Posts Tagged ‘ public health ’

The Sandy Hook Anniversary: The Public Health Challenges That Still Remain

Friday, December 6th, 2013

As we mark the one year anniversary of the Sandy Hook shooting, it is a salient time to consider the substantial public health challenges that were raised by that tragedy – and that still remain. Three are most prominent.

School safety is an ever-present concern. Although no school can eliminate the potential for a tragedy, strides are being made at many schools across the country to put into place practices and technologies to keep children as safe as possible. It has been suggested that 90% of school systems have made some type of concrete change to improve school safety in response to the Sandy Hook tragedy. Lock down drills have become a reality for children, practiced with the regularity and acceptance of a fire drill. Teachers and administrators are trained to know how to react in the event of an attack and how to best try to secure the safety of their students.

Some schools have video surveillance systems in place that are monitored for potentially suspicious activity. Schools may have changed their policies concerning entry at different times of the day. And at some schools there is a police presence or security guards in place. Yet these types of changes will undoubtedly need to be evaluated, and potentially evolve over time. It does appear, however, that that sad and startling day at Sandy Hook Elementary promoted a nearly universal awareness that no school can be assumed to be safe – and that every school needs to take a comprehensive approach to trying to best ensure their students’ safety.

Gun control – always a polarizing topic – remains a hotly contested issue in the aftermath of Sandy Hook. There have been some actions to promote gun control in some states, and some reactions to ensure gun owner’s rights in other states. As the swinging pendulum of gun control plays out across the country – evidenced by the current swirl of debate surrounding how access to firearms should be regulated – what remains most clear is that we are no where close to coming up with a focused effort to reduce the likelihood of someone with a gun entering a school and killing children and adults. Most influential – and sobering and inspiring – has been the efforts of Sandy Hook parents to promote a ‘cultural change campaign’ to properly orient our attention on violence prevention, particularly gun violence aimed at our children.  It is hoped that this effort will inspire a change in our collective mindset that will do away with the philosophical rhetoric about the pros and cons of gun control and gun rights and focus instead on ways to prevent gun violence from permeating our schools.

Mental health remains another core public health issue that has been illuminated by the Sandy Hook massacre. We have yet to get a good handle – at the most public level – on the burdens faced by those with mental illness, the importance of properly recognizing and treating those who suffer, and the myths and realities about the risk posed to society by some individuals. What can be stated with confidence is that despite the substantial progress made over the last few decades in the identification and treatment of mental illness, we simply need much more support for research and intervention.

This unfortunately comes at a time when our national finances are such that research funding has been cut dramatically over the last few years.  We just witnessed a government shutdown that kept scientists away from doing their work. Deciphering the inner workings of the brain, the effects of genes on development, and the impact of a multitude of environmental factors that convey risk for mental illness is a task of extraordinary complexity. Bringing sustainable, evidence-based interventions to those in the population who need them is a daunting undertaking. Until we grasp how important this effort is, and embrace how much financial support it will take, we may find ourselves wondering and debating  if a future shooting could have been prevented via advances in knowledge and practice.

Although these three public health challenges remain, it is good to know that they are at least not being dismissed or are fading away. We may eventually look back on that horrific day at Sandy Hook Elementary as a turning point and catalyst for making real and sustainable progress in our efforts to keep children safe in school.

More on Sandy Hook

Sandy Hook via

Joe Biden Answers Your Gun Safety Questions
Joe Biden Answers Your Gun Safety Questions
Joe Biden Answers Your Gun Safety Questions

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Is “Ignorance” Killing Our Kids?

Thursday, January 31st, 2013

An editorial in the New York Times suggests this is so in relation to gun control issues and the devastating losses of young lives that we continue to witness, the most recent being the Sandy Hook Elementary massacre. The crux of the argument is that we need to consider the seemingly endless stream of senseless murders (from Columbine to Virginia Tech to Aurora to Newtown) from the perspective of public health – meaning we need to treat this like an epidemic and rectify all the gaps in knowledge that currently exist about guns and violence.  I couldn’t agree more.

This month, I used the public health framework to discuss our knowledge base on the four central issues we have all been discussing in relation to Sandy Hook:

Mental Health

Gun Control

School Safety

Violent Video Games

The conclusion each time was that we really are pretty ignorant about how these factors come together to lead an individual to murder innocent youth. What we need now is to start asking pointed questions in research designed to help us arrive at meaningful next steps that would reduce the likelihood of these heinous acts taking innocent lives – based on reputable data and not just rhetoric or philosophy. That’s what public health research does – plain and simple, it identifies factors that can be modified to prevent the probability of death, and conducts scientific tests to generate an empirical foundation for making decisions that impact the problem. Studies showed that seatbelts save lives – we require use of seatbelts. Studies showed that teens who text when driving are at increased risk for getting killed – we ban texting. We don’t know right now the relative mix of influence posed by mental health issues, access to guns, and exposure to violent video games – and we need the studies to sort that out rather than pitting one factor against the other in a philosophical game of chess that does nothing to improve school safety. Public health is agnostic – just get answers and act on them. If we don’t take that principle seriously, then yes, ignorance is killing our kids.


Epidemiology and Public Health via


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Sandy Hook Aftermath: Gun Control As A Public Health Issue

Thursday, January 3rd, 2013

Even in the aftermath of the Sandy Hook shooting, there are few topics more polarizing than gun control. But from the perspective of public health, I would hope everyone would agree that we have an urgent need to make children’s lives safer than they are right now. 

Let’s look at some numbers. Using data from the Centers for Disease Control and Prevention (CDC), the Children’s Defense Fund generated the following statistics:

In 2008, 2,947 children and teens were killed by guns

In 2009, 2,793 children and teens were killed by guns

The majority (about 2/3) were homicide related; around 1/4 were due to suicide; and around 5% were accidental deaths.

If you peruse the CDC site – specifically the section on Injury Prevention and Control – you will note a few key points:

Injuries are the leading cause of death in the U.S. for individuals between 1 and 44 years old

3/4 of all deaths of young people are due to injuries – with homicide being the 2nd leading cause of death for 15-24 year-olds (motor vehicle accidents are the leading cause)

As noted by the CDC, in principle all the deaths due to injuries are preventable. While this goal is not achievable (we live in an unpredictable world), the public health perspective is to do everything we can to reduce the probability of injury and death. For example, with respect to motor vehicle accidents, we focus on a number of issues, including: enforcing speed limits; requiring safety belts; trying to ensure that babies, toddlers and kids are secured as safely as possible in motor vehicles; trying to prevent drinking and driving. We also take on new topics when they emerge, like the very real public health issues that have been raised in more recent years by cell phone use (including, of course, texting) in motor vehicles. Why am I belaboring this example? Because I don’t think many of us find the attempts to reduce mortality due to motor vehicle accidents to be controversial. It’s a public health issue – motor vehicle accidents are the leading cause of death in youth, so we have to try to find ways to reduce that morbidity. In the same way, we all can take as a starting point the need to reduce mortality attributable to firearms.

Now, I’m not here to resolve the issue – far from that. There’s plenty to debate, and to do this in a real way, we will need to consider a lot of perspectives. What has concerned me is the tendency we all have to polarize an issue – even in the face of the devastating tragedy at Sandy Hook Elementary – because it typically leads to no action at all. It’s not all about guns – or not at all about guns. It’s that grey area in between where we have to deal with the realities of how we will take on the firearms issue to try to make the world safer for our kids. Whether you are philosophically for or against gun control, reducing mortality due to firearms is a public health issue, and a part of the equation, as are other factors – including bringing a similar lens to mental health:

Sandy Hook Aftermath: Mental Health As A Public Health Issue

Epidemiology and Public Health via





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