Banner by Korrina Gidwani

A Public Health Approach to Gun Violence

By Carolyn Fochek

A school in Uvalde. An Airbnb party in Pittsburgh. A supermarket in Buffalo. A subway car in Brooklyn. A Fourth of July parade in Highland Park. An LGBTQ nightclub in Colorado Springs. These locations experienced mass shootings that comprise just a fraction of the gun violence that has devastated communities across the U.S. in the past year. Data reveals that there were an estimated 47,286 firearm-related deaths in 2021, with significantly more individuals suffering from nonfatal gunshot wounds annually. 

The debate on how we address gun violence spans many overlapping sectors, from public policy and social services to mental health and education. Politicians, lobbyists, activists, and communities fight over who has the best approach every time there is a new gun violence headline in the news. There is one novel approach that is especially worth looking at, though, as it has the potential to exist outside of partisanship and the gun lobby: a public health approach. Public health professionals have continuously tackled issues that meet at the intersection of health and socioeconomic conditions, and they are prepared to do the same for gun violence. 

One public health professional already tackling community violence in Pittsburgh is Richard Garland. Garland is an assistant professor at the University of Pittsburgh’s School of Public Health and the Director of the Violence Prevention Initiative at Pitt Public Health’s Center for Health Equity. Garland says his program continuously monitors the state of gun violence through partnerships with four local trauma units in two different health systems. He describes these local institutional partnerships as a way to identify the sources of violence quickly, as they allow his team to communicate with gunshot wound victims directly. During this process, Garland also works to prevent what he calls “emergency department recidivism” by separating the disease (gun violence) from the susceptible individual. Emergency department recidivism refers to the idea that individuals will end up in the emergency department again from interpersonal violence. For his team, this idea of preventing readmission to the emergency department may mean finding connections to a legitimate job for an individual, working with the county’s DHS to move a person or family to a new community, or getting an individual into a meditation program. 

Garland describes violence as a disease and notes the importance of local interventions and individuals to stop the spread of further gun violence: “I believe in using outreach workers, people from the community, to interrupt the transmission of the disease.” Garland describes these outreach workers, or “violence interrupters,” as “people from the community who could have been formerly incarcerated — former gang members, former drug dealers — but they have a lot of juice in the community where kids look up to them and some of their peers.” These reformed individuals use their reputation to terminate ongoing conflicts through communication and outreach. Incorporating these individuals as a part of the solution is essential because they uniquely understand the community norms and societal factors that predispose their communities to violence. Similarly, in epidemiology, public health professionals do not ignore the groups who have already had a disease, but rather they incorporate the unique information that these individuals hold into the process of disease eradication.

Garland deeply understands what it means to incorporate individuals once immersed in the problem into the solution, because that was his journey. He grew up in Philadelphia, fell into gangs in his adolescence, and spent one-third of his life in prison. In prison, though, he was able to work towards his bachelor’s degree, as the prison brought in college professors, and he was guided towards nonviolence by older incarcerated individuals and the multifaceted advocacy organization MOVE. Education gave him the socioeconomic opportunity needed to live independently from gangs once he was released, and behavioral guidance gave him a new outlook on life.

As exemplified by Garland’s experience, positive relationships among communities, at-risk individuals, advocates, and institutions can play a significant role in preventing violence and crime. Such networks allow incarcerated individuals to actually be a vital part of Garland’s violence prevention team: even if someone is in jail, “[they] can make a phone call and squash whatever's going on in the streets…Everything is about relationships.” Because of the variety of factors relating to gun violence, there is also a place in this model to incorporate different types of professions. Garland, who holds a master’s degree in social work, highlighted the ongoing need for professionals in social work and community organizing who are willing to work towards non-violence. “I need more young people to have that zeal about giving back to the community, and we can change the world,” Garland proclaims. 

While positive relationships are essential in preventing gun violence, they must be accompanied by tangible societal changes to be fully transformative. The Health Impact Pyramid of Gun Violence Prevention is a tiered public health intervention strategy that lays out and pieces together all of the necessary factors for violence eradication. It starts broadly at the bottom of the pyramid with the promotion of general societal well-being and becomes more targeted towards the individual as the pyramid narrows. First, communities must address the socioeconomic factors that predispose individuals to commit violence. This includes funding social services, education, housing, and job training. The next step is implementing regulations that make an individual's default decisions healthy, such as universal background checks and firearm licensing legislation. Further, the schema proposes long-lasting protective interventions that include ‘red flag’ laws to prevent high-risk individuals from having continued access to lethal weapons. 

Following steps in the clinical intervention stage are guided by mental health and social service professionals. At this level, healthcare providers facilitate conversations with patients who may be suicidal and discuss safe gun ownership, coping strategies, and resources of support during crisis. From a clinical health perspective, these conversations with at-risk gun-owners are important because 90% of firearm-related suicide attempts are fatal versus 5% of all other attempts. This is also where Garland's community outreach leaders would come in to talk through local conflicts. The final steps of this intervention plan are centered around counseling and education, which involve safe storage campaigns and firearm training courses.

All of these factors come together to prevent individuals who are at-risk for homicidal, suicidal, or violent behaviors from having unchecked gun ownership in an effort to prevent both planned and spontaneous acts of gun violence. The public health method is just one option to consider when leaders and civilians look to prevent further gun violence, but it is unique in the way that it incorporates various institutions into one preventative continuum. Next steps include ongoing research into the efficacy of Garland’s interventions and implementation of programming into new areas. This approach also acknowledges that gun violence comes from different triggers, contexts, and societal conditions with different interventions necessary for different people. Since it is a public health approach, the physical and mental well-being of all American civilians is prioritized with data-driven, proactive strategies.