Docs: It’s High Time to Declare Gun Violence a Public Health Emergency

In the aftermath of the mass shooting at an elementary school in Uvalde, Texas, healthcare providers expressed grief, anger, and frustration that gun violence isn’t being treated as the major public health problem that it is.

Joseph Sakran, MD, MPA, MPH, has a particularly unique perspective: He is the director of emergency general surgery at Johns Hopkins Medicine in Baltimore and a survivor of gun violence.

“Here we are, waking up in yet another scenario where we have, in this case, children that are slaughtered at an elementary school. And I’m just, honestly, sad. I’m angry,” Sakran, who advocates for gun violence prevention, told MedPage Today.

“I come to this from both the vantage point of being a survivor, as well as now a trauma surgeon, and my heart breaks for those parents and for the communities,” Sakran added. “And I’m just so frustrated. I’m so angry with our community leaders and elected officials that have refused to put partisan politics aside and take real action on this issue.”

“The things that people have tried to do [to prevent gun violence], they’re not working,” he stated. “And how many more? … ‘What’s your number?’ How many are we willing to allow to be injured or killed before we act?”

American Academy of Pediatrics (AAP) President Moira Szilagyi, MD, PhD, said in a statement: “As a pediatrician, parent, and grandmother … I speak for all of those who care for children: We are in shock. We cannot understand why this happened, and we stand with all of those who are mourning this heartbreaking and senseless tragedy.”

“Many more daily acts of gun violence that don’t make the headlines also rob children of their childhood and families of their community every day,” she continued. “Communities of color are disproportionately harmed. When will we as a nation stand up for all of these children? What, finally, will it take, for our leaders in government to do something meaningful to protect them? The AAP has called on the federal government to increase funding for research into gun violence prevention and for common-sense laws that protect everyone in a community.”

War Wounds

In 2016, the American Medical Association (AMA) declared firearm-related violence a public health crisis. In a statement Wednesday, the AMA reiterated the “numerous policy recommendations” it has made over the last 2 decades “to reduce firearm trauma, injury and death.”

In the statement, AMA President Gerald E. Harmon, MD, emphasized that “As physicians, our mission is to heal and to maintain health. But too often the wounds we see in America today resemble the wounds I’ve seen in war.”

He noted that more than 45,000 Americans die from gun violence every year, and that disparities in these deaths are growing to include younger people, more men, and more Black people.

“More and more it is clear no place is safe — malls, schools, movie theaters, places of worship, and grocery stores have all been targeted. Firearm injuries and deaths are preventable,” Harmon said. “And while the ideal time to act and find common-sense solutions and common ground might have been years ago, the best we can do now is act today.”

Georges C. Benjamin, MD, executive director for the American Public Health Association (APHA), said in a statement that “This carnage must end, because we’ve seen this all too often. This is the 27th school shooting this year.”

“Our leaders must act now and implement the many proven commonsense solutions that will reduce the risks of these horrendous acts of violence. Gun violence is preventable and we don’t have a moment to wait,” he said, directing people to an APHA resource page for addressing gun violence.

Part of Patient Care

In 2018, the American College of Physicians (ACP) released a position paper on firearm injuries and death. The National Rifle Association (NRA) responded in a tweet by chastising “self-important anti-gun doctors” who should “stay in their lane.” That gave rise to the group @ThisIsOurLane, described in a New England Journal of Medicine (NEJM) Perspective as a group that “calls attention to the role of physicians from many walks of medical life” and includes colleagues such as paramedics, nurses, housekeeping staff, pharmacists, “and everyone who helps survivors piece their lives back together and helps families recover from loss. This is their lane, too.”

In response to the most recent incident in which 19 children and two adults were killed, ACP President Ryan D. Mire, MD, called on fellow physicians to sign the Health Care Professional’s Pledge, “pledging to ask their patients about firearms and counsel them about how they could reduce the risk in their households.”

Mire added in a statement Wednesday, “I also remind the NRA, which has steadfastly opposed efforts to make the country safer from gun violence and told ACP in 2019 to stay in our lane, that tackling gun violence is in a physician’s lane as a public health crisis; we will not be intimidated from speaking out for the care of our patients.”

Mire said expressions of sorrow for the victims and loved ones, while simultaneously blocking policy that would reduce gun deaths and injuries, “are hollow words,” and called for an immediate public health intervention.

Sakran pointed out that, “If you take a step back for a second and just think about healthcare in general … [it] is intertwined in so many of the social issues we’re facing in this country, whether it’s gun violence, or COVID, or immigration, or climate change, or racism, or health inequity.”

“The best medical treatment is prevention,” he stressed. “When someone comes in that’s shot in the head, there’s only so much that I can do. So we have to prevent this from happening.”

In the short term, Sakran said federal-level actions, such as community violence intervention programs, are a strong start to addressing the issue. He said he’d like to see more executive action on background checks and banning importation of AR-15-style assault weapons. Sakran also outlined other actions he’d like to see on a national level, such as:

• A Surgeon General’s report on gun violence, as proposed in a 2018 NEJM Perspective
• A declaration that gun violence is a public health emergency from the secretary of the Department of Health and Human Services
• A declaration by President Biden of a “war on gun violence” similar to Cancer Moonshot

Finally, elected officials could push for more gun violence prevention research; implement extreme risk protection orders (“red flag” laws); and help the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) with oversight of the more than 50,000 federally licensed gun dealers.

Sakran shared that “My own siblings were worried about sending their kids to school today … doing nothing is not an option, and being silent is complicit.”