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A way to prevent gun violence? Treat it as a public health problem

Law enforcement officers in the Cleveland, Texas neighborhood where a man allegedly shot five of his neighbors after they asked him to stop shooting in their yard.

David J. Phillip/AP

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David J. Phillip/AP

Law enforcement officers in the Cleveland, Texas neighborhood where a man allegedly shot five of his neighbors after they asked him to stop shooting in their yard.

David J. Phillip/AP

Dr. Deborah Prothrow-Stith was working in an emergency room as a medical student more than four decades ago when she realized that victims of violence were being treated and released, unlike other patients, without any type of preventive care.

“And one night at 3:00 in the morning, a young man told me very specifically that he was going to go out and cut the guy who cut him,” she says. “I thought, this is not suitable. My answer is not suitable. My profession’s answer is not suitable.”

Prothrow-Stith has played a key role in defining youth violence as a public health problem in the years since (her 1991 book deadly consequences is considered a classic in the field). That means focusing on prevention efforts, not just in emergency rooms, but also in doctor’s offices and schools.

And guns are increasingly a part of that conversation.

Prothrow-Stith, who is dean and professor of medicine at Charles R. Drew University of Medicine and Science in Los Angeles, recalls that when it began, stabbings were “the number one way young men were killed” in Philadelphia. . The image of violence changed dramatically in a matter of years.

“Guns in America play a huge role, especially as we start to see the weapons of war available and the mass shootings that are happening,” Prothrow-Stith says. morning editionIt’s Michel Martin.

The Centers for Disease Control and Prevention recorded 48,830 US firearm deaths in 2021, latest year for which complete data is available. Those include suicides, which have long accounted for the majority of gun deaths in the US, as well as homicides.

Culturally, suicide is more common in white America and homicide is more common in black America, Prothrow-Stith notes. But she stresses that violence in general is learned behavior.

“We don’t come out of the womb ready to commit suicide or homicide,” he adds. “And I think as a culture, (we need) to understand that children who are hurt, hurt others or hurt themselves. And our job is not to give them a weapon, but to figure out how to help them heal.”

The role of guns in the United States, told by a doctor

Prothrow-Stith says it’s clear that guns turn “an everyday emotional situation” into fatal encounters.

“We know that sometimes people act differently when they have a weapon in a situation, feeling invincible or escalating a situation that they might otherwise de-escalate,” he added.

And at least when it comes to teens, he says, there are some similarities in the contributing factors that can lead to homicide and suicide.

Most homicides are the result of arguments between people who know each other, be they family, friends or romantic partners, he says.

“I remember some youth workers saying, ‘Well, I’m not surprised he killed someone because he didn’t care about himself, so why would he care about anyone else?'” says Prothrow-Stith. “If you think about it, not caring about yourself is a symptom of depression. It’s a symptom of clinical illness and should be explored that way.”

What could the prevention of gun violence look like?

How would prevention work from a public health perspective? Prothrow-Stith uses the analogy of smoking and lung cancer.

First, there is primary prevention, which consists of informing the general public about the consequences of smoking. The second phase is to help smokers to quit and the third is treatment for those who have lung cancer.

When it comes to gun violence, Prothrow-Stith says the main phase should be raising awareness and trying to increase safety.

The secondary phase is all about understanding risk factors. “How do we help children who are hurt, either because they are victims of violence or because they witness violence, especially domestic violence or gang violence, on a regular basis?” she asks. “How do we help them heal from the anger, the guilt, the pain, but also give them the strategies to move on?”

Shows like “Big Brothers Big Sisters” are a great example of a secondary intervention because they provide children with distractions, purposes, and opportunities. Don’t underestimate the power of keeping busy, adds Prothrow-Stith.

She shares the story of a high school student who, when asked how he stayed out of trouble, said he played soccer even though he didn’t particularly like it. Sports gave him an excuse to stay up late and escape late-night social events as needed.

“He had developed his own strategies for dealing with peer pressure,” she says. “Those are the things that are very, very important to kids ‘in the thick’, so to speak.”

Focus on what works: an assault weapons ban

Many people are used to thinking of guns as a political problem rather than a public health problem. But Prothrow-Stith says a more productive way to talk about it would be to start where the United States has been successful in the past: in banning assault weapons from 1994 to 2004.

Studies have shown a decline in gun massacre deaths during the decade the federal ban was in effect, and an increase after it expired, which Prothrow-Stith attributes to the gun industry strategically “flooding the market” with assault weapons.

There are many more deaths in mass shootings when high-powered assault weapons are available, he adds.

“It’s like the movies and the sequel where more people are killed in the sequel than in the first movie with these assault weapons, weapons of war,” he says. “We’re seeing more and more people dead with each episode.”

In practical terms, the guns are here to stay in the US, says Prothrow-Stith.

“But we don’t need assault weapons,” he adds. “And I think we focused on that argument. And I think it’s a matter of time.”

Let’s go back to the cigarette analogy. Prothrow-Stith recalls that smoking was ubiquitous and glamorous when she was growing up, and that it took about half a century after her first report of its health effects for the public to understand.

He is confident that the United States will have the same transformation with weapons. “It’s time again to address this epidemic, lower our rates, and stay with it,” she says. “We’ve done it before. We can do it again… just make our kids safer.”

Ben Abrams produced and Olivia Hampton edited the audio version of this interview.

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