More than 'thoughts and prayers:' Dr. Megan Ranney on actionable ways hospitals can help stop gun violence

If you are looking for a silver lining from the COVID-19 pandemic, it's this sad short-lived truth, Megan Ranney, MD, deputy dean at Providence, R.I.-based Brown University School of Public Health, told Becker's: "During the pandemic there were no school or workplace shootings."

With businesses and schools shuttered — everyone working and learning remotely — and the cancellations of any type of crowd-based activities, the opportunity for mass shootings didn't exist. However, she said, there was still plenty of gun violence. 

"We saw a big rise in gun homicides and a small uptick in gun suicides," said Dr. Ranney, who assumes her new position as dean of the Yale School of Public Health in New Haven, Conn., in July. The pandemic may have provided a short hiatus from mass-casualty shootings, "but gun violence has been rising overall for more than a decade."

With the end of the public health emergency in sight (May 11) and school and events back to normal across the country, public mass shootings are back in the news — Louisville, Ky., Nashville, Tenn., Buffalo, N.Y., and Uvalde, Texas, to name a few. A mass shooting is defined by the Gun Violence Archive as an incident where four or more people are shot or killed.

According to the Gun Violence Archive, as of April 17, more than 30 mass shootings were reported in the first half of this month and 163 mass shootings were reported this year alone. This means there have been more mass gun violence events reported in the United States in 2023 than there have been days. 

That being said, Dr. Ranney said the mass shootings are "the tip of the iceberg." One of the biggest challenges is how to stop gun violence before it even happens — not by trying to take away anyone's right to own a firearm, but to make sure legally owned guns are stored properly to best eliminate the possibility of a firearm getting into the wrong person's hands. Purposeful shootings and accidental shootings are both gun violence.

It's time to go past all the "thoughts and prayers" and pay attention to gun violence as a serious threat to communities, she said, and hospitals can play a vital role in attempting to stem the violence.

Media coverage of mass shooting events creates "a sense of hopelessness and fear" about gun violence across the country, Dr. Ranney said, noting the focus needs to be better directed where it's needed most by people who are in the best position to connect with people about important messaging — hospitals, healthcare systems and their associated community outreach programs.

Editor's note: The following responses have been lightly edited for clarity and brevity.

Question: What's the most important thing you want hospital leaders and clinicians to know about gun violence?

Dr. Megan Ranney: First, there needs to be an awareness that this is very much a health issue, not just after the mass shootings, but also in those everyday shootings that we see in every trauma center across the country. The community violence, which disproportionately affects Black and brown youth, hurts the victim, hurts the family and it hurts the community. And it causes a ripple effect that leads to more violence. 

It is also a health issue when it comes to gun suicides. Hospitals need to realize these are deaths that rarely come through the doors of the hospital because they are so often fatal. But these are one of the most common types of gun deaths in this country. And this is where hospitals can play an important role.

Q: What role can hospitals play to stem gun violence before the wounded arrive in the emergency department?

MR: As healthcare practitioners, we are talking to patients who are depressed or suicidal. And so awareness of the gun suicides as a health issue is something that we can and should do. 

Be aware, in your interactions with patients, of people who are at high risk of firearm injury. This would be parents, because kids find the firearm and unintentionally hurt themselves or someone else; people who are depressed or suicidal; people who are victims of domestic violence; people with substance use disorder; and people with post-traumatic stress. 

With these high-risk patients, we should be asking them if they have access to a firearm and counseling them on safer storage. We have the ability to talk about how to keep a firearm out of the hands of someone who either doesn't know how to use it properly or who has an intention of hurting themselves or others. 

This is the first thing that we can and should be doing today. And we do far too rarely. 

Q: How can this be done without infringing on people's right to own a gun?

MR: It's possible to have these conversations in a way that's nonjudgmental, that creates an alliance with a patient and creates change. It's not about making a political statement. It's about trying to reduce harm. We counsel people about the benefits of wearing seatbelts and locking up poisons underneath the kitchen sink. 

There's a big difference between having firearms that are stored properly and being part of a militia. There are ways in which we can reconcile our long-standing tradition of firearm ownership in this country. 

So, making sure that the wrong people aren't able to get guns is a part of it. But the truth is that 40 percent of households have a firearm. So we have to make sure that those guns are stored safely and in a way that does not allow someone who has the intention to harm themselves or others to have access to that gun. 

The leading source of guns used in gun deaths right now is guns that are improperly stored in cars. That's terrifying. These guns are being stolen and then used in gun crimes. 

Just think about the suicides or one person that kills another person because they took their parking spot. This just has to stop. People have to think about gun safety differently. I really believe we can help our communities move into a different reality from the one we are living in now. 

Q: How can hospitals start conversations that will move that needle?

MR: We must be active in trying to improve the community in which we are located. Trauma centers, in particular, are often in communities that have higher rates of violence. There's a lot that can be done outside of legislation to help decrease the cycle of violence. 

One thing hospitals can do is hold violence intervention programs to help survivors as well as their families to heal after a gunshot wound. This helps them heal psychologically. Most important, it's a step on a path where their folks are less likely to get caught back in that cycle of violence. 

We can absolutely tackle this problem if we work together. I can quote example after example through history of huge problems such as car crash deaths and HIV/AIDS that we solved by investing resources. We can also work on harm reduction education. We're not going to change it overnight, but we can shift it. If we don't do anything, of course, we're not going to change it. But it is possible to shift things over time. 

In order to change the patterns of firearm injury and death in this country, we have to talk about more than stopping mass shootings. If we only concentrate on those, we're not going to get to the underlying drivers that are leading to this increase. We have to do it all.

Q: Gun violence is one of the top population health issues, along with chronic disease, substance addiction and abuse, mental health issues and lack of vaccinations. Would violence be the one you tackled first if you had the power to choose?

MR: Violence, mental health and substance use actually all go together. These issues are about the depths of despair people find themselves in. People have a lack of community, a lack of a support system, a lack of hope and a feeling of isolation. That's why we need to find classic teachable moments with our patients.

When someone comes into your healthcare system, there is a moment or a chance to talk to them about something that potentially impacts their health. We know that living in a house with a gun that is not properly stored increases the chance of gun deaths.

So we have to find a moment in those interactions to talk to people about what can be done better. We are trusted messengers in a position to find a teachable moment. When we know someone has COPD, we have no problem talking to them about stopping smoking, right? We need to do the same for gun violence. 

Q: Can community outreach programs sponsored by hospitals play a part, too?

MR: Absolutely. Those community health programs are so effective. If you hold an event that includes private screenings, you can use that time as an entry point to have discussions about these other drivers of poor health, whether it is mental health, substance use or violence. 

It's an entry point for people into a system that feels scary, discriminatory or inaccessible. The medical community provides one service, and it can serve as an entry point into others. They provide a tremendous opportunity to improve community as well as individual level health.

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