Health Systems Interventions to Prevent Firearm Injuries and Death Proceedings of a Workshop (2019) / Chapter Skim
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3 The Toll on Individuals and Communities
3 The Toll on Individuals and Communities
Pages 11-26
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From page 11... ...
Therese Richmond, the Andrea B Laporte Professor and associate dean for research and innovation at the University of Pennsylvania School of Nursing and the Penn Injury Science Center, spoke about the psychological and social burdens of firearm violence on communities.
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From page 12... ...
. SOURCES: Adapted from a presentation by Lucas Neff at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; ACS, 2019.
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. SOURCES: Adapted from a presentation by Lucas Neff at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; ACS, 2019.
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. SOURCE: Adapted from a presentation by Lucas Neff at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; ACS, 2019.
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SOURCES: As presented by Therese Richmond at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; Branas et al., 2004.
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The city in Pennsylvania thought of itself as a "gun-toting" community and was not eager to have Richmond and her colleagues looking at the burden of firearm violence there, but it wanted to use those data to secure law enforcement money to address a gun homicide problem that the community blamed on drug traffickers from New York traveling south through the community. However, after gathering data from every source possible -- this was before the National Violent Death Reporting System existed -- Richmond found that the real burden on the community was not homicide but firearm-related suicide, particularly among older white men (see Table 3-2)
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From page 17... ...
60. SOURCES: Adapted from a presentation by Therese Richmond at the workshop on Health Systems Interventions to Prevent Firearm Injuries and d Having a gun violence victim in SN in a lifetime was calculated using the formula 1 – (100 ∗ ((1 − rate of fatal and non-fatal gun injuries)
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18 TABLE 3-2 Firearm-Related Homicides and Suicides per 100,000 Individuals in Three Communities Homicide Suicide PA OH IA PA OH IA n = 56 n = 304 n = 45 n = 189 n = 160 n = 280 Death rate per 100,000 2.02 12.50 1.08 6.82 6.58 6.72 Race White 1.36 2.92 0.84 6.96 6.80 6.80 Black 15.9 77.48 10.80 2.64 5.42 3.92 Gender Male 3.26 21.86 1.58 12.24 11.90 13.16 Female 0.70 3.46 0.68 1.46 1.66 1.06 Ratio of firearm deaths to 67% 92% 61% 50% 55% 52% intentional deaths by other means NOTE: IA = Iowa; OH = Ohio; PA = Pennsylvania. SOURCES: Adapted from a presentation by Therese Richmond at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; Richmond et al., 2004.
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From page 19... ...
Retaliation Options for safety after injury: Lack of faith "move away" in police "avoid public transportation" "stay in the house" "police as the last resort" REINJURY FIGURE 3-5 Pathways to recurrent trauma among young African American men. SOURCES: As presented by Therese Richmond at the workshop on Health Systems Interventions to Prevent Firearm Injuries and Death on October 17, 2018; Rich and Grey, 2005.
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, experiencing increased depression, suicidal ideation, and suicide attempts (Lambert et al., 2008) , and achieving poorer academic performance and having shorter telomere lengths and increased allostatic load (Theall et al., 2017)
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Richmond and Hargarten agreed that this is an important societal issue but also that it is one that may be beyond the scope of health systems to address on their own. Hargarten added that there is now a section in the American College of Emergency Physicians on social emergency medicine that is dedicated to being better at addressing the social determinants that are evident, or perhaps not so evident, when a patient comes into the emergency department.
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At Froedtert Hospital's Level 1 Trauma Center, for example, clinical psychologists are embedded in other practices, including the trauma surgery unit. A second approach, which Hargarten said his psychiatry colleagues are taking, is to accept that other health care professionals, such as psychiatric nurse practitioners, psychiatric social workers, and clinical psychologists, work with these patients and thus that they should be embedded in the system of care rather than remain siloed in a mental health clinic.
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From page 23... ...
Such a partnership is proving important, he said, because not all cases are known to the police and the atlas allows law enforcement and public health to be more proactive, not just reactionary, in efforts to address violent injuries in a community setting. Viviana Goldenberg from Kaiser Permanente asked the panelists about the role that primary care providers can play in screening individuals who have no previous history of diagnosed mental illness -- and thus who cannot legally be restricted from access to firearms.
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From page 24... ...
Aerielle Matsangos from the Coalition to Stop Gun Violence asked the panelists if they could recommend how to communicate and work with police officers in emergency situations involving firearms. Hargarten replied that he and his colleagues are piloting a program based on the Cardiff model for collecting data and collaborating with law enforcement and the public to predict and prevent violence, and he said that he sees this as a means of bringing together sectors of civil society to talk about how to make communities healthier and safer.
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From page 25... ...
Anna Cupito from the National Academies asked how the issue of health disparity plays into the discussion of gun violence and if the panelists had any thoughts on how to discuss social determinants of health in a way that includes interventions on gun violence. Richmond replied that since firearm violence is a determinant of health and because social determinants play a role in firearm violence, it is essential to incorporate social determinants of health into any discussion on gun violence.
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