One of the key recommendations of a recent United Hospital report on gun violence was that a system-wide response, involving collaboration between community-based organizations, government, law enforcement, criminal justice, and health care organizations, is required to address this major public health issue. Given the profound impact on the overall health and well-being of both individuals and communities, health systems have an especially significant role to play.
But many health systems have not yet addressed gun violence with the same level of priority and commitment with which they have confronted other public health problems, such as tobacco cessation and motor vehicle safety.
So, what can and should health systems do?
TAKING ACTION
Some health care organizations have stepped forward to tackle this tragic and pervasive problem. One strategy implemented by Northwell Health is universal screening of all patients regarding firearm injury risk, which began in the emergency department (ED). Each patient entering the ED is screened for both access to firearms in the home and the risk of firearm violence in their local community. Over 30,000 patients have been screened, and the screening has expanded to pediatrics, behavioral health, and trauma, with plans to scale to the entire organization.
The goal is to “normalize” these conversations, much as health care providers routinely ask patients about tobacco or alcohol use. This approach recognizes that trusted health care providers are uniquely positioned to identify patients at risk for gun violence, counsel them, and make referrals to programs in the community as needed.
VIOLENCE PREVENTION
Hospitals are also well suited to participate in violence intervention programs. Every year millions of Americans visit hospitals as a result of firearm injuries. In fact, in many cases, trauma surgeons are leading the efforts in their organizations to reduce gun violence. Hospital-based violence intervention programs (HVIPs) recognize that these patients need more than care for their physical wounds. HVIPs are multidisciplinary programs that identify patients at risk of repeat violent injuries while they are still in the hospital and provide resources aimed at addressing underlying risk factors.
One example is BRAVE (Buffalo Rising Against Violence) at Erie County Medical Center, a level 1 trauma center in Buffalo. Through the BRAVE program, individuals at high risk for repeat gun violence are identified while in the hospital. Trained professionals provide support, counseling, follow up, and a variety of services to the patients and their families to reduce the likelihood of future violence. BRAVE addresses the structural causes of gun violence in the community and treats both the physical and emotional trauma of gun violence.
These are just two examples of hospitals taking meaningful action to address the problem of gun violence in their communities.
DATA IS KEY
Successful public health approaches must be data driven. Due to a decades-long ban on federally funded gun violence research, there has been little research on gun violence as compared to other leading causes of death. But given the recent lifting of the federal ban, a significant opportunity has emerged to explore the most effective interventions to reduce gun violence. Research being conducted by organizations, such as the Johns Hopkins Center for Gun Violence Solutions, is critically important to identify the most successful approaches that hospitals and other organizations can implement.
Sadly, the devastating toll of gun violence in our country, state, and local communities only continues to grow. It is clearly time for a coordinated, intersectional response, and health systems must play a central role.
