CONTENT WARNING:
This article mentions topics related to suicide. If you or someone you know is struggling with suicidal thoughts, please know that there are resources available to help. In the U.S., dial 988 to reach the National Suicide Prevention Lifeline, text 741741 to the Crisis Text Line, or go to suicidepreventionlifeline.org. Outside the U.S, seek local resources and support networks. Lock 2 Live, created by Ranney and the University of Colorado-Denver, may help: lock2live.org.
Almost two decades ago, Megan Ranney’s life changed.
It was a warm July night in Providence, Rhode Island, where she was working as an attending physician in an emergency department. And, as usual, she knew there was a good chance that someone who’d been involved in a violent situation might come through the doors.
That night was no different. The team got a call from EMS saying they were on their way with a “GSW,” or gunshot wound, patient. Ranney, an emergency physician who is now dean of the Yale School of Public Health, had treated countless firearm injuries before. But when EMS arrived that night, the patient wasn’t responding to treatment. They couldn’t save him.
That patient wasn’t a victim of community violence. He had shot himself with a family member’s firearm in a moment of desperation. After his death, Ranney started thinking a lot about how society could have prevented this tragedy. Specifically, she asked herself why the public health tools used to prevent cancer, heart attacks, or car crashes couldn’t be applied to firearm injury, a very common health problem in the United States.
“That case changed the course of my life, and it was really the moment where I started to dedicate an increasing proportion of my time to trying to understand and then addressing the American epidemic of firearm injury,” Ranney said.
Last year, nearly 47,000 people died from a firearm injury in the U.S., according to the Centers for Disease Control and Prevention, and, according to the best available estimates, another 100,000 or so people survived an injury related to firearms. That includes homicides, accidents, and suicides. But too often, she says, this data is obscured by political arguments and partisan divides. Treating firearm injury as a public health issue, rather than a political one, she says, opens the door to new possibilities for solutions.
In an interview, Ranney explains the importance of framing firearm injury as a public health problem, how it will help society find common ground on the issue, and how and why YPSH is moving forward on this problem.
The interview has been edited for length and clarity.
Megan Ranney: When we talk about firearm injury as a public health problem instead of as a criminal justice or political problem, it opens up a whole suite of potential solutions and approaches that we may not otherwise be aware of. It helps us figure out how to measure the problem — not just the physical injuries but also the emotional injuries and the ripple effects on survivors, their family members, and their community.
It helps us think about risk and protective factors a little bit differently. Instead of always focusing on firearm purchase, we can also think about reducing access to a firearm in a moment of hopelessness or anger. We can think about root causes of firearm injury and testing what interventions work to address these.
The beautiful thing about the public health approach is it creates a whole set of different types of interventions that go far beyond just legislation or policing. They’re interventions that involve individuals, families, health care providers, and society at large, and they provide us with a path forward to get out of this epidemic in a way that doesn’t necessarily force us to take sides.
When we talk about it from a public health approach, it opens up a suite of potential interventions that people can agree on.
Ranney: The public health approach really is four basic steps. First, you measure how common a health problem is. Second, you figure out what puts someone at risk of that health problem or what protects them from it happening. Third, based off that information, you develop and then evaluate potential interventions, or steps you could take to reduce risk or improve protection. The evaluation part is super important because you don’t want to develop something, spend a lot of time and money putting it in place, and then find out it doesn’t work, or worse, does harm. Fourth, you scale up what works. You take the things that you figured out in the first three steps, and you share them with communities across a county, a state, or a country.
When you take that four-step approach, it works over and over. We’ve used it for car crashes to decrease car crash deaths by more than 70% over the last few decades without, of course, taking cars away. We’ve used it to reduce deaths from HIV/AIDS and from opioid use disorder. It’s a very standard set of steps that help us come to real solutions that help real communities.
Ranney: The public health approach helps people find common ground around firearm safety in a couple of different ways. The first is by framing firearm injury as a health problem. It grounds it in something that we all care about: No one wants themselves, a family member, or a friend to be shot. The second part is when we talk about it from a public health approach, it opens up a suite of potential interventions that people can agree on, regardless of where they sit on political divides, regardless of whether they are firearm owners or not, regardless of where they live geographically. The third thing about the public health approach that helps us overcome political divides is that, at its core, all four of those basic public health steps are rooted in listening to and collaborating with the community. We work with anyone, regardless of who they are or where they come from, to advance their health.
That approach helps us to sidestep some of those political barriers to creating change – as we demonstrated in our recent screening of the film “The Tennessee 11.” It might challenge some of your preconceptions about this issue!
Ranney: Community is at the center of the public health approach. You can’t talk about the health of the public without including the public and without grounding your work in what folks care about, in what motivates them, and in how they perceive problems. You also, of course, have to understand what interventions are possible in a given community versus not. That’s where local politics may play a role. But the local trusted messengers — the leaders in a community that can make a really big difference — are sometimes the real influencers. This is why we have a full-time Community Scholar Nelba Márquez-Greene as part of our Yale School of Public Health firearm injury prevention program and why our work always includes community members as co-equal partners. The community scholar helps us build trust amongst our partners that this work is being done both with and for them.
Ranney: Legislation or regulations are, of course, part of the solution to almost any public health problem, including firearm injury. There have been some great studies showing that certain policies, like safe storage laws, laws around alcohol outlets, and red flags laws, can decrease the number of shootings or the number of deaths in a community. That legislation can be local, state, or national.
But legislation alone is never sufficient for fixing a public health problem. You can pass laws that don’t get enforced, right? A great example is texting and driving. We have laws against that. But I challenge you to drive down the street and not see someone holding a phone in their hand.
Sometimes legislation is not even necessary. For example, our Firearm Injury Prevention program’s scientific director, faculty member Chris Morrison, has shown that the arrival of ride-sharing services (like Uber and Lyft) can result in decreases in drunk driving crashes.
Similarly, our firearm injury prevention program’s executive director, faculty member Kerri Raissian, is working with others to incentivize safer firearm storage through messaging, partnerships, and insurance.
So you can imagine how non-legislative interventions can have a huge impact on firearm injury. We’re excited to be working on all of these solutions here at YSPH.
Photo Credit: KAZ SASAHARA