Gun Violence Is a Public Health Issue—What if We Treated It Like One?

From mass shootings to violence taking children's lives every day, gun violence is a public health crisis. Admitting that is the first step in finding solutions.

Demonstrators attend a March for Our Lives rally against gun violence on the National Mall
Photo: Tasos Katopodis/Getty Images

He was losing too much blood.

I was a medical student rotating on trauma surgery, watching a teenager die in front of me. He arrived at the emergency department with multiple bullet wounds and multiple organs lacerated. His face looked so young—barely in high school. But there was nothing we could do, and he did not make it to surgery.

I went with the supervising doctor to tell the patient's family. They erupted with grief. His mother rocked back and forth, asking God why her child was killed when he had harmed no one. Later, I overhead doctors discussing the patient: "Yeah, another one whose family claims he is innocent. That's what they all say. I'm sure he was in a gang."

I wondered if they treated all gun victims with such callousness or just the Black kids.

The nation is reeling after the mass shooting in Uvalde, resulting in the deaths of two teachers and 19 students. Accounts of the brutal injuries sustained by the gun victims have been released, along with stories humanizing them. All gun victims deserve that compassion. But, many children, like my patient in medical school, don't receive it—and their stories will never be shown on the news.

Joshua Harris-Till, fellow, Everytown survivor network

To me, gunshots were the soundtrack of my childhood…Black children shouldn't have to grow up like I did, with gunshots a more common refrain than ice cream truck songs on warm summer days…Our stories matter. We're not just dots on a map.

— Joshua Harris-Till, fellow, Everytown survivor network

Calls for gun policy changes abound in the wake of mass shootings, but mass shootings represent a tiny fraction of American gun deaths, although they often garner mass attention in the media. Gun violence was the top cause of death for children in 2020 and in 2019, enough children died from gun violence to fill over 168 classrooms. America suffers from a gun violence crisis and it disproportionately impacts Black Americans. Black children and adolescents are four times more likely to be killed by a gun than their white peers. A young Black man dies by a gun every three hours.

Gun violence reflects the trauma of white supremacy and the intentional economic oppression of Black Americans across centuries. Black communities impacted by gun violence are the same communities greatly impacted by structural racism and oppression. Communities with under-sourced schools, lower property values (which have ties to home loan racism and redlining), and fewer resources are more likely to suffer from gun violence.

The gun violence that Black youth are subjected to is not just within their communities—it is also due to hate crimes and police brutality. In 2020, Black Americans were the target of most racism-motivated murders. Black Americans also suffer disproportionately from police gun violence. This, in addition to a legacy of racism that has endured since the slave patrols, fuels the long history of Black Americans not trusting the police. This results in a brutal cycle, where some Black community members feel they need more guns to protect themselves.

Youth living in communities impacted by gun violence experience a sequela of mental health issues including depression and post-traumatic stress disorder. Further, it can result in a sense of constant hypervigilance, stress, and disempowerment for Black children.

But gun violence is a societal crisis, and not just for Black Americans living in communities impacted by gun violence—58% of Americans report being impacted personally by gun violence or caring for someone who has. And gun violence does not only impact the mental health of survivors and communities, it also has financial, legal, and medical impacts as well.

Even still, more than half of gun violence survivors reported that they lacked access to resources and support to cope with their tragedies. Although recent federal legislation created the Crime Victims Fund, many gun violence survivors are unaware of this financial resource.

Yet even though gun violence is a public health crisis, the United States has not taken a public health approach to solve it, and American children are suffering. To date, there is no centralized system, on a federal, state, and/or local level, to support youth gun violence survivors or to prevent and mitigate gun violence, but there should be.

Instead, communities are left to fend for themselves. Community-led interventions may not be tracked using research and data, which is important for gauging their effectiveness and replicating the programs in other communities. It is known that communities suffering from structural racism suffer from gun violence, but there is no organized, well-funded system in place to financially invest in these communities.

It is known that gun violence affects mental health, yet there is a dearth of mental health support in place for gun violence victims and their communities, and the mental health system is difficult for many to access and navigate. A truly public health approach to gun violence would involve an in-depth study of the causes and risk factors for gun violence and the implementation of strategies, on an individual, interpersonal, community, and societal level, to mitigate and prevent it. Strategies would also address the medical, legal, financial, and mental health sequelae of gun violence. Some of these strategies exist and should be further invested in so that they can be widely disseminated.

Everytown Research and Policy, for example, conducts independent, data-driven analyses of the impacts of gun violence on individuals and their communities, but gun violence research is underfunded overall. And beyond research, there is a strong need for school and community education about gun violence from coping to prevention. It is not widely taught in schools that gun violence reflects structural racism and oppression. The harms of gun violence are also not routinely addressed in schools so that youth can understand how to cope with gun violence, whether in the media or in their own communities.

Community interventions, such as violence intervention programs, have been shown to be effective as well, but not all states fund them and there is a need for a standardized approach to providing these, as well as other interventions, across the country. And finally, real policy changes are needed that mitigate gun violence, from repealing racist Stand Your Ground laws and No-Knock warrants to, of course, gun reform.

American children desperately need a public health approach to mitigating gun violence. Mass shootings should receive attention and action but let us not forget about all the other children impacted by gun violence.

Dr. Amanda J. Calhoun is an Adult/Child Psychiatry Resident at Yale Child Study Center/Yale School of Medicine. She is also a Public Voices Fellow of the OpEd Project at Yale University.

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  1. Current Causes of Death in Children and Adolescents in the United States, N Engl J Med 2022; 386:1955-1956, DOI: 10.1056/NEJMc2201761

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