Public Policy

A public health approach to gun violence

Hospitalists have a role to play



In 2014, 33,594 people were killed by firearms in the United States. More than 21,000 of these deaths were suicides. The rest were primarily homicides and accidental shootings. Meanwhile, firearm deaths represented nearly 17% of injury deaths that year.1,2

In a 2015 Perspective published in the New England Journal of Medicine, author Chana Sacks, MD, pointed out that 20 children and adolescents are sent to the hospital daily for firearm injuries and 2,000 people each year suffer gunshot-related spinal cord injuries and “become lifelong patients.”3

At the same time, Federal Bureau of Investigation data show that the number of active shooter situations rose between 2000 and 2013, with an average of 6.4 incidents a year for the first 7 years of the study, conducted in 2013, and an average of 16.4 in the last 7 years of the study. More than 1,000 people were wounded or killed across 160 active shooter incidents, defined as an individual or individuals actively engaged in killing or trying to kill people in a populous area.4

“Gun violence is undeniably a public health issue,” said Dr. Sacks, a hospitalist at Massachusetts General Hospital and instructor at Harvard Medical School, both in Boston, and a vocal proponent of addressing firearms in the public health sphere. Her cousin’s 7-year-old son, Daniel Barden, was fatally shot at Sandy Hook Elementary School in Newtown, Conn., in December 2012.

Yet, the notion of firearm injuries and deaths as a public health issue is, in America, an issue of contention. How can hospitalists and other health care providers avoid wading into the political thicket while also looking out for their patients?

For one, it’s not the only controversial issue with which providers are confronted, Dr. Sacks and others say. From taking sexual histories, counseling patients about abortion and adoption, and discussing end-of-life issues, clinicians may routinely face uncomfortable interactions in the name of patient care.

“It’s not a question about their right to a weapon; it’s about how individuals can stay as safe as possible and keep their families as safe as possible,” said Dr. Sacks, who also wrote in a January 2017 opinion for the American Medical Association that: “Counseling about gun safety is not political – no more so than a physician counseling a patient about cutting down on sugary beverages is an act of declaring support for New York City’s attempted ban on large-sized sodas.”5


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