Public health approach: Physicians aim to prevent gun violence

Indianapolis trauma surgeon Gerardo Gomez, MD, treats shooting victims nearly every day, including some who have been on the operating table before for gunshot wounds.

In 2009, Dr. Gomez and colleagues at Wishard Health Services agreed that they needed to do more than treat firearm injuries. They decided to help prevent them.

They started Prescription for Hope, a project that educates patients about the consequences of violence and links them to community services, such as drug rehab programs. The goal is to keep them out of violent situations after they leave the hospital.

“We look at shootings and the victims as a public health problem, just as we do infectious diseases,” said Dr. Gomez, founder and medical director of Prescription for Hope at Wishard Health Services, which has a Level 1 trauma center. “There’s no question this intervention project is making a difference.”

Since implementing the program, the portion of patients returning to the trauma center for violence-related injuries has decreased from 31% to 4%.

For years, many health professionals have advocated that the United States adopt a prevention-based strategy to decrease shootings nationwide. That proactive approach has been slow to get started due to limited federal funding for firearms research.

But several recent large-scale shootings, including the movie theater killings in Aurora, Colo., have reignited discussions about viewing gun violence as a public health problem. Some health professionals hope new attention will increase awareness about the need to study gun deaths and injuries so that research can be used to help save lives.

Opponents to a public health approach say gun violence is a criminal justice problem. Some worry that firearms research by health organizations would lead to campaigns to ban guns. But public health experts say preventing unnecessary deaths and injuries from guns is their only goal.

“The same evidence-based approach that is saving millions of lives from motor-vehicle crashes, as well as from smoking, cancer and HIV/AIDS, can help reduce the toll of deaths and injuries from gun violence,” according to a commentary in the July 27 issue of The Washington Post co-written by Mark Rosenberg, MD, president and CEO of the Task Force for Global Health, an Atlanta-based nonprofit public health organization. He wrote the commentary with Jay W. Dickey Jr., a former Arkansas congressman, in response to the July 20 Aurora shootings.

Dr. Rosenberg and Dickey once were on opposite sides of the issue. Dickey, as the point person in Congress for the National Rifle Assn., submitted legislation that led Congress in 1996 to reallocate $2.6 million from the budget of the Centers for Disease Control and Prevention from firearms-related research to other areas of research. At the time, Dr. Rosenberg was director of the CDC’s National Center for Injury Prevention and Control, which had conducted firearms research.

“The best time to start [firearms research] was 20 years ago,” the two men wrote in their commentary. “The second best time is now.”

Little funding for research

There were 31,347 U.S. firearms deaths in 2009. About 60% of those were suicides and 37% were homicides, according to CDC data. The rest were unintentional shootings or of an undetermined intent.

The figure is similar to the 32,885 Americans who died in motor vehicle crashes in 2010. Yet the government spends hundreds of millions each year on traffic safety research, which has significantly reduced motor vehicle crashes, while there is still little publicly funded research on firearms injuries, Dr. Rosenberg said.

Gun violence “should be a priority for public health because it is one of the leading causes of injury and death,” he said. Injuries “cost the country billions of dollars [each year] and take many lives.”

The impact of violent acts, including shootings, extends beyond the physical injuries of people harmed to the health of communities where incidents occur, said Linda C. Degutis, DrPH, director of the CDC’s National Center for Injury Prevention and Control. In high-crime neighborhoods, some studies have shown that people are at risk of becoming overweight and obese because they don’t feel safe playing or walking outside, Degutis said.

The CDC monitors violence-related injuries through the National Violent Death Reporting System, a surveillance program that operates in 18 states. The information is used to help create violence prevention initiatives and evaluate the effectiveness of existing programs, Degutis said.

Monitoring the scope and nature of a problem typically is the first step of any public health approach, said Stephen Hargarten, MD, MPH, director of the Injury Research Center at the Medical College of Wisconsin in Milwaukee. Examining data on shootings would help researchers “start to identify high-risk groups and environments,” he said. “It’s how the CDC has made such significant contributions in other disease areas.”

A typical public health approach focuses on prevention and involves a collaboration among experts in the field, public safety officials and others.

“We did this with automobile accidents,” and it contributed to a significant reduction in motor vehicle crashes and injuries during the past few decades, said Georges C. Benjamin, MD, executive director of the American Public Health Assn.

For example, traffic safety research led to the inclusion of air bags and seat belts in vehicles, spurred educational campaigns on the dangers of driving while drunk and resulted in speed bumps on some streets.

American Medical Association policy urges Congress to provide the CDC with sufficient resources to study firearm-related injury data. The AMA also encourages the development and presentation of gun safety programs that educate the public on the responsible use and storage of firearms.

But advocates of making gun violence a public health issue say funding is needed for research before proven preventive steps can be taken to address the problem nationwide.

“I hope that people will see this is not a question of taking everyone’s guns or banning firearms,” Dr. Rosenberg said. “We’re talking about preventing unnecessary deaths.”