Issue link: https://beckershealthcare.uberflip.com/i/644565
33 POPULATION HEALTH Q: There's no medical cure for violence. What makes it a public health issue? Dr. Humikowski: e modern era of medicine really isn't about cure; it's about predictive analytics and prevention. ere is no medical cure for violence, but violence is a pervasive problem in our culture that leads to disease states. In that sense, we have to understand what fac- tors contribute to it and limit those factors so fewer people are injured by violence in the population of patients we care for. Gun injuries and gun-related deaths are instantaneous. You go from being a healthy kid — my perspective on this is as a pediatric intensiv- ist — to a neurologically devastated person in a vegetative state. ere is no transition state. You are either protected or you are really, really badly hurt. To me, it makes this a crisis beyond typical health propor- tions. Dr. Bokhari: It is important to put this in perspective. Look at how much violence you see in the U.S. It's not just Chicago; it's not just major cities; it's also small cities. It's everywhere. ere are 10,000 deaths in the U.S. from homicide gun violence an- nually, but on top of that, there are 20,000 suicides per year, which is a lot for an industrialized nation. Our death rates from gun violence are 10-fold compared to countries similar to us. So something is not right here. Gun violence has become a public health issue because it affects more than the people who are dying. For each person killed, there are 10 times as many people disabled by it, and somebody has to bear the cost for that. Somebody has to bear the cost for dying people as well. Ms. Cosgrove: When we think about public health issues as a whole, we oen think of disease — diabetes or cancer — as a leading cause of death. Violence is too. We have 60,000 violence-related deaths per year. Violence is the leading cause of death among African American males. It has huge implications for the public health system as a whole and for an entire community. People exposed to violence regularly are 30 times more likely to be involved in violence in their lifetimes. e more we see, the more it does to our mental health and our phys- ical health. Stress related to violence causes our blood pressure, heart and even cancer risks to increase. We really believe if we don't stop this epidemic, it will be difficult to establish health in our nation. Q: What preventive measures can be taken? How do you successfully pinpoint and reach those most likely to pull the trigger? Dr. Bokhari: Before you take any preventive measures, you need to know where gun violence is occurring, who is doing it and why. You need to make sure you are not biased through your own lens. So if you are a public health official, you don't want to define everything else through the public health lens of where, who and why, and the same thing for the police officers. You have to be balanced, yet come to a solution kind of fast. Dr. Humikowski: No. 1 is don't keep guns at home with children — and I know that's an extreme view and a lot of people won't hear that. At the end of the day, guns are deadly weapons and really should not be around children. ere are actually data to show preventive educational strategies directed at kids don't work. In real time, when kids are faced with a violent weapon, all the things they have learned in simulations and classes don't apply. Kids are impulsive by nature. It's responsible and imperative pediatricians speak to families about gun safety, because it really is like any other safety issue. Any responsi- ble pediatrician would talk to family members about how to keep their kid safely strapped into a car, bathtub safety, pool safety, how to store household cleaners. e sad reality in our country is that guns are no different. No. 2 is if you have a gun at home with a child, it should be stored and locked separately from the ammunition. Even if you find your patient doesn't have a gun in their home, they may send their children to a home that does have a gun. Pediatricians can still counsel parents who are not gun owners about how to keep their children safe in homes that may have guns. No. 3, and I think this is really where physicians can get involved, is lobbying for common sense, safe gun manufacturing. at's trigger safety. Not an easy lock a kid can undo, but fingerprint identification. at's something pediatricians and physicians can lobby for in the name of safety for children. Ms. Cosgrove: One of the key pieces is really having trusted com- munity members involved with violence prevention. When Dr. Slutkin worked with the World Health Organization in Africa, he lived there for 10 years and worked with six other physicians to help control the spread of cholera, tuberculosis and HIV. ey trained individuals to de- liver messages through the community about food handling, sanitation, etc. From there, he was able to get ahead of the trend of these incredi- bly contagious diseases.