This Time, Some Better News About Guns: A Reblog in Appreciation of the Biden-Harris Plans to Treat Our Public Health Epidemic

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Note:

Of course we need common sense gun safety legislation, but it doesn’t seem likely that we’re going to get it any time soon. However, the plans and programs that the Biden-Harris administration just introduced are truly significant. Shannon Watts, founder of Moms Demand Action for Gun Sense in America, called the initiative “wonderful.” 

There are six important elements in this plan, which will be enacted with the Department of Justice. They are detailed in the FACT SHEET: Biden-Harris Administration Announces Initial Actions to Address the Gun Violence Public Health Epidemic. I hope you’ll read the entire Fact Sheet.

Two items in the portion I’ve included below–community violence and suicide–are discussed in the 2019 post I’ve reblogged below that. Since researching this post, I’ve lamented that community efforts that were shown to save lives would then lose their funding. 

Thus, I read that portion of the Fact Sheet with particular delight. It demonstrates how well the administration did its homework in determining to place its funding on evidence-based programs. Most important are the details of the research that formed the basis of the plan. Please click on the link at the end of the Fact Sheet excerpt if you’d like to see how thoughtful and inclusive this plan is.

I am very hopeful that the program can make meaningful inroads in our huge gun violence problem.

 FROM THE FACT SHEET

The Administration is investing in evidence-based community violence interventions. Community violence interventions are proven strategies for reducing gun violence in urban communities through tools other than incarceration. Because cities across the country are experiencing a historic spike in homicides, the Biden-Harris Administration is taking a number of steps to prioritize investment in community violence interventions.

  • The American Jobs Plan proposes a $5 billion investment over eight years to support community violence intervention programs. A key part of community violence intervention strategies is to help connect individuals to job training and job opportunities.
  • The U.S. Department of Health and Human Services is organizing a webinar and toolkit to educate states on how they can use Medicaid to reimburse certain community violence intervention programs, like Hospital-Based Violence Interventions.
  • Five federal agencies are making changes to 26 different programs to direct vital support to community violence intervention programs as quickly as possible. These changes mean we can start increasing investments in community violence interventions as we wait on Congress to appropriate additional funds. Read more about these agency actions here.

MY ORIGINAL BLOG (SLIGHTLY REFORMATTED) STARTS HERE

Treating Gun Violence as a Public Health Epidemic

There’s broad agreement, as noted in Part 1 of this post, that gun violence (indeed, all violence) should be viewed as a public health issue.

That idea was clearly stated by Dr. Gary Slutkin, an epidemiologist trained in infectious diseases, when he returned to the US after a decade spent in Somalia, Uganda, and other countries where epidemics of such diseases as cholera, tuberculosis, and AIDs were common. In his final assignment before coming home, he was tasked to design interventions.

As he describes in a 2013 TEDMED talk, he was looking for something to do when he began hearing stories of children shooting other children.

When he asked friends how America was addressing this issue, one response was through punishment.

But, he said, “We who had worked in behavior know that punishment was something…that was highly overvalued” because it wasn’t a main driver of either behavior or behavior change.

What’s more, it reminded him of responses to epidemics long ago—before science cast better light on issues.

The other response was what he called the “‘everything’ theory, or EOE: Everything on Earth:” fix the schools, home, community, family, etc. He said he realized from treating other problems that you don’t always need to treat everything.

Assuming violence behaves like a contagious disease, Slutkin describes three things necessary to counter it.

First: interrupt transmission by detecting and finding the first cases, which includes identifying and training special workers to locate those cases, eg, “someone who’s very angry because someone looked at his girlfriend or owes him money.”

Second: “to prevent further spread…find out who else has been exposed,” but not as severely, and manage them as well.

Third: shift the norms.” This is an extensive effort involving community activities, public education, helping people improve communication and resolve their conflicts peacefully.

Slutkin notes:

“And then you’ve got what you might call group immunity. And that combination of factors is how the AIDS epidemic in Uganda was very successfully reversed.”

Slutkin and his colleagues put all these ideas together in 2000, and tried them out in the West Garfield neighborhood in Chicago—the worst police district in the United States at the time.” The result: a 67% drop in shootings and killings.

What Slutkin began in Chicago became an organization originally called “CeaseFire,” but more optimistically renamed “Cure Violence.” It’s now a national model, with local groups operating under various names. [UPDATE: Cure Violence is referenced in the material linked to the Administration’s FACT SHEET.)

And several of those local groups are in the California Bay Area, which is the subject of the year-long examination that Lois Beckett and her colleagues at The Guardian have undertaken. (See Part 1 of this post.)

The reduction in violence in this region from 2007 to 2017 is remarkable—even more so because it occurred while homelessness caused by gentrification has been rising.

Due to the impact of Silicon Valley, writes The Guardian,

“For each new millionaire household the San Francisco Bay area has produced, there are at least four new people living below the poverty level.”

Nevertheless, gun homicide was down substantially in the ten-year period in more than 100 cities throughout the region. In Oakland, a 44% decrease. In San Francisco, 49%. In Richmond, 67%. With Stockton as an outlier (98% increase), the overall drop in the region was 30%.

Writes The Guardian:

“There’s early evidence that local violence prevention strategies—including a refocused, more community-driven ‘Ceasefire’ policing strategy, and intensive support programs that do not involve law enforcement at all—were a ‘key change’ contributing to these huge decreases.” 

Lest anyone conclude that gentrification resulted in the reduced gun violence, it’s noteworthy that there was no uptick in violence in the suburbs to which the people forced out of the city moved.

One local activist noted:

“The idea that gentrification is more responsible for the reduction in shootings and homicides is offensive to the hundreds of outreach workers, community members and practitioners on the frontlines actually doing this work daily.”

As Slutkin had observed, pinpointing the source of the infection is critical to containing it. The Guardian quotes experts:

“Longtime community outreach workers and violence interrupters, many of whom are formerly incarcerated, are crucial to making these public health strategies effective.” 

A Richmond official, DeVone Boggan, who’s developed a nationally recognized fellowship program for men at highest risk for violence, says:

“We have to extend the idea of what public safety is beyond policing and incarceration, to include these things like intervention, outreach, and neighborhood empowerment.”

In line with using data wisely, Oakland did a 2017 study of every homicide over 1-1/2 years and found that 0.16% of Oakland’s population (about 700 men) were responsible for the majority of the homicides. That enabled more effective interventions.

Here’s something both fascinating and integral to program success: Boggan says some credit must go to the shooters who are no longer shooting, who are now making healthier decisions…I think these individuals have to be a productive part of the solution. They have to be embraced and brought into the discussion.”

One young man, now a college graduate entering business school, sounded remarkably like Slutkin, the epidemiologist.

“Gun violence is pretty much a form of disease. Once it starts affecting one person, it starts spreading.”

He’d never considered carrying a gun until he was shot listening to fireworks one July 4th. He went to jail for illegal possession, but later entered Boggan’s fellowship program “with other young men caught up in the long-running cycle of local fights and retaliations,” writes The Guardian.

Says this young man:

“To have somebody who believes in you, and knows you’ve got the potential to go for it, stuff like that makes you want to keep going right.”

The situation isn’t nirvana at present. Throughout the region, black residents are 22 times more likely to be killed with a gun than white residents, and many residents, black and white, still don’t feel safe. Property crime has risen significantly.

But the improvements are dramatic, and the cluster of approaches seems to work.

These programs can cost tens of millions of dollars—and they require sustained attention. But consider that amount when compared with the costs of the damage done by gun violence.

Sadly, as of 2017, Cure Violence was woefully underfunded in Chicago, the city where it began, existing on just a few grants. That meant a dearth of Violence Interrupters. The group’s leaders attributed an increase in Chicago’s violence to that drop in funding, reported The Trace.

I’m not sure the program exists at all any more, though Chicago neighborhoods are in such ongoing crisis that one would think the funding could be found. [UPDATE: it appears that it has been found!]

Congressman Danny Davis, testifying just days ago (September 26, 2019) before a Congressional subcommittee hearing on The Public Health Consequences & Costs of Gun Violence, cited a University of Chicago Crime Lab estimate that gun violence costs Chicago and its residents $2.5 billion a year.

He stated:

“Despite the high cost of gun violence, not one penny of the approximately $624 million raised by federal taxes on guns and ammunition in 2018 went to gun violence prevention. Rather, all gun and ammunition excise taxes go to fish and wildlife conservation.”

I’m all for fish and wildlife conservation, but there seems to be a huge disconnect here.

Hospital Emergency Departments and the “Teachable Moment”

One of the most promising developments in breaking the cycle of violence is Hospital-based Violence Intervention Programs. [UPDATE: This program also appears in the Administration’s plan.]

Originating in the 1990s in community groups in Oakland, California, and Milwaukee, Wisconsin, they resulted from hospital medical staffs’ recognition that, from their location on the “front lines,” they could work with “trusted community-based partners who were well-positioned to provide intervention to violently injured youth after hospitalization.”

The umbrella group is now called The Health Alliance for Violence Intervention. I’m quoting from their White Paper, which I found extremely valuable.

Based on the premise that victims of interpersonal violence may well then retaliate as a “natural response borne out of societal pressure,” the programs begin when the youth is hospitalized and continue well after release.

Trained Intervention Specialists serve as mentors at the “teachable moment”—a time when the youths are believed most receptive to changing their behaviors and making changes in their lives.

Follow-up includes mental health care when needed to address the psychological traumas, and broad additional assistance: academic, vocational, housing, and help in honing in on the youths’ skills and interests to guide them toward productive careers.

A number of studies have documented the effectiveness of these efforts in reducing violence and costs that result from it.

“Collaborating With Gun Owners on Suicide Prevention”

Just as Cure Violence collaborates with actual shooters to turn them away from gun violence, a program based in Salt Lake City, Utah collaborates with gun owners on suicide prevention as part of a public health approach to reducing gun deaths.

As noted in Part 1 of this post, nearly 2/3 of gun violence consists of suicides, and we know the presence of guns exponentially increases the lethality of these attempts.

In Utah, reports Morissa Henn, Community Health Program Director at Intermountain Healthcare, that rate is 85%. Henn also testified at the September 26, 2019 Congressional subcommittee hearing.

The number has increased since 1999, when Surgeon General David Satcher called for the US to “address suicide as a significant public health problem.”

Henn says the high rate is due to the country’s failure to address “the inextricable link between suicide and firearms.” Although there’s not much evidence in support of most existing suicide prevention programs, she says,

“One of the only empirically based, high-impact suicide prevention strategies is reducing access to lethal means—which, in the United States, means reducing access to firearms for people who are at risk for suicide.”

Although lethal means reduction isn’t widely discussed in the US, awareness has grown since Surgeon General Regina Benjamin called for it in a 2012 National Strategy tied to a public health approach to suicide prevention in individuals at high risk.

Henn is part of a coalition of health professionals, gun owners, and others seeking to prevent suicide by firearms in Utah. Of this unlikely partnership, she says:

“In my experience, building productive and trusting relationships with gun owners on suicide has made us all think bigger, rooted the efforts in real-world context, and connected the data with culturally relevant messages and best-positioned messengers.

“Over time, I have learned that advancing these non-traditional partnerships is not only possible, but is a critical step if we are going to move the dial on gun death in America.”

“Similar to the way that shifts in social norms around drunk driving did not require all-out bans on cars or alcohol, a shift in voluntarily putting space and time between a suicidal impulse and a gun is framed in our coalition as a preventive, not prohibitive strategy. That small shift in framing opens the door to dialogue.”

Some accomplishments:

*an emergency department study found that among gun-owning parents of suicidal youth, 33% had unlocked guns at home before training; none did after training.

*with bipartisan support from the coalition, the state legislature passed a Suicide Prevention and Gun study that has gathered important data being applied to prevention. “It exemplifies how gun-related research can bring people and data together to drive collective action.”

*they developed a suicide prevention module for firearm instructors that the state adopted for permit seekers that’s won support from 79% of concealed carry instructors.

*a Safe Harbor Law permits gun owners or those they live with to temporarily store firearms with law enforcement for free if they believe someone in the home is a danger to self or others.

*They’ve joined with government, faith, business, and firearm stakeholders in a statewide media and education campaign with private dollars matched by public funds to extend awareness of suicide and lethal means reduction.

Though they don’t yet have impact data, they are optimistic because of the momentum they’ve built and what they’ve accomplished to date—and Henn recommends similar steps on the federal level. She believes it’s important to:

“Create political space in Congress for more open dialogue—engaging firearm owners and non-firearm owners in trusting partnerships can help us advance life-saving messages and behaviors.” [UPDATE: hmmmmm!]

Sandy Hook Promise (SHP)

Our country was struck to its core by the horror of Sandy Hook, the 2012 mass shooting that killed 20 6- and 7-year-olds, as well as 6 adults. Some of those grief-stricken parents have built an enduring legacy to their children by trying to prevent similar violence through identifying people at risk and getting them help before they act.

It’s an extensive program, and I can’t do justice to it here. I encourage you to explore the website.

SHP calls itself a “modest, above-the-politics organization that supports sensible program and policy solutions that address the ‘human side’ of gun violence by preventing individuals from ever getting to the point of picking up a firearm to hurt themselves or others.”

On the website, a March 22, 2019 press release describes the impact of SHP’s “Say Something” program.

When students at a Connecticut Middle School, who had just received the training, “saw disconcerting information and behaviors coming from one of their peers“ they averted a potentially violent situation in their school.

The Missing Piece…

After discussing the hopelessness that so many Americans feel about gun violence in Part 1 of this post, I felt the need to shed light on some programs that are, in fact, preventing gun violence.

But none of this should detract from what I—and the vast majority of Americans—feel is an imperative: the passage and enforcement of meaningful federal gun safety legislation.

All the above programs may well be more effective—and less urgently needed—if we can enact sensible laws to reduce the carnage that has affected individuals, families, and our society so deeply.

I thank my friend Dennis—one of the untold numbers of volunteers and staff in gun violence prevention organizations and elsewhere who are working so hard to keep us safe by bringing such laws to fruition. Dennis has directed me to several of the sources that I’ve used here.

Annie

32 thoughts on “This Time, Some Better News About Guns: A Reblog in Appreciation of the Biden-Harris Plans to Treat Our Public Health Epidemic

    1. Thank you, Keith. I realize it’s long, even by my standards(!). But there are so much interesting and affirmative efforts going on that would be helped by public support.

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      1. Annie, beyond the “hopes and prayers” throw away line and the “now is not the time” stalling technique, what irks me the most is the comment that this change would have not stopped this act. That may be true, but per your post and others, a series of changes to address the holistic nature of the problem allowing communities to do specific things, will help.

        It comes down to the US has more gun deaths than the next 23 wealthiest nations combined on an annual basis. That is not American exceptionalism, that is a travesty. The leading gun death cause in America is suicide, by far. That is not American exceptionalism, that is a travesty. Google six year old shoots four year old and read the stories. That is a travesty.

        Failing to do something is not leadership, it is cowardice and extremely poor stewardship. I lay this at the feet of Senator Mitch McConnell and other Republican leaders. Get off your hind end and act like parents and grandparents. Keith

        Liked by 1 person

  1. Really interesting to see violence treated as a public health issue. There has obviously been this debate about drugs for years, and I would suggest it is a phenomenon which is fast being accepted as a PH issue. Interesting implications for law enforcement, too.

    Liked by 2 people

    1. This concept of violence as a public health issue has been floating around for some years now. I’m so delighted to see the Biden administration adopt it—and use the phrase “public health epidemic” to refer to gun violence, specifically.

      Liked by 1 person

      1. I see the approach laid out at a lot of conferences I go to, but it needs law making and legislation that supports this approach. Hopefully Biden will be able to bring it about, although the full effects won’t be seen for years; it will need a forward-thinking next couple of next administrations to carry it through. Fingers crossed.

        Liked by 1 person

    1. Right—and in a smart and evidence-based way.

      People don’t realize that though the mass murders are horrific and should move legislators to change gun safety laws, they actually account for a relatively small amount of our shockingly high numbers of gun deaths.

      Liked by 1 person

  2. I don’t understand why Biden just doesn’t raise the excise tax on ammunition. Exempt law enforcement and the military from paying it. Dennis.

    Liked by 1 person

    1. It’s a thoughtful suggestion, Dennis. I took a quick look and it seems that the President and his Treasury Department have the right to include some taxes in their programs, but with the Congressional divide so great, would the benefits of his taking such a step outweigh the opposition it would generate? I don’t know. He’s clearly willing to push for things that he thinks will work.

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  3. Keith, I emphatically agree. And I was trying to stress that we have models of programs that have worked—so we know how to make a big dent in this huge, very American problem.

    It’s not just Mitch McConnell, though.
    Biden needs to have a United Democratic Senate. Joe Manchin, who I thought had shown bravery after Sandy Hook, when he met with the parents and promised he would do something, should be out front now trying to make good on that promise. To date, I’ve seen no evidence of that.

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      1. Hi, Annie: yes, this is a 60-80 year plan, which is not so long in the larger scheme of things, but yes, it will not fit into one lifetime.

        They are starting something ambitious, and comprehensive. I merely hope that it becomes more comprehensive as we learn that we must pass the baton on to our inheritors, who must continue this marathon of human learning and empathy-building…

        Liked by 1 person

      2. No, it won’t be easy, but then nothing ever is, is it? As Ned just pointed out, that we are building tools of various kinds, and putting them into the same tool box, that we can share.

        Liked by 1 person

  4. The striking thing about the ideas you list is that none of them, at least based on how you describe them, actually involve taking guns away from people. That’s why they’re able to be effective — they don’t face the Constitutional barriers to being enacted, or the cultural barriers to being carried out, that proposals to disarm people would face. Since these ideas have actually reduced violence in some places where they’ve been tried, it seems that attacking the root causes of violence is the correct approach. I hope Biden and Congress will focus on supporting efforts like this — it seems likely, since he strikes me as a pragmatist.

    Liked by 1 person

    1. You’re so right, Infidel. It would be nice if that fact evoked a little encouragement from the opposition. But what I expect to hear is how expensive these programs are. That’s true; it also seems to be the reason they’re effective. And despite the condemnation of violence in the cities, there’s no willingness on the part of Republicans to address it productively.

      I definitely see Biden as a pragmatist. He’s doing this now, knowing there’s no way to get an assault weapons ban at this point.

      Liked by 1 person

      1. But what I expect to hear is how expensive these programs are. That’s true; it also seems to be the reason they’re effective

        Considering the number of lives lost to such violence, the expense is well worthwhile, so long as the programs are effective. We invest enormous amounts of money in medical research to prevent deaths, and rightly so. This is the same principle.

        Liked by 2 people

      2. Absolutely, Infidel. That is the rational approach one would hope is the guiding principle in a civil society. It is clear to me that it underlines the “go big” Biden-Harris proposals. We have real opportunities now if we’re able to muster sufficient public support.

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  5. I love the idea of drafting the shooters who are no longer shooting as educators. It reminded me of the piece you did about winning over white supremacists. Thank you, Annie.

    Liked by 1 person

  6. Hi Annie, Very interesting indeed. Living in Ireland I am less exposed to gun violence, but we read daily about the terrifying increase in deadly incidents in the USA. Did I read that on average 35 deaths’ every day of the year? However in Europe, many places have “knife violence” problems just as difficult as gun related incidents. Strikes me all of the programs and interventions you are highlighting should be equally applicable. But the bottom line here is the correlation between poverty, joblessness and violent crime. And here there is an unimaginably huge problem because our neoliberal politics in western so called democracies has deliberately engineered that. Have you discovered any sources of data that sheds light on correlations?
    Great job! Best Wishes, David

    Liked by 1 person

    1. Thanks, David. Tragically, the statistics appear even worse than the one you cite. According to Everytown for Gun Safety, a prominent organization, the daily average in the US is 100 deaths from gun violence—and 230 wounded. That should be unbearable to us all, and the majority of Americans, including gun owners, do support sensible gun safety legislation.
      Unfortunately, “majority rules” has become a questionable concept among too many elected officials—and their constituents.

      Liked by 1 person

  7. I realize I’m late to this conversation — thanks, Annie, and thanks to your readers. Thanks so much for laying it out so well. Of late Biden has called the mass shootings a “public embarrassment.” Interesting choice of words. I, too, see him as a pragmatist. Let’s see if he can get this done.

    Liked by 1 person

  8. I do think “embarrassment,” if it were used at all, should have been amplified with stronger references to the horror of this distinctly American disaster. But considering how many enormous issues he’s dealing with, I guess that’s a quibble. I know where his head and heart are.

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  9. There is a flawed policy that requires gun owners to have a firearms safety course certificate only if they apply for a hunting license. It would make more sense to require firearms safety training BEFORE the firearms are acquired.

    Liked by 1 person

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