A third of Americans show signs of clinical depression and an anxiety. These and other mental conditions are becoming amplified during the recent pandemic, while COVID-19 patients and their families are also at high risk to develop depression and anxiety.
- While more than 35,000 Americans die each year from gun violence, similar to that of liver disease, research on this topic is comparatively underfunded
- Mass General's Gun Violence Prevention Coalition focuses on developing clinical guidance documents so physicians can discuss gun-related violence with patients
- By treating gun violence as a public health crisis and, in turn, funding prevention efforts, the number of related deaths and injuries could be greatly reduced
Gun violence claims the lives of more than 35,000 Americans a year, which is about the same amount of deaths caused by liver disease and sepsis.
Although those conditions receive millions of dollars for research on prevention, the same can't be said for gun-related violence. Chana Sacks, MD, an internist at Mass General Hospital, is hoping to change that discrepancy.
'What Happened in Newtown Can Happen Anywhere'
Daniel Barden, the 7-year-old son of Sacks's cousin, was one of 26 people killed in the Sandy Hook Elementary School shooting in 2012. His death had a profound impact on her and her family. Daniel's father, Mark Barden, introduced former President Barack Obama in the Rose Garden after the Senate voted to block expanded background checks on gun sales, and said, "What happened in Newtown can happen anywhere. In any instant, any dad in America can be in my shoes."
When describing that moment, Dr. Sacks said, "I rewatched that introduction that he gave, and he was standing there with his two kids and his wife, and he was so shell-shocked. This idea that this unimaginable thing had happened and even this, which everybody agrees on, couldn't get through, and that was just such a sign of how broken things are."
Dr. Sacks, who was a second-year resident at the time of the shooting, said she followed her cousin's lead to work toward preventing gun violence. She has published on the topic and, in 2015, co-founded Mass General's Gun Violence Prevention Coalition. The multidisciplinary group of more than 100 people includes everyone from doctors and nurses to security personnel and students. The group focuses on developing clinical guidance documents and raising awareness about the documents to try to help physicians have conversations about gun-related violence with patients.
Chana Sacks, MD
Anything that's taken the lives of this many people, this many young people in this country, in this world, needs to be something that we focus on.
Co-Director, Mass General's Center for Gun Violence Prevention
The coalition has also joined with Massachusetts Attorney General Maura Healey's office to develop guidance on gun ownership, including what gun locks look like, where to get them, and how much they cost. Dr. Sacks said 4.7 million children in the United States live in homes with loaded guns that are not locked up. Her group is starting a pilot program to hand out free gun locks in hopes of preventing more instances of accidental shootings.
Is Gun Violence a Public Health Crisis?
The debate over whether gun violence is a public health issue is a complex one, Dr. Sacks said. While 35,000 is the number that is most often associated with gun-related deaths, there is no way to know for sure if that's accurate because it's not really being studied, Dr. Sacks said. It also doesn't take into consideration nonfatal gunshot wounds.
"Not that we have to justify why it's a health issue," Dr. Sacks said. "Anything that's taken the lives of this many people, this many young people in this country, in this world, needs to be something that we focus on."
In February 2019, 166 national, state and local medical, public health and research organizations sent a letter to the Senate asking for $50 million in funding for the Centers of Disease Control and Prevention to conduct public health research into firearm morbidity and mortality prevention. The letter noted that federally funded public health research can reduce public health-related deaths from smoking and sudden infant death syndrome, and should be expanded to increase gun safety and reduce the number of injuries and deaths related to firearms.
How Can Physicians Help?
Beyond increased funding, there also needs to be an emphasis on training clinicians on how to talk to their patients about gun-related violence. Organizations like the American College of Physicians have offered policy recommendations that would recognize the role of the physician as a source for education around the risks of firearm ownership and the need for firearm safety. The American Academy of Family Physicians has also advocated for the ethical responsibility of family physicians to speak up if they feel current gun laws are not in the best interest of patients or the community.
At Mass General, Dr. Sacks said every trainee that comes into a residency program will go through some training on gun-related violence.
"You can really build a culture and make changes in that way. And I think we have those really big opportunities," said Dr. Sacks, who is co-director of the Center for Gun Violence Prevention, which launched in 2019 to continue the efforts of the Gun Violence Prevention Coalition. "We're trying to make a dent and take a swing every place we can."
Preventing gun violence requires an open discussion and a unified approach, and it is critical to bring responsible gun ownership to the forefront of the conversation, Dr. Sacks said. Because the issue has touched so many lives, everyone has a story to share and a role to play in prevention.
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