On October 8, the American College of Emergency Physicians more officially joined the ranks of several other medical organizations, including the American Medical Association as well as the American Public Health Association, in declaring gun violence a public health crisis in the U.S.
This effort has been a long-time coming, dating back to the early 1990s when emergency physician researchers like Arthur Kellermann, MD, MPH, published groundbreaking papers that quantified the link between guns in the home and deaths. Upon telling the public that having a gun in the home nearly tripled the risk of in-home homicide, there was immediate backlash. Intense lobbying from the National Rifle Association (NRA) sought to eliminate federal dollars from funding gun violence research.
In the years that followed, a generation of physicians and injury prevention researchers were advised to avoid looking at firearms, fearful that a successful career based on federal research grants would be difficult to sustain. The NRA’s grip on the public health research community thawed after Sandy Hook, when President Obama directed the CDC to be more proactive in funding this type of research.
However, the gun lobby remained undeterred in its apparent attack on doctors. In a 2018 tweet, the NRA told physicians to “stay in their lane,” well aware of the power of public health and public policy to stop the blood flow in our communities. The medical community responded forcefully by declaring that our lane included dealing directly with gun violence both inside the trauma bay and outside the four walls of the hospital.
Physicians, especially those trained in public health methods, are well equipped to offer a prescription for this uniquely American crisis. Public health, like medicine, focuses on three stages of prevention: primary, secondary, and tertiary.
Primary prevention means preventing disease before it occurs by altering behaviors. In medicine we counsel for exercise or for vaccinations. Regarding firearms, that means supporting background checks on all firearm sales so that these inherently dangerous products do not fall into the wrong hands.
Secondary prevention identifies diseases at the early stage, allowing doctors to take steps to minimize morbidity and mortality. Every time we screen for cancer in people at risk, we conduct secondary prevention. Similarly, when we screen people with domestic violence offenses for deadly weapons and allow for law enforcement to remove guns from those homes, we know beyond a reasonable doubt that we will save lives.
Tertiary prevention happens after danger has struck. In medicine, once someone is shot, we activate trauma systems to save their lives. The public health parallel, violence intervention programs, have the potential to stop the cycle of violence. Examples of these programs include Temple University Hospital’s Cradle to Grave and the Trauma Victim Support Advocates.
Recognizing that public health can complement the medical field in saving lives from gun violence — which includes both intentional and unintentional shootings — warrants applause. I am proud of my emergency physician colleagues for joining other medical professional societies who agree that gun violence is a public health crisis in need a multifactorial solution. Only then will the daily deluge of gun violence witnessed in emergency departments every day across this country begin to subside.
Cedric Dark, MD, MPH, is an emergency medicine physician, and an associate professor in the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine in Houston. He is the author of the forthcoming book, Under The Gun (2024).