Michael Dowling: Bending the curve of gun deaths in America

To borrow a phrase used regularly during the height of the COVID-19 pandemic, we are beginning to "bend the curve" since firearm-related deaths reached an all-time high of nearly 49,000 in 2021.

At a recent NRA event in Pennsylvania, our former president boasted that his administration purposely "did nothing" to try to curtail the spike in gun violence. 

Fortunately, others inside and outside of government have been unwilling to embrace the inaction on gun violence touted by the former president, or the sentiment that we should simply shrug off the carnage being inflicted on cities and towns across America. 

The numbers show that our collective fortitude in combating this public health crisis is starting to pay off. To borrow a phrase used regularly during the height of the COVID-19 pandemic, we are beginning to "bend the curve" since firearm-related deaths reached an all-time high of nearly 49,000 in 2021.

Over the past two years, gun homicides have dropped nearly 8%, according to provisional data from the CDC. That's certainly no cause for a victory lap — there are still about 50 Americans being murdered every day with firearms, and I recognize the decline is small solace to victims' families. But the fact of the matter is we are making progress. 

At a gun violence prevention forum I hosted this week in New York, we announced plans to further accelerate our advocacy by launching a nationwide public awareness campaign in collaboration with the Ad Council. Members of a coalition of 53 health care leaders we created in 2022, called the National Health Care CEO Council on Gun Violence Prevention and Safety, have made an initial donation of $10 million as the seed of a greater $40 million fundraising goal over the next two years to support the campaign's large-scale plans to reduce firearm deaths and injuries in the U.S. 

The Ad Council has done extraordinary work over many years in helping to drive social change on issues that divide Americans, and few issues are more politically polarizing than the debate over Second Amendment rights. Using a playbook that was widely effective in promoting acceptance of the COVID vaccine, the Ad Council is working on developing the campaign's strategy and messaging with input from a wide range of advisors, including those with expertise in public health, mental health, community violence prevention and policy, as well as gun violence survivors who have lost family members in firearm-related deaths.

This exciting new effort speaks to the power of collaboration and what we can collectively achieve if we pool our resources and talent. It underscores the pivotal role that healthcare providers — who see the tragic consequences of gun violence on a daily basis — and other sectors of society can play in turning the tide of gun violence, working in collaboration with schools, social services and other community-based organizations, advocacy groups, the broader business community, law enforcement and government.

When it comes to government, the collective outrage that so many Americans experienced after the massacre of 19 students and two teachers in Uvalde, Texas, in 2022 helped inspire long-overdue changes that have helped contribute to declines in gun deaths. 

A normally recalcitrant Congress, unwilling to consider any gun safety legislation since 1993, even after the horrific deaths of 20 children and six staff in 2012 at Sandy Hook Elementary School in Newtown, Conn., passed the Bipartisan Safer Communities Act in June 2022. The legislation, negotiated by two U.S. Senators at opposite ends of the political spectrum, Chris Murphy (D-Conn.) and John Cornyn (R-Texas), was immediately signed into law by President Joe Biden, freeing up billions of federal dollars to address some of the underlying causes of gun violence.

Most notably, the new law led to major investments in mental health and violence prevention programs, the strengthening of background checks on young people under age 21 looking to buy firearms, including a review of juvenile and mental health records, and funding to help states implement "red flag" laws aimed at preemptively disarming people who show warning signs that they could be dangerous to themselves or others.

Unfortunately, our progress in combating gun violence over the past couple years has been tempered by several troublesome trends that underscore the need for greater scrutiny:

  • For the third consecutive year, the CDC's provisional data from 2022 shows that firearms continued to be the leading cause of death for children and teens.
  • Suicides continue to account for the majority of US gun deaths, increasing every year since 2019. In 2021, the most-recent year for which the CDC has complete data, 54 percent of all firearm deaths involved those who took their own lives with a gun — more than 26,000 individuals in total. 

The responsibility to reverse these heartbreaking trends rests with all of us, but hospitals and health systems can play a critically important role in filling gaps in services, especially when it comes to intervening with young people exhibiting suicidal behaviors and serious anger management issues. 

That's why Northwell recently announced an initiative to invest several hundred million dollars to expand pediatric behavioral health services that we currently offer to dozens of schools in the New York area, recognizing that only about half of US public schools offer mental health assessments and even fewer offer treatment services, according to a 2022 Pew Research Center survey.

Another big hurdle is finding better ways to intervene with young people who often get lured into gangs and fall prey to violence. With that goal in mind, Northwell began screening emergency patients in 2021 to identify those who may be at risk of gun violence

Similar to how clinicians routinely ask patients about their diet and exercise habits, whether they drink, smoke or use other substances, those coming into our emergency departments for whatever reason are asked whether they have access to a firearm, and if so, how it is stored. Adults and adolescents (ages 12-17) are also asked questions such as: "How often have you heard guns being shot or had someone pull a gun on you?" In addition, teens are asked if they have gotten into serious fights, or if their friends carry knives, razors or guns. 

If patients are deemed at risk based on their responses, clinicians trained in motivational interviewing counsel them on changes they can make in their lives to avoid becoming a victim and refer them to violence interrupter programs that provide long-term support. Over the past 2.5 years, we have screened more than 32,000 patients, referred several hundred people for counseling and distributed thousands of gun locks.

Considering that economic disparity is one of the factors contributing to gun violence, employers in all industries can help provide this generation of young people with career paths that provide access to a solid education and good jobs as an alternative to a life of crime. That's one of the reasons why Northwell is joining with NYC Public Schools and Bloomberg Philanthropies to create a School of Health Sciences in Woodside, Queens. In addition to providing our hospitals and other facilities with a pipeline of new, young talent, a career-focused high school like this will prepare students for well-paying, high-demand jobs.

While these kinds of innovative partnerships require upfront investment, they can pay huge future dividends for employers in dire need of talent and offer a pathway of hope for young people looking for a better future.

The voices of business leaders are incredibly important in helping to reframe gun violence as an apolitical public health issue, which is why I invite all employers to embrace the urgency of this moment and join our efforts to curb this epidemic.

Michael J. Dowling is president and CEO of Northwell Health, New York's largest healthcare provider and private employer.

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