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‘Shouldering a great responsibility:’ Public health experts tackle gun violence

March 11, 2024
by Jane E. Dee

Early in her career, Yale School of Public Health Dean Megan L. Ranney, MD, was told “in no uncertain terms by well-meaning mentors” not to talk about gun violence as a health problem.

Only a few years earlier, in 1996, a Congressional budget restriction known as the Dickey Amendment all but ended the flow of federal funds into gun violence research and resulted in the suppression of gun violence studies. The amendment, named after Jay Dickey, a Republican from Arkansas, resulted in a lack of data that continues to stymie public health researchers today.

The loss of decades of potential data about gun violence in the United States, and the related loss of the promise of a public health model for reducing firearm injury and death, were discussed at two recent events where Ranney was a guest speaker: The Gun Violence Prevention Forum on February 27, hosted by Northwell Health in New York City, and a panel discussion about public health approaches to reducing targeted violence on February 29at the Yale Jackson School of Global Affairs.

Ranney, the C-E. A. Winslow Professor of Public Health (Health Policy), is also an emergency medicine physician who has seen first-hand the trauma that guns inflict on individuals, their families, and communities, as well as on the first responders and health care workers who rush to treat the victims of gun violence. She states that a public health model that has been effective in reducing deaths from other epidemics could reduce gun deaths and injuries as well.

Despite her mentors’ warnings not to talk about gun violence as a health issue, Ranney continued to work behind-the-scenes. When the Sandy Hook Elementary School shooting took place in 2012, shocking the country with the murder of 20 first graders and six adults, Ranney and her colleagues doubled down. “There was probably a dozen of us in a room,” trying to do research despite the lack of federal funding, she recalled.

In 2018, the American College of Physicians endorsed a public health approach to firearm-related violence. This provoked the National Rifle Association of America, which warned “self-important doctors” to stay in their lane. Ranney and her colleagues responded with the hashtag, #This Is Our Lane. Their tweets went viral, raising awareness of gun violence as a health issue among traumatized health professionals and the public.

Since then, progress has been made, but gaps remain, Ranney said. The new Research Society for the Prevention of Firearm-Related Harms on whose board Ranney sits, holds yearly conferences to promote and mentor scientific research. The Aspen Institute’s bipartisan Health Strategy Group released a report recently that contains ideas on how the health sector can tackle gun violence. Ranney served as an expert advisor.

And, starting in 2020 for the first time in decades, Congress appropriated funding of $25 million, divided between the National Institutes of Health and the Centers for Disease Control and Prevention, to jumpstart federally funded gun violence research.

“With the federal funding that’s been released, we’ve seen an approximately 90% increase in the number of publications, and a similar significant increase in the numbers of clinical trials,” Ranney said. “There’s been an incredible growth in gun violence-related research and evidence.”

And yet, as of Feb. 15, 2024, at least 4,994 people have already died from gun violence in the U.S., an average of about 108 deaths each day. Gun deaths continue to be the leading cause of death for U.S. children and teens.

According to a 2023 study, 21% of U.S. adults said they have personally been threatened with a gun; 19% said a family member was killed by a gun (including death by suicide), and 17% have witnessed someone being shot. About half (54%) of U.S. adults said they or a family member have had one of these experiences.

Gun-related injuries and deaths, as well as worries about gun violence, disproportionately affect people of color in the U.S., according to the same study. 31% of Black adults have personally witnessed someone being shot, as have 22% of Hispanic adults. 34% of Black adults have a family member who was killed by a gun, twice the share of white adults. In addition, 32% of Black and Hispanic adults said they worry either “every day” or “almost every day” about themselves or someone they love being a victim of gun violence (compared to one in 10 white adults). And about 20% of Black and Hispanic adults feel like gun-related crimes, deaths, and injuries are a “constant threat” to their community, more than double the number of white adults.

“It has been decades of real determined work by physicians, nurses, criminologists, public health researchers, survivors of gun violence and others to redefine how we approach gun violence,” Ranney said. “We’ve made real progress, but there are continued challenges.”

One of those challenges is translating public health research “into actual action on the ground,” she said. “It’s how each of us in this room can commit to working with the communities that we live, work, and depend on… to put the programs in place that we know work.”

‘A Great Responsibility’

What exactly the public health approach consists of is up for debate. At the Northwell Health Forum, Ranney mentioned Jonathan M. Metzl, whose new book Ranney recommended to the audience. Metzl, professor of psychiatry and sociology at Vanderbilt University, is, like Ranney, a physician and public health expert. Although he embraces the idea of gun violence as a public health issue, he states that public health policy also requires attention to the larger social, racial, and political forces at play in the U.S.

Framing gun violence as a public health epidemic risks missing the larger political meanings and implications of civilians owning and carrying guns, Metzl said. He argues in his book, What We’ve Become: Living and Dying in a Country of Arms, that “public health-based policies crafted in academia are often uneasily applied in real-world America – particularly when objects as historically and racially charged as guns, or people as unpredictable as mass shooters, are the objects of our intervention..... Public health needs to protect the public.”

Former President Bill Clinton, who gave the Northwell Health Forum’s keynote address, encouraged public health leaders to “draw people out.” To be effective, “you have to learn to talk to people and to set up systems to systematically reach enough people to make a difference,” said Clinton, who also served as Governor of Arkansas. “I know it sounds crazy, but I think you should feel encouraged, and you should feel honored that you are being asked to shoulder a great responsibility, because we can’t live with these gun disparities.”

Ranney said this approach – in which public health and public safety are intertwined – is exactly the foundation of the Firearm Injury Prevention program that is being built at the Yale School of Public Health with Nelba Márquez-Greene and collaborators across Yale University. “We have to address the drivers of fear and firearm purchasing if we are to get a handle on this epidemic,” Ranney says.

Public Health Approaches to Reducing Targeted Violence

“Public Health Approaches to Reducing Targeted Violence,” was co-hosted by the Yale School of Public Health and the Yale Jackson School for Global Affairs and moderated by Shan Soe-Lin, a lecturer at the Jackson School. Ranney gave brief opening remarks before turning the discussion over to the three guest speakers: Matthew Schumacher, a Navy veteran and clinical and operational psychologist for the Los Angeles Sheriff’s Department; Myrieme Nadri-Churchill, executive director of Parents for Peace; and Brian Hughes, acting director of the Polarization and Extremism Research and Innovation Lab (PERIL) at American University.

Stopping School Shootings

Schumacher is a national security psychologist who specializes in protective intelligence – protecting groups or targets, including schools.

Students who carry out school shootings are likely to be from the school, and many are in crisis, Schumacher said.

Most mass shooters, especially if they’re radicalized, will have had some sort of suicide attempt, an admission to a hospital, or suicidal ideation, Schumacher explained.

Instead of looking for signs that a student has been radicalized, he recommends training school resource officers to identify suicidal students.

“You could have 100 school resource officers in 100 schools over 100 years and maybe find one or two radicalized persons. But you will find thousands upon thousands of kids that are suicidal,” he said.

“I wouldn’t bother training the police to deal with radicalization because they could never see it,” Schumacher said. Instead, he would teach them the warning signs of a suicide crisis, and how to get help. He advises against punishment as it can worsen a person’s grievances.

By looking for early warning signs, and intervening, you are “starting the conversations much sooner than left of bang,” Schumacher said.

The goal is to get to the place where the person under stress is, as soon as possible, “so we’re not waiting for full-blown PTSD or a suicide attempt,” he said. “All of this stuff gets paid forward in the rest of society and does become a sort of contagion. So, if we can, we stop that process earlier,” he said.

“We’re trying to be left of bang. But I don’t think we should be anywhere near bang, by the way,” he added.

Parents for Peace

Myrieme Nadri-Churchill, a native of Morocco, was so affected by being a targeted as a child for having a Black Muslim father and a white Christian mother that she became a therapist. As the executive director of Parents For Peace, Nadri-Churchill specializes in deradicalizing extremists and supporting their families.

As she traveled around the world to meet the families of terrorists, Nadri-Churchill realized that parents don’t always understand the signs that their son or daughter is being radicalized, and when they do, they don’t know where to turn for help. She also learned that “parents do not call the cops on their children,” she said.

Parents for Peace is “pioneering a public health approach to extremism prevention.” In 2017, the organization launched a helpline for families and individuals to call when they see the first signs of radicalization.

Nadri-Churchill is concerned that “the people we are seeing are younger and younger, from 12 to 14 years old. This is not normal,” she said.

“People who are drawn into extremism are using extremism as a drug of choice, a coping mechanism,” she said. “Just like someone would use drugs to numb their pain, they are using ideology to numb their pain.”

Resources to End Radicalization

“We’re trying to address problems before they have to be handed off to Myrieme or Dr. Schumacher,” said Brian Hughes of the Polarization and Extremism Research and Innovation Lab (PERIL) based at American University.

“By the time a case gets referred to Parents for Peace, a tragedy has already occurred – something profound has gone wrong – an act of violence or criminality, and the problem has the potential to metastasize,” he said. “We want to reduce or eliminate that potential for violence in the first place.”

Radicalization occurs when someone’s online activities – reading, watching videos, or socializing ­­– leads them to adopt politically or religiously extremist views. Extremists believe that an imagined conflict between groups of people can only be resolved through separation, domination, or violence. This frequently leads to anti-democratic opinions and goals.

Hughes’ team creates public health videos to educate people about the ways extremist propaganda can manipulate individuals to believe in things that are false. People who watch the videos are more likely to recognize and resist manipulative extremist propaganda, he said.

The videos and other resources are available on the PERIL research website.

Submitted by Jane E. Dee on March 11, 2024