CHICAGO: As firearm deaths continue to increase in the United States,1 the American College of Surgeons (ACS) Improving Social Determinants to Attenuate Violence (ISAVE) task force outlined steps the medical community must take to understand and address the root causes of firearm violence. At a panel presentation during the 2020 ACS Clinical Congress, the multidisciplinary taskforce urged health care leaders to treat firearm violence as a public health crisis, understand its social causes, and develop interventions to address them.
“Despite dramatic increases in firearm deaths, solutions to the problem continue to be mired in polar political battles,” said Eileen Bulger, MD, FACS, Chair of the ACS Committee on Trauma (COT). “We need to see this as a public health problem, so we can finally take meaningful action to reduce firearm deaths.”
Panelist Earl Frederick, MD, an emergency medicine physician and consulting medical director at NextLevel Health, Chicago, noted that 78 percent of the variation in firearm violence between communities can be attributed to social factors, including racial residential segregation, educational attainment, marital status, household income, and geographic location.2
“Violent crime is a public health problem, yet we use criminal justice tools to solve it and wonder why things keep getting worse,” he said. Mass incarceration has been shown to contribute to violent crime, community destabilization, and racial disparities, yet the United States continues to spend two to five times more on incarceration than education, Dr. Frederick said.
During the discussion, members of the ISAVE taskforce outlined steps to reduce firearm violence by addressing social factors, including:
- Helping trauma survivors cope with the aftermath of a traumatic event and heal by implementing trauma-informed care in more trauma centers. Recognizing that many victims of violence have suffered through multiple episodes of trauma in their lives, this approach aims to reduce patient fear and anxiety, encourage steps to build trust between providers and patients, encourage respect for patient privacy, and promote ways for patients to collaborate on their care decisions.
- Training more physicians in basic social work principles and more closely integrating social care and medical care into a patient’s care plan.
- Creating a roadmap for investment in at-risk communities to improve health equity and increase safety. Areas of focus will include public and mental health, residential desegregation, affordable housing, early childhood development, education and vocational training, small business and local infrastructure investment, community cleanup, and establishing a living wage.
“We know we can’t solve this problem with medical care alone,” said ISAVE Chair Rochelle Dicker, MD, FACS, professor of surgery and anesthesia and vice chair for critical care, UCLA Medical Center, Los Angeles. “Fundamentally, a change in mindset is key for the medical community to be able to take effective action on firearm violence.”
The ISAVE taskforce is producing several outputs useful to trauma centers and ultimately to the people they serve, including a manuscript outlining steps to address the social factors of firearm violence. Simultaneously, it will develop a curriculum for trauma-informed care that will be piloted in several trauma centers in early 2021, with the goal of releasing it to trauma centers for broad use. It will also develop roadmaps for integrating social care into trauma care, as well as outline concepts and concrete examples of how trauma centers can invest in their communities. All of these ISAVE themes will be supported by advocacy to gain local support and shape policy.
“We know how to solve this problem,” said Ronald M. Stewart, MD, FACS, Medical Director, ACS Trauma Programs. “Decades ago, we took a public health approach to motor vehicle deaths, and they have steadily declined since. We can replicate that success by taking a similar approach to preventing firearm deaths. This means working together to understand and address the root causes of violence, while making firearm ownership as safe as possible.”
“If we are going to address the root causes of violence, we must commit to building communities that advance health and wellness for all people,” said Dr. Bulger. “Treating firearm violence not as a political issue but a public health issue is the first step in helping us end this epidemic in our country.”
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Addressing the Social Determinants to Reduce Firearm Violence, panel session, American College of Surgeons Clinical Congress 2020, October 6, 2020.
- National Center for Health Statistics. All injuries. Available at: https://www.cdc.gov/nchs/fastats/injury.htm. Updated February 28, 2020. Accessed October 1, 2020.
- Goin DE, Rudolph KE, Ahern J. Predictors of firearm violence in urban communities: A machine-learning approach. Health Place. 2018;51:61-67. doi: 10.1016/j.healthplace.2018.02.013
