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Standing AFFIRM

Standing AFFIRM

A Lesson in Public Health from an Unlikely Place

Barsotti, Christopher MD

doi: 10.1097/01.EEM.0000827672.25525.c7
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    public health, firearm injury prevention, firearm safety
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    It's good to pause from time to time to reflect on where we are as a profession, what we're doing, and where we want to go. Perhaps it's time to try something new if we're not achieving the results we desire. Now is such a time for those of us working to decrease firearm-related injuries and deaths.

    We in medicine, nursing, and public health share a goal to develop health-based approaches to firearm injury prevention. Numerous consensus conferences have been dedicated to this, from the National Academies of Sciences, Engineering, and Medicine (https://bit.ly/3rMybPU) to Northwell Health (https://preventgunviolence.com) to the American College of Surgeons (https://bit.ly/3gPg3ia), to name a few.

    Because gun safety has not been part of our medical training, our profession is developing education and guidance for discussing safe firearm storage and lethal means counseling among patients at risk for self-directed and interpersonal harm. Many physicians own and use firearms, but most do not, and this education establishes a proficiency we all need when discussing firearms with our patients.

    We as health care providers understand all too well the consequences of gun misuse. Few people understand the trauma of penetrating firearm injuries and their catastrophic ripple effects as we do. And we realize that firearm injury and death are ultimately a problem of human behavior influenced by mental, physical, and social health determinants that establish an individual's capacity for harm.

    Avoiding Traumatic Outcomes

    Pairing capacity for harm with the opportunity for using lethal means can lead to traumatic health outcomes we all wish to avoid. We physicians seek to attenuate this risk in every way possible, which requires understanding and addressing the capacity and opportunity for firearm injury among people at risk for all forms of harm: intimate partner violence, suicide, targeted violence, and cognitive decline among them.

    Because the public health approach requires engaging the people who make up the public, I participated in the 2022 National Shooting Sports Foundation (NSSF) SHOT Show, the largest firearm industry trade exposition in the United States (47,000 attendees; https://shotshow.org). The firearm industry comprises not just manufacturing, as many may presume, but also firearm training, retail, distribution, marketing, and media. Of course, the primary orientation of the event was commerce, but another topic was front and center on everyone's mind: safety.

    Firearm safety was featured prominently in media and organizational activities throughout the industry. Safe firearm storage, especially around children, a priority among physicians, was addressed thoroughly and repeatedly, most notably through the widely successful Project ChildSafe by NSSF. (https://projectchildsafe.org.)

    Suicide prevention is another priority of the firearm community, which has mounted a broad and robust response to this epidemic through numerous effective, evidence-based, and trusted programs. Among the many examples are Hold My Guns (www.holdmyguns.org), a growing national network of gun shops and individual federal firearm license dealers that works with gun owners to provide safe off-site gun storage during moments of crisis, and the Overwatch Project, a peer-to-peer network dedicated to preventing veteran suicide through a model based on the “friends don't let friends drive drunk” campaign. (https://overwatchproject.org.)

    Working Together

    But we need to address all complex issues of mental, physical, and social health that influence behavior to reduce the risk of harm and prevent firearm injuries across the board. Organizations like the U.S. Concealed Carry Association (www.usconcealedcarry.com) and the National African American Gun Association (https://naaga.co), among others, maintain a growing library on health topics ranging from bias and human trafficking to aging and cognitive decline.

    This is the “public” in the public health approach, and they are practicing injury prevention and harm reduction strategies with an intensity and impact that we health professionals are struggling to achieve. Despite their efficacy, vigor, and established channels, however, these programs and this community have not been included in our medical consensus conferences or educational initiatives.

    Why is our health industry working separately from the firearm industry on the same core topics? I will address those reasons next month, but the relationship between the medical profession and firearm industry have been strained at best and openly antagonistic at worst. This higher-level discord between the industries trickles down to our individual relationships at the bedside. We have lost the trust of this community and must dedicate ourselves to the work of restoring it.

    No one wants to see guns misused. Everyone agrees too many preventable firearm injuries and deaths occur in this country. We all want to work to reverse this trend. We would do well to pause at this juncture, reflect on progress, and seek space where we can build trust to collaboratively craft, enhance, and deploy the public health approach to firearm injury prevention that our society needs.

    Dr. Barsottiis the program director of AFFIRM at the Aspen Institute, a program dedicated to reducing firearm injuries in the United States through health-based, nonpartisan approaches. He is also a community practice emergency physician at Berkshire Medical Center in Pittsfield, MA, and a certified 4-H youth rifle safety instructor. Read his past columns athttp://bit.ly/StandingAFFIRM, find more information about AFFIRM athttps://affirmresearch.org, and follow the foundation on Twitter@ResearchAffirm.

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