Gun violence is a public health crisis that is notoriously difficult to study because of politics. Finally, a new research initiative has the green light to collect life-saving data.
- New York's Northwell Health system recently received a $1.4 million grant for a new study on gun violence prevention.
- The study tasks doctors with asking all patients about their access and exposure to guns, and recommending interventions and safety tips as needed.
- The goal is to destigmatize doctor-patient conversations about guns, and reframe gun violence as a public health issue.
Reframing conversations on gun violence<p>One major goal of the study is to reframe how health professionals and patients discuss gun violence—an issue that's often couched only in political terms.</p><p>"Our big push is to consider <a href="https://www.northwell.edu/news/gun-violence-is-a-public-health-issue" target="_blank">gun violence as a public health issue</a>," said Dr. Sathya. "For decades, we've tried to get doctors to try to ask [patients about firearms access and exposure]. They won't, because it's not considered part of the usual care."</p><p>Dr. Megan Ranney, an emergency physician and Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, said talking about guns from a different angle can lead to meaningful reductions in injuries and deaths. </p><p>"When we reframe [gun violence] as a public health issue, then we're able to use the same strategies that we've used to decrease car-crash deaths, decrease infections and deaths from HIV, and reduce injuries and deaths from a host of other problems," said Dr. Ranney. "We don't waste our time arguing while death rates go up. Instead, we actually do something that we as individual Americans can take on."</p>
Moving forward on gun violence research<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk0MTM0Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMDAxMTIwMX0.Urx2J0MFe2lW2WAt9T1dwuo6ZubtKMisdtaQ_R4AZxg/img.jpg?width=980" id="f35eb" class="rm-shortcode" data-rm-shortcode-id="2db88a0c7cac7228bf26e73da87c1b20" data-rm-shortcode-name="rebelmouse-image" data-width="1426" data-height="934" />
Mortality rate vs funding for 30 leading causes of death in the United States.
Credit: Stark et. al. / JAMA<p>Over the past couple of decades, researchers have conducted many studies on gun violence. But hardly any received federal funding. To put it in perspective, a <a href="https://jamanetwork.com/journals/jama/fullarticle/2595514" target="_blank">2017 study</a> found that the federal government spends about $63 on firearms research for every life lost to gun violence in the U.S. Compare that to $182,668 in funding for every life lost to HIV.</p> <p>The funding freeze stems largely from the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993413/" target="_blank" rel="noopener noreferrer">Dickey Amendment, which Congress passed in 1996</a> to ensure that "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control."</p> <p>"It comes from a perception that research was done with an agenda of legislative change, which it isn't," said Dr. Ranney. "Research is done in order to advance health, and it ideally happens from a perspective that is independent of personal belief." </p><p>Focused on public health instead of politics, the new study aims to broaden the scope of firearms research.</p> <p>"The studies that have been conducted with respect to firearms have been so limited," said Dr. Sathya, noting as an example how doctors might ask about firearms only if a patient is suicidal. "Because there has been no funding, we're starting from scratch in many ways."</p>
Hospitals and gun violence prevention<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDk0MTY4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MjI5NDA1NX0.VawFYH1HlHUb_5PGFgG5H-XcsPexTYN-OEChswldgVU/img.jpg?width=980" id="17c92" class="rm-shortcode" data-rm-shortcode-id="fdcb8f981260299213e4c90d450277ad" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Dr. Sathya and Mr. Dowling are spearheading Northwell's gun-violence prevention efforts, including the "We Ask Everyone. Firearm Safety is a Health Issue" research study.
Credit: Northwell Health<p>One reason health professionals are uniquely suited to play a lead role in preventing gun violence is that they're often the first point of institutional contact for at-risk people. By normalizing doctor-patient conversations about guns, health professionals would be able to intervene early.</p><p>For example, they could connect at-risk patients with violence-prevention resources like the <a href="https://criminaljustice.cityofnewyork.us/programs/office-to-prevent-gun-violence/" target="_blank" rel="noopener noreferrer">New York City Mayor's Office to Prevent Gun Violence</a>, which curbs gun violence through strategies like "<a href="https://www.ny1.com/nyc/all-boroughs/in-focus-shows/2020/11/15/interrupting-gun-violence" target="_blank" rel="noopener noreferrer">violence interrupters</a>," liaisons between communities and public officials, and funding for community-based activities to make neighborhoods safer.</p><p>Northwell Health president and CEO Michael Dowling also noted that about 40,000 people die from guns every year in the U.S., while thousands more are injured. For the health professionals that treat the victims, these statistics aren't abstract.</p><p>"Gun violence is a public health problem, period," said Dowling. "As guardians of public health, <a href="https://www.northwell.edu/news/insights/where-are-health-care-ceos-in-the-fight-against-gun-violence" target="_blank">it is our responsibility</a> to address this scourge on our communities, and the clinicians who are knee-deep in the carnage."</p><p>In 2021, Northwell Health plans to begin sharing and discussing the results of its multi-year study with other health systems as part of its Gun Violence Prevention Learning Collaborative. </p><p>"We hope that it serves as a blueprint for other hospitals and health systems as to how to institute this universal approach so that doctors can start asking the question more and more, and so it isn't an awkward topic to talk about," said Dr. Sathya.</p>
By projecting lifetime risk, an alarming new medical study centers the human lives that will be lost due to gun violence and drug addiction in the United States.
- A new study found that the risk of a person dying from a gunshot is about one percent, while the risk of death by drug overdose is at 1.5 percent.
- If this death trend continues on this trajectory, it means that approximately one out of every 100 children today will die from a firearm while one out of 70 will die by drug overdose.
- Presenting these statistics in terms of "lifetime risk" makes the numbers personal by centering the human lives that will be lost and demands ethical action to protect those lives.
Place and identity<p>Of course, location, racial ethnicity, and gender are relevant when it comes to calculating the risk of dying by either gunshot or drug overdose. The study found that the lifetime risk of dying by firearm is the <a href="https://www.amjmed.com/action/showFullTableHTML?isHtml=true&tableId=tbl0002&pii=S0002-9343%2820%2930363-6" target="_blank" rel="noopener noreferrer dofollow">highest among Black boys</a>, with one out of 40 calculated to die by gunshot. That's a 33-fold higher risk when compared to Asian American females. This risk of dying by gun violence is highest for individuals living in Alabama and New Mexico. </p><p>The lifetime risk of drug overdose is the highest among Black and white boys and in the state of West Virginia, where one out of 30 children will die this way.</p>
Beyond absolute numbers<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU3NDM4MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MzY3NzQxN30.ouQk9iFvjDN6oY7-Oe7tGq_yVZkfPjxtxt3LVuB0Fa0/img.jpg?width=1245&coordinates=0%2C481%2C0%2C481&height=700" id="7b819" class="rm-shortcode" data-rm-shortcode-id="7d9c612a79b64bba6eae77175ed091e9" data-rm-shortcode-name="rebelmouse-image" alt="children sitting on a bench" data-width="1245" data-height="700" />Photo by Piron Guillaume on Unsplash<p>The presentation of the data in this study puts the human being in the center of the fatalities. Media and policy makers typically discuss these social issues in terms of numbers of death; e.g. <a href="https://www.pewresearch.org/fact-tank/2019/08/16/what-the-data-says-about-gun-deaths-in-the-u-s/" target="_blank" rel="noopener noreferrer dofollow">40,000 firearm deaths in 2017</a>, or 21.6 overdose deaths a year for a population of 100,000 in 2017. But those absolute numbers omit a vital, personal part of the story and can undermine the ethical demands of the issue by de-centering the human lives that will be lost.</p><p>To do this study, Ashwini Sehgal, MD — a professor of medicine at Case Western Reserve University in Cleveland, Ohio, and a physician at MetroHealth Medical Center — used data from official death certificates to project the likelihood that an American will die from either gun violence or a drug overdose in his or her lifetime. </p><p>"While absolute numbers of deaths and annual death rates describe mortality over a short period of time, lifetime risk tells us more about long-term consequences," he said in a <a href="https://www.elsevier.com/about/press-releases/research-and-journals/new-study-calculates-alarming-lifetime-risk-of-death-from-firearms-and-drug-overdoses-in-the-us" target="_blank">Elsevier news release</a>. Sehgal explained how thinking about the risk in a person's entire lifetime shifts perspective, noting that the study findings haunted him when he was touring a new elementary school in his Midwestern community. "I had a hard time concentrating on the gleaming whiteboards, the new computers, or the cheerfully decorated walls. I realized that one child on every floor of the school would likely die from firearms and another one from a drug overdose in the years ahead. If I were across the border in West Virginia, then one child per classroom will have their life ended by an overdose."</p>
Encouraging change<p>In the study, Sehgal wrote that presenting information on lifetime risk of death may be a more useful way to communicate the impact of gun violence and overdose deaths to the public and policy makers. He advised that lifetime risk be included in news stories and government reports, also recommending that it be compared with the lifetime risk of dying by other causes — such as terminal illness — and figures from other nations.</p> <p>"For example, the lifetime risk of dying from an overdose is similar to the lifetime risk of dying from colon cancer," <a href="https://www.elsevier.com/about/press-releases/research-and-journals/new-study-calculates-alarming-lifetime-risk-of-death-from-firearms-and-drug-overdoses-in-the-us" target="_blank" rel="noopener noreferrer dofollow">reported Elsevier's news release</a>. "Moreover, firearm deaths in our country are six times more common than in Canada and 50 times more common than in the United Kingdom, two countries that are culturally similar to the US." </p> <p>It may also be beneficial to highlight changes in chance of lifetime death by these causes over time. American drug overdoses, for example, have quadrupled over the last 20 years. </p> <p>The lifetime risk calculations made by Sehgal are based on the assumption that future death rates will parallel the current ones measured. But if the public and policy makers take action, this can change. </p> <p>"The big differences in firearm and overdose deaths by race, gender, state, and country, and the sizable changes over time indicate that high levels of firearm and overdose deaths are not inevitable," <a href="https://www.elsevier.com/about/press-releases/research-and-journals/new-study-calculates-alarming-lifetime-risk-of-death-from-firearms-and-drug-overdoses-in-the-us" target="_blank" rel="noopener noreferrer dofollow">said Sehgal</a>. "Let's take sensible steps now to help our children avoid the preventable tragedies of firearm and overdose deaths."</p>
The Response Act calls on schools to increase monitoring of students' online activity.
- The Response Act was introduced by Senator John Cornyn, a Texas Republican, and was co-sponsored by five other Republican senators.
- Among other measures, the bill aims to "incentivize schools to enforce internet safety policies that detect online activities of minors."
- However, there is no evidence showing that student surveillance technologies actually prevent violence.
The $3 billion school security industry<p>Many U.S. school districts have turned to the <a href="https://technology.ihs.com/600401/school-security-systems-industry-us-market-overview" target="_blank">school security industry</a> for help in the wake of school shootings. In addition to more traditional security techniques like metal detectors and X-ray machines, the school security industry offers services that keep a close eye on what students are doing online.<br></p><p>Companies like Gaggle, for example, monitor students' activity on school computers by scanning through documents, emails and even calendar entries. Meanwhile, companies like Social Sentinel look beyond school networks to scan students' social media profiles for potential threats, claiming to offer schools "total awareness."</p><p>It's unclear exactly how many schools use these services, but it's likely that millions of students in the U.S. are being surveilled when they walk into school. The problem that some privacy and student advocates have is that there's no hard evidence showing that these new approaches really work.</p>
False flags and a lack of evidence<p>There's no evidence that <em>any </em>measure to prevent school shootings is effective, according to a 2019 <a href="https://www.liebertpub.com/doi/10.1089/vio.2018.0044" target="_blank">study</a> that examined various prevention techniques and school shootings from 2000 to 2018. But school security technologies do produce false flags, whether over "To Kill a Mockingbird" essays or tweets about the movie "Shooter".<br></p><p>"There's no proven information showing that social media monitoring is useful," Amelia Vance, a student privacy advocate with the Future of Privacy Forum, told <em><a href="https://www.npr.org/2019/09/12/752341188/when-school-safety-becomes-school-surveillance" target="_blank">NPR</a></em>. "We have a lot of data showing it overwhelms with false flags."</p><p>Vance also noted that surveillance systems – which can divert school districts' time and money away from other areas of investment – can change the learning environment.</p><p>"You are forcing schools into a position where they would have to surveil by default," Vance told <a href="https://www.theguardian.com/world/2019/oct/23/republicans-mass-shootings-school-surveillance?utm_source=share&utm_medium=ios_app&utm_name=iossmf" target="_blank"><em>The Guardian.</em></a> "There's a privacy debate to be had about whether surveillance is the right tactic to take in schools, whether it inhibits students' trust in their schools and their ability to learn."</p>
No easy solution<p>In the wake of the 2018 school shooting in Parkland, Fla., members of the public at a school board meeting in Old Bridge, N.J., asked school officials, "What are you going to do to prevent the next school shooting?"<br></p><p>"Things changed after Parkland," David Cittadino, superintendent of Oak Bridge schools, told <em>NPR</em>.</p><p>Facing this kind of pressure from scared and frustrated parents, it's no wonder that many schools are willing to try out unproven methods in an attempt to bolster security for students.</p><p>"It's similar to post-9/11," Rachel Levinson-Waldman, a lawyer with the liberty and national security program at the Brennan Center for Justice at the New York University law school, told <em></em><em><a href="https://www.edweek.org/ew/articles/2019/05/30/schools-are-deploying-massive-digital-surveillance-systems.html" target="_blank">Education Week</a></em>. "There is an understandable instinct to do whatever you can to stop the next horrible thing from happening. But the solution doesn't solve the problem, and it creates new issues of its own."</p>
With little progress on other avenues to preventing mass shootings, one firm has employed architecture to save students.
- A school in Michigan is being remodeled in a way to minimize the effect of a shooter should the worst happen.
- It features limited sight lines, bullet proof windows, and doors that can be locked at the push of a button.
- Some research casts doubt on how effective the plans will actually be.
The world Americans live in now<p>TowerPinkster, an architecture firm based in Michigan, has designed a school for the hamlet of Fruitport. It features many design elements selected by the firm to limit the impact of a shooter. While the project won't be finished until 2021, some elements are already in place as part of the longterm $48 million remodeling effort.</p><p>The campus will feature a series of fire doors which can all be closed and locked with the pushing of a single button, to isolate an attacker in one area. Hallways will be slightly curved to cut off the shooter's line of sight; intermittent wing walls will dot the halls as well so that children might hide behind them. Similar barriers will exist behind classroom doors in hopes that teachers and students can hide in their rooms as <a href="https://www.dezeen.com/2019/09/05/fruitport-high-school-tower-pinkster-michigan-mass-shooting" target="_blank">well</a>.</p><p>Lockers will no longer line walls, but instead, be located on islands in the middle of wide-open spaces. The stated benefit of this is to allow teachers to see the whole room without obstruction. The lockers will also be much shorter than most high school lockers. The building's windows will be covered in a bulletproof film.</p><p>Before you get too shocked by all this, Sandy Hook was recently rebuilt with an eye towards keeping people <a href="https://www.dezeen.com/2017/10/26/new-sandy-hook-school-designed-prevent-unwanted-intrusions-kind-news-architecture/" target="_blank">out</a>, and the American Institute of Architects came up with several ideas to make schools less vulnerable to mass shootings last <a href="https://www.dezeen.com/2018/08/14/architects-have-role-addressing-school-gun-violence-aia/" target="_blank">year</a>.</p>
Do people think this will actually work? What are experts saying?<div class="rm-shortcode" data-media_id="ZWIytwT3" data-player_id="FvQKszTI" data-rm-shortcode-id="3c2989a7d9bd26eb6fd1e09abca5c1ba"> <div id="botr_ZWIytwT3_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/ZWIytwT3-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/ZWIytwT3-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/ZWIytwT3-FvQKszTI.js"></script> </div> <p>The designs are mostly untested, and their effectiveness during an active shooter situation is still theoretical. The <a href="https://www.americanprogress.org/issues/education-k-12/reports/2018/12/19/464445/smart-investments-safer-schools/" target="_blank">Center for American Progress</a>, a non-partisan think tank, has data that suggests that making schools "hard targets" isn't very effective and has unwanted side effects on students. The center's experts, instead, suggest we do something about gun violence overall, in terms of policy — a common <a href="https://bigthink.com/politics-current-affairs/effectiveness-gun-laws?rebelltitem=1#rebelltitem1" target="_self">refrain</a> from other <a href="https://bigthink.com/politics-current-affairs/gun-violence" target="_self">researchers</a>.</p><p>It should also be said that some are concerned that if the worst should happen, the same features that are supposed to protect students could make it harder for the police to apprehend the <a href="https://archpaper.com/2019/08/fruitport-high-school-towerpinkster-renovation/" target="_blank">shooter</a>. This isn't too farfetched, in 2003 SWAT team members blamed the design of a Frank Gehry building for delaying their capture of a shooter — it took seven <a href="https://www.nytimes.com/2003/05/11/us/ex-employee-held-in-campus-attack.html" target="_blank">hours</a>. </p><p>The people who built the school in Fruitport are also quick to say that it isn't "impenetrable," but do suggest that the design could make a difference in an emergency. </p><p>Given the stance of the American Institute of Architects and the number of expert resources that TowerPinkster had to turn to, it is likely that we will see more schools like this before we see fewer. Additionally, some of the design choices were suggested by the National Institute of Crime Prevention's Crime Prevention Through Environmental Design program.</p><p>In a Kafkaesque vision of things that may be, Fruitport Superintendent Bob Szymoniak did say of the building's <a href="https://www.newsweek.com/newly-built-high-school-was-designed-hiding-places-curved-hallways-make-things-harder-mass-1455827" target="_blank">features</a>: "These are going to be design elements that are just naturally part of buildings going into the future."</p><p>As the United States continues to grapple with gun violence, private actors are beginning to step in where policy has failed. While the actual effectiveness of a "massacre proof" school remains unknown, it is understandable why some people would turn to one for a feeling of security. </p>
Is it time media outlets stop publishing the names and photographs of mass shooters?
- The study examined mass shootings from 1966 to 2018, finding that shootings have become more common and more deadly since 2000.
- The results showed that fame-seeking mass shooters received significantly higher media coverage than their counterparts, with 97 percent of fame-seeking mass shooters getting a mention from the New York Times.
- Recent research shows connections between the amount of media coverage on mass shootings and their likelihood to occur shortly after.