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Standing AFFIRM: Placing the “public” in public health : Emergency Medicine News


public health, armed violence, violence prevention


Americans come together in grief over every gun tragedy and senseless loss of life. We share our astonishment that the people closest to the attacker did not recognize the warning signs and appropriate precautions were not taken when strong risk factors are identified from dangerous people with access to firearms.

We are all frustrated by the lack of consensus on strategies to end these tragedies from happening and distraught by the reality that the only way any of us as people can help prevent gunshot wounds. to fire is to participate in a spiteful political advocacy debate focused on controlling a consumer device.

As emergency physicians whose practice is based on evidence and whose profession focuses on health outcomes, we must admit that our current approach of the company to defend the policy for preventing arms control fire legal injury of a consumer appliance did not yield results.

The number and frequency of school shootings – in fact, gunshot wounds and deaths in general – are only increasing. It’s high time for a new approach that treats gunshot wounds for what they are: a health problem requiring health solutions.

Unmet health needs

The first step in establishing a health approach is to recognize that firearm injuries occur as a result of the misuse of firearms, which allows us to separate the safety of the device from the factors of health that determine human security. Firearms safety training teaches us to use the device safely for its intended purpose, be it sporting, hunting, or defense.

The ultimate use of the device, however, is determined by the mental, physical, and social health of the manipulator. Inappropriate use of the device to inflict injury (firearm misuse) occurs when an individual has unmet health needs: injured people injure themselves and others. True gun safety requires training on the device along with health education. The latter has been largely absent from gun safety training to date.

The second step is to recognize that the approach to health requires the engagement of communities of experts, which in this case necessarily means the American public who choose to exercise their second amendment constitutional right. Hundreds of millions of guns belong to tens of millions of gun owners, including more than a third of emergency physicians and more than 40% of trauma surgeons. Until now, this community has been largely absent from firearms-related public health education.

We need to unify the traditions and responsible management of knowledge of firearms that have long existed within the firearms community with the expertise and methods of risk reduction that exist in the health professions. We need to bring interdisciplinary professionals, health systems and the populations we serve together to understand the problem as it exists in our unique communities and recognize the many resources we already have to address the health factors that contribute to or protect against the misuse of firearms.

Injury Prevention

The line between safe and unsafe gun ownership is dynamic, and we know that many health factors contribute to harmful behaviors. Many of these can be identified (up to 80% of perpetrators of targeted violence, for example, communicate their intent through leaks or threats) and then changed through health interventions. Equally important, we know that many protective factors can be improved by clinicians, families and communities. Our goal is to prevent injuries, which means caring for and supporting people at risk of hurting themselves and others, helping their families and strengthening their communities.

Fortunately, all of these things are within our immediate reach. The public health approach is a reliable tool for harm reduction and injury prevention and will reduce the incidence and prevalence of firearm-related injuries. The public health approach involves four steps: defining the problem; identify risks v protective factors. testing and evaluating intervention strategies; and ensure widespread adoption of effective strategies.

Politics is usually how we scale effective interventions (the last step), but that’s what we as a society focus on at the expense of fully elaborating the first three steps and drives away the essential population with the apparatus that has the capacity, expertise, traditions and desire to participate.

Preventing firearm injuries and deaths is a priority concern for all Americans. It’s time to practice what we preach in public health and empower everyone to be part of the solution.

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Dr. Barsottiis the director of the AFFIRM program at the Aspen Institute, a program dedicated to reducing firearm injuries in the United States through nonpartisan health-based 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 on, find more information about AFFIRM at, and follow the foundation on Twitter@ResearchAffirm.