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Public Health Critical to Addressing Gun Violence Epidemic

November 29, 2018
by Colin Poitras

Gun control activists speaking at a Yale School of Public Health forum this week urged public health professionals to join their efforts in combating the pervasive gun violence that has become a major public health threat across the country.

We’re weaving a fabric together that we hope will save lives, said Stacy Spell, a former New Haven police detective and program manager of Project Longevity, a community-based organization dedicated to reducing violence in Connecticut. “The more people we bring into it, the stronger the fabric, the stronger the impact we’re going to have on the violence.”

Po Murray, chair of the Newtown Action Alliance, a gun control advocacy group formed after the 2012 mass shooting at Sandy Hook Elementary School, said evidence-based research and other support from public health professionals is vital to the continued push for stricter gun laws at the national, state, and local level.

“It’s really critical that we have your support,” said Murray, noting that there has been no federal action on gun violence prevention since 1993.

The Nov. 27 forum was organized by three Yale School of Public Health students, who saw a need for an informed conversation about the role public health professionals and the Yale School of Public Health can have in addressing gun violence.

“We hope this event catalyzes a long-term commitment to gun violence prevention at the Yale School of Public Health,” said Krishna Naik, an M.P.H. candidate from Florida. Naik spent several months lining up speakers for the event with her peers Madelyn Good, an M.P.H. candidate from Newtown, and Farah Rhaman, a Las Vegas native and research assistant at the Yale School of Medicine. “While this is just the start, we are hopeful for the role YSPH can play in addressing this public health crisis both locally and nationally,” Naik said.

The three student organizers come from areas that have experienced mass shootings. Associate Professor Kaveh Khoshnood, Ph.D. ’95, M.P.H. ’89, Associate Professor Judith Lichtman, Ph.D. ’96, M.P.H. ’88, and Dean Sten Vermund, M.D., Ph.D., helped organize the forum.

Some have questioned whether gun violence belongs in the public health realm. Dr. Ali Rowhani-Rahbar, M.P.H. ’05, a nationally-known violence prevention epidemiologist from the University of Washington, told the large gathering that there is absolutely no question gun violence is a public health concern. The statistics he presented to back up his claim were sobering.

  • 80,000 injuries from firearms each year in the United States, 38,000 fatalities.
  • 90 people die from gun-related injuries every day in the United States. Eight children a day die from guns.
  • Among persons age 1 to 24, deaths caused by gun-related injuries are about two times that of cancer, five times that of heart disease and 15 times that of infections.
  • 60 percent of all firearm deaths are suicide.

“Gun violence is a major public health problem and a leading cause of death in this country and we need to do something about it,” said Rowhani-Rahbar, an adjunct associate professor of pediatrics and the Bartley Dobb Professor for the Study and Prevention of Violence at the University of Washington.

Public health professionals and those in various medical fields are increasingly speaking up and searching for ways they can help prevent gun violence, Rowhani-Rahbar said. But they face a significant obstacle when it comes to research funding. The so-called Dickey Amendment, a 1996 Congressional spending provision, prohibits the federal Centers for Disease Control and Prevention from using any of its funds for injury prevention to support research that could be perceived as advocating for or promoting gun control. Rowhani-Rahbar said that just because federal funding is tight, that doesn’t mean other funding opportunities don’t exist, especially at the state and local level.

After the Sandy Hook shooting, Rowhani-Rahbar’s research team received $150,000 from the city of Seattle to look at what happened to shooting victims before they were shot and after they were released from the hospital. The study found that shooting victims were 21 times more likely to be shot again than people who were hospitalized for reasons other than firearms. Shooting victims were also at much higher risk of getting arrested.

Gun violence is a major public health problem and a leading cause of death in this country and we need to do something about it.

Ali Rowhani-Rahbar

Those findings, published in the Annals of Internal Medicine, led to the creation of HIFI (Helping Individuals with Firearm Injuries), a hospital-based intervention program in Seattle designed to identify and address the mental health, substance abuse and other needs of shooting victims.

Rowhani-Rahbar cited another example where student researchers on his team used a $20,000 donation from Grandmothers Against Gun Violence to publish a paper regarding firearm ownership, gun storage practices and suicide risk factors. The research, published in JAMA Pediatrics, led to stricter guns storage laws in Seattle and surrounding King County.

“So, we have this amazing translation of scientific evidence to policy that was really wonderful to see,” he said.

Yale Psychiatry Professor Madelon Baranoski, M.S.N. ’74, said public health professionals can play a role in helping to clarify misinformation when it comes to gun violence and mental health. Baranoski noted that while some reports have linked mass shootings to individuals with a history of mental illness, a closer look at the data shows the relationship is not as strong as people may believe.

Signs of mental illness – such as desperation, fear and rage – are also evident in human distress, Baranoski said.

“The majority of gun deaths come from increased impulsivity, decreased judgement and affective disruptions and that isn’t necessarily mental illness,” she said. “The message has to be that people with mental illness are actually suffering from the disorder and not perpetrating crimes against others.”

Regardless of what path public health professionals choose to pursue – research, advocacy, education – they have the tools and expertise to address gun violence, Rowhani-Rahbar said. And there is a template to guide them. Since 2015, former U.S. Surgeon General Dr. David Satcher has been leading a campaign to treat violence as a health issue. More information about that campaign, which includes a diverse range of professional and social organizations, can be found at

“Right now, the majority of our responses (to gun violence) are justice responses,” Rowhani-Rahbar said. “We need to change that narrative. There has been a national movement happening on this since 2015 and I encourage all of you to join that movement.”

Public health professionals and students can find more information about anti-violence groups in Connecticut by visiting Moms Demand Action, the Connecticut Coalition Against Domestic Violence, and Connecticut Against Gun Violence. Representatives of each group attended the Nov. 27 forum.

Watch a livestream of the gun violence forum.

Submitted by Elisabeth Reitman on November 30, 2018