Firearm violence is a pervasive and uniquely American problem. Our firearm homicide rate is 25 times higher than that of similarly large and wealthy countries, despite comparable rates of crime overall.
Annually in the U.S., approximately 40,000 people are killed by firearms and more than 100,000 survive a gunshot injury; countless others experience gun violence indirectly, e.g., via the loss of a loved one, witnessing shootings or hearing gunshots. While public mass shootings dominate news headlines, everyday incidents of gun violence (including firearm suicide) in homes and communities constitute most of the human toll of this public health crisis.
In 2020, the destabilizing impacts of COVID-19 contributed to increased firearm purchasing, a breakdown of key social services, and inequitable community conditions for safety. While more research is required, the result appears to be an historic spike in gun violence, with the highest annual death toll in decades and increases in non-fatal shootings in 73 of the 100 largest cities. As with COVID-19, a disproportionate share of the death, injury and trauma caused by gun violence is shouldered by Black and Brown communities left more vulnerable by historical and present-day structural racism and other systemic barriers.
Health systems are on the front lines of the gun violence epidemic, and their leaders can help ensure that community safety is at the very core of the institutional mission. To meet this critical moment—at a time when long-standing racial injustices and police violence have sparked a nationwide protest movement, and elected officials have made unprecedented commitments to invest in violence intervention and prevention—the role of healthcare organizations cannot be limited to treating the physical wounds caused by gun violence. Systems of care must also leverage their clinical and nonclinical assets to bolster community-driven approaches to preventing gun violence, supporting healing and improving community safety. Such changes are easiest when strong leadership comes from the top.
Fortunately, the science and practice of public health, in combination with the wisdom of community members most impacted by gun violence and injustice, have already taught us promising ways that health systems and their leaders can more fully engage in this work:
- Align and use the human and economic resources of the institution—including sourcing and procurement, workforce development, training, investment capital, education programs, research, data analytics, community health initiatives, environmental stewardship, and clinical prevention—to help create the conditions that neighborhoods need to be safe. Such community-based anchor initiatives are designed to fundamentally alter key underlying determinants—such as income and wealth disparities, generational poverty and trauma, substandard housing, and overall disinvestment in marginalized communities—that elevate the risk for gun violence.
- Normalize the practice of health professionals talking with patients about access to firearms, risk of gun injury, and harm reduction strategies—including safe storage and temporary firearm transfers during periods of elevated risk. Nationally, fewer than 10% of adults in gun households have ever received gun safety advice from a clinician, despite widespread public support, including among firearm owners, for engaging in these conversations, especially when the patient or someone in their home demonstrates risk factors for firearm-related harm. When discussing firearm injury prevention, care providers should adopt a conversational and collaborative approach rooted in cultural humility and trauma-responsive practices, acknowledging the complexity and fluidity of culture, identity and generational experiences with healthcare and criminal-legal systems.
- Advocate for and partner with community violence intervention (CVI) efforts, such as hospital-based violence intervention programs (HVIPs), transformative skill-building, and intensive peer mentorship, that actively support individuals at highest risk of violence involvement. These person-centered approaches use relatable and credible professionals from the community to help address complex needs related to violence risk. Health system leaders can build relationships with CVI and other community resources to offer referrals for patients, or as with HVIPs, implement their own programs. Such strategies have recognized potential to address gun violence and inequality: The American Rescue Plan provides $350 billion to localities to mitigate harms associated with COVID-19 and can be used for CVI. CMS has announced that violence prevention services are reimbursable through Medicaid. The Break the Cycle of Violence Act, reintroduced in Congress in June, would invest $5 billion over eight years in CVI programs.
Health systems are uniquely positioned to harness their social, economic and political power to advance community safety, not simply treat violent injuries. This is an essential time for system leaders to realize their potential impact and commit to action—both within and outside institutional walls—to reduce gun violence.