Ideas
June 27, 2022 3:33 PM EDT
Ranney MD MPH, Professor of Emergency Medicine and Associate Dean of the School of Public Health, Brown University. Twitter: @meganranney

Last week, we saw the passage of the first package of new federal firearm-injury-related policies in a generation. We heard that funds for firearm injury prevention are likely to be reallocated. And we learned that—with the stroke of a Supreme Court decision—states will lose a common mechanism for deciding who gets to carry a firearm.

Meanwhile, in the last two months, our nation has suffered the horror of a white supremacist shooting grocery shoppers in Buffalo; the cold-blooded murder of 19 children and two teachers in Uvalde, TX; a series of mass shootings in malls, on streets, and at graduation parties that left dozens of people injured or dead; and countless, largely unreported, firearm suicides. All this is layered over unrequited grief for more than one million Americans killed by COVID-19, two years of disrupted school and work, deepening political divisions, and a relentless push of new judicial activity.

The changes seem dizzying—both hopeful and, at the same time, insufficient. As a trauma-trained physician, I know we build resilience against despair through action and purpose. At what point does that action and purpose-sustaining optimism become hollow? The worsening toll of death and injury feeds a soul-crushing narrative.

Nonetheless, from my vantage point as both the person who treats gunshot wounds, and as a public health professional who works to prevent them—I am not ready to give up what I consider pragmatic optimism. I both see the urgency, and know that opportunities for action exist.

The science of public health teaches us very clearly that no single act, no single law, no single organization can or will turn the tide. It’s the combination that creates change. We needed a combination of vaccines, tests, ventilation, and masking during surges to reduce the toll of COVID-19. Reducing firearm injuries and deaths, demands similarly broad action. The federal level firearm-related policies of the past week are, in and of themselves, both wonderful and insufficient.

And if there’s good news here at all, here it is: Despite two decades of federally-stymied research, we have a growing (but still insufficient) body of evidence on what makes a difference. Very little of it, policy or otherwise, has been implemented. Which leaves us a clear “to do” list of evidence-based actions we can take, today:

  1. Get involved in community groups. Community engagement is effective in preventing violence in all its forms, particularly for younger Americans, who make up a growing proportion of all firearm injuries and deaths. Individually-focused organizations like Big Brothers, Big Sisters and community-wide coalitions such as the extensively studied Communities That Care program help improve not just the risk of violence, but also multiple other risk factors for kids. Other groups, like the Nonviolence Institute (on whose Board I sit), Chicago CRED, and the Wraparound Project, address root causes of firearm injury through a combination of hospital and street outreach, job training, and community support. These organizations need mentors, financial support, and local engagement to succeed. You can find them—and help them—in almost every city and town across the country.
  2. Plant a garden. This might seem frivolous, but the evidence is incontrovertible: planting a garden in a vacant lot is associated with a decrease in the number of gunshots in that vicinity. Working to support a sense of place and engagement with the natural world also mitigates depression, anxiety, and isolation.
  3. Promote safe firearm storage. Most kids who shoot themselves or someone else, do so using a family member’s firearm. Many gun crimes are committed with a stolen weapon. But we already know how to keep firearms from unauthorized users. There are highly effective solutions, ranging from safes to trigger locks. Many firearm owners make responsible use of at least some of these tools. Unfortunately, cost, convenience, and education mean that these life-saving practices are not universal. One of the most practical and effective steps everyone can take is to review and discuss safe storage practices. Changing norms can literally save lives.
  4. Make sure that existing laws are enforced. We can also work to support enforcement of existing laws designed to reduce firearm injury, many of which are not well known nor well understood. One example among many: knowing that firearms are the leading cause of death in domestic violence homicides, and a common risk factor for mass shootings, many states (including my own, Rhode Island) have laws requiring that those subject to a domestic violence restraining order surrender their firearms. However, enforcement of such laws (including in my state) is spotty. Locally, we can help to share awareness and support implementation of policies that are already on the books.
  5. Be familiar with warning signs, and know what to do when you see them. To be clear, mental illness does not cause mass shootings. But it is associated with self-harm. And there are lots of other warning signs of an increased likelihood of firearm violence, including substance use, dementia, online threats, and perpetrating domestic violence. We need to know how to recognize and do something about these risks. Some states have so-called “red flag laws” allowing the removal of firearms from some risky individuals, but public awareness remains sparse. But even in the absence of such legislation, friends and family members can remain alert to early warning signs—and know what resources exist to help, before it is too late. I and others are working on training healthcare providers and non-healthcare-providers alike on how to do this. You can join us in sharing this training.
  6. Know the facts and share your stories. More than 100 people die and more than 200 are injured by firearm every day across the U.S.—and the majority of these deaths are firearm suicides. Almost all Americans personally know someone who has been affected by firearm injury. By sharing both facts and stories, we can destigmatize this epidemic and advance coalitions for change.

We each have very real opportunities to reshape the dynamics that contribute to firearm injuries—before the gun and the ammunition ever reach the hands of those prepared to misuse them.

It may feel overwhelming to think about all the ways that individual, family, community, and society needs to shift, but it’s still in our power to create change today.

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