Firearm safety is a critical public health issue in the United States. More than 38,000 people in the U.S. die each year as a result of firearm violence, and many more are injured. Recent data suggest the cost of initial hospitalizations for firearm-related injuries averages $734.6 million per year. Firearm-related injuries are among the top five causes of death for people under 65 in the U.S., and the second-leading cause of death in children, closely behind motor vehicle crashes. The toll of firearm injury and death is disproportionately borne by younger individuals and is strongly associated with place of residence, race and ethnicity, and level of education.
Baylor College of Medicine, like numerous leading professional and public health organizations, supports a public health approach to instituting standards of firearm safety. In our own work, we have advanced this commitment through strategies like educating patients on safe storage practices, providing and investing in violence-prevention programs, working with our hospital affiliates to provide trauma services and follow-up care for victims of firearm violence, and providing ethical analysis to support policymaking and public dialogue on effective solutions to reduce firearm-related injury and death.
Baylor College of Medicine is not taking a position on the right to gun ownership; rather we are taking a stance on firearm safety as an important public health topic. The key elements of our position on improving firearm safety include the following:
- Government and privately funded public health research is critical to reduce firearm-related injury and deaths. Government (state and federal) and privately-funded public health research has played a key role in reducing injury, illness and death related to numerous public health challenges, including motor vehicle crashes, tobacco and infectious disease. Similar investment is urgently needed to understand the causes of firearm-related injury and death, strategies that effectively promote firearm safety, and ultimately to develop appropriate solutions to prevent future injury and death. For the first time in over two decades, U.S. lawmakers recently passed a $25 million government spending bill for the Centers for Disease Control and Prevention and National Institutes of Health to conduct gun violence research. Baylor College of Medicine strongly supports these efforts and the need for continued and significant funding to advance research in this crucial space.
- More investment in school and community-based prevention and intervention programs is needed. We applaud states and cities, such as California, Texas, New York City and Philadelphia, that have sought to find community-based solutions to prevent firearm-related injury and death. Given the disproportionate toll of firearm-related injuries and death among our youth, we support providing on-site services with school and community-based health centers and similar service models. This type of initiative should be part of a broader effort to support students’ health and promote social problem-solving skills through diverse, culturally-appropriate programing to address bullying, violence, trauma and other social and emotional issues and help create a culture of inclusion.
- Safe and secure storage practices are essential to reducing the risk of firearm injury and death. Ensuring firearms are stored safely and securely is critically important to preventing both unintentional and intentional injuries, particularly in homes with children, adolescents and individuals with dementia or substance use disorders. In several states, failure to securely store firearms could have legal ramifications. For example, in Texas it is a Class C misdemeanor to make a firearm accessible to a child and can be enhanced to a Class A misdemeanor if the child discharges the firearm and causes death or serious bodily injury to themselves or another person. More efforts to ensure responsible storage can help enhance compliance with the law and ultimately reduce the number of injuries and deaths. We also support the use of extreme risk protection orders (ERPO) or “red flag” laws that allow state officials to seek a court order to temporarily seize firearms from an individual exhibiting dangerous behavior.
- We support efforts to identify innovative technological approaches to advance firearm safety. While specialized firearm trigger locks and safes have been developed and public support exists for their use, there has been little uptake of these “smart firearm” technologies. We support greater research into these and other technological strategies to prevent firearm misuse, including unintentional shootings and self-harm.
- Physicians must be trained and enabled to counsel patients on firearm safety. Physicians have a critical role in advising patients on a range of health issues and have an ethical obligation to protect their patients from harm. Physicians routinely counsel patients on injury prevention, from use of infant car seats to prevention of childhood drownings to tobacco use. Healthcare professional counseling has been shown to increase safer storage of firearms. The majority of clinicians feel that firearm injury prevention counseling is within their professional responsibilities. However, most do not counsel their patients, citing the barriers of limited training and lack of time. Most patients also are receptive to learning about firearm injury reduction strategies and counseling from their clinicians. In this context, we support broad educational efforts to train students, residents, fellows and practicing clinicians on how to counsel patients on firearm safety in a culturally competent manner and adequate reimbursement for such services as part of regular patient care.
- We oppose laws that forbid physicians from discussing firearm ownership and safety practices. We believe health professionals should be trained to recognize and respond to at-risk individuals and call for more investment in hospital-based intervention programs, such as those at the Trauma and Grief Center at Texas Children’s Hospital, where our faculty are training pediatricians in the community and pediatric trainees to provide safe firearm storage counseling in order to decrease unintentional deaths and suicides within our community. We have also trained hundreds of school-based clinicians across the greater Houston community in evidence-based, school-based interventions for traumatized and grieving youth exposed to community violence.
Baylor College of Medicine is committed to preventing future injury and death caused by firearms. Our faculty have spoken out about the need for research, explored trends in firearm mortality, reviewed teaching techniques and existing surrender laws, presented on opportunities for injury prevention, and participated in local and national efforts to discuss and provide recommendations. Through our Baylor Community Programs we provide group experiential education aimed at decreasing juvenile crime, and we provide individual counseling and therapy, including addressing the trauma-related needs of those exposed to violence through our Baylor Teen Health Clinic, Menninger Clinic, Trauma and Grief Center, Harris Health, and others. Our Office of Community Engagement & Health Equity seeks to foster a culture of inclusion through programing, resources and training, and our Center of Excellence in Health Equity, Training and Research focuses on innovative approaches to reduce or eliminate health disparities.
We believe protecting this nation’s most precious natural resource, its people, needs to be a top priority. As a premiere health sciences university, we have a responsibility to create scalable solutions and build meaningful collaborations that help keep our communities safe. Our hope is that in addition to the education, research and care we provide every day, we can shine a light on this topic and play a part in making a positive impact that ultimately saves lives.
Contributors: Stephanie Morain, Clarice Jacobson, Joslyn Fisher, Alison Haddock, Toi Harris, Cedric Dark, Robert Levine, John Coverdale, Michael Coburn, Mary Brandt, Bindi Jayendra Naik-Mathuria, Asim Shah, Ruth Buzi, Julie Kaplow, Kimberly Lopez and Amy McGuire on behalf of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.