. To my tremendous surprise, she said yes. Over the next several days, we spent extra time together and I made her promise to call me first if she felt like she would hurt herself before getting professional help. Thankfully, she was able to get help. That this crisis didn’t materialize is an example of the power of asking whether or not someone has access to a gun.
THE POWER OF PRIMARY PREVENTION
The point of me sharing these personal stories is that, though the data speak loudly about who is more likely to be most directly or indirectly affected by gun violence—young Black men and their families and older white men and their families—we can never predict who might be at risk for the ripple effects of gun violence by just looking at them. We need to ask people what’s going on with them specifically related to gun violence.
Medical societies that include primary care physicians, such as the American College of Physicians, American Academy of Pediatrics, and the American Academy of Family Physicians, have recommended guidelines for their members to gauge risk of firearm-related morbidity and mortality that include an annual assessment of whether their patients have a gun in the home and if it is safely stored.
These two simple questions can help save lives because they can be effective deterrents to the impulsive nature of gun violence, especially inside the home. They are also classic examples of primary prevention—efforts that can be broadly applied to everyone and are low cost and high yield. And they are questions we can and should all be asking, as suggested in Northwell Health’s “ferocious tiger” gun violence prevention ad.
INTERRUPTING VIOLENCE
There’s an additional question we should be asking that I haven’t seen broadly promoted in primary care: “Can you name someone that can help you think of other ways to settle a beef that doesn’t involve a firearm?”
In many ways, this is what violence interrupter programs do in communities with elevated risks of gun violence. As residents of the communities they serve, violence interrupters are in the know when beefs are brewing. They can engage involved parties in finding alternative ways of settling disputes. Studies of violence interrupter programs, while mixed in outcomes, show limited yet promising indications that they can be effective in changing attitudes around the acceptability of using guns to settle disputes. Asking this additional simple question during a primary care visit can help diversify and augment the cadre of messengers delivering gun violence prevention interventions and those they are engaging.
Gun violence is a major public health issue requiring more research, awareness of how it affects so many parts of our lives, and investment from all levels of government and sectors of society. But there are also basic things we can all do to help stem this tragic toll. Often, it can start with a few simple questions.
This commentary appears in the spring 2023 issue of Blueprint.