A Public Health Approach to Reducing and Preventing Firearm Violence

April 03, 2023 | Caitlin Langhorne, Tanya Baker

ASTHO comes to our health agencies and partners saddened by our country's recent mass shooting. We mourn the losses of life from firearm violence as our families, schools, and communities continue to be impacted. ASTHO supports you now more than ever. The epidemic of firearm-related injury and death in the United States has become a critical public health and safety concern that affects everyone.

The Gun Violence Archive (GVA) highlights back-to-back—and record-setting—years of mass shootings in 2021 and 2022. Continuing on a steep upward trend this year, the GVA already counted 1,249 firearm deaths across the United States from March 1 - 28. Combined firearm-related deaths nationally reached a record high in 2020, with more than 45,000 intentional and unintentional deaths. Of those deaths, 54% were from suicide, 43% from homicide, and 3% were unintentional. In 2020, firearms were the leading cause of death in children ages 1-19, exceeding motor vehicles and other accident-related injuries and congenital diseases.

The economic and psychological impact of surviving firearm-related violence and accidents affects victims, their families, and society. Of more than 80,000 survivors each year, some may physically recover quickly, while others face a lifetime of treatment for physical and mental health conditions. Families of survivors of firearm-related injury, suicide, and homicide can also endure lasting mental and behavioral health effects.

Youth who survive, witness or who have caregivers and/or family members who are victims of firearm violence—widely considered to be adverse childhood experiences (ACEs)—are at greater risk for future engagement in self-harm and aggressive behavior toward others. This, in turn, perpetuates cycles of negative societal outcomes such as greater concentrations of community violence, justice involvement, poverty, reduced quality of life, limited access to care, and other contributors of inequities seen in a higher degree of severity in some communities than others.

To reverse and prevent negative outcomes in their communities, health agencies and their partners must understand and address the root causes of violence and risk and protective factors that intersect multiple forms of violence. The public health approach to firearm injury and violence prevention involves a collective, multi-sectoral, cross-collaborative effort that leverages equitable data to influence and inform violence-reduction policies and strategies. The public health approach to firearm violence prevention also relies on science to identify and test effective solutions to build safer communities, especially where children and families are disproportionately affected by historical trauma and systemic racism.

How States Are Preventing Firearm Injury and Violence

With support from federally funded Injury and Violence Prevention Programs, health agencies are protecting the public's health and aiming to improve outcomes by addressing all forms of violence, including firearm violence. Upstream approaches such as integrating health equity to address root causes of violence and embedding a shared risk and protective factor approach into prevention programming are helping to mitigate intergenerational cycles of community violence stemming from systemic racism and historical trauma.

Implementing effective violence reduction strategies also helps advance a multidisciplinary approach through community-wide partnerships and supported by health agencies. Safe storage, reducing access to lethal means, and recognizing warning signs of persons at risk for using firearms for suicide and other violent acts are all examples of strategies currently being implemented as part of a spectrum of solutions.

States are increasingly recognizing firearm violence as a public health issue, and some have established special offices to bridge gaps in firearm violence prevention efforts and scaffold organizations that operate via limited resources and volunteerism (e.g., grassroots and faith-based organizations). Some states with dedicated workforces and resources to address firearm injury and violence prevention as a statewide priority include California, Colorado, Illinois, Oregon, and Washington. These state programs emphasize broad collaboration among public and private sectors to increase community capacity, address root causes of violence, provide access to evidence-based and trauma-informed services to those most at-risk, and advance equity and racial justice.

Colorado’s Office of Gun Violence Prevention supports organizations committed to preventing gun violence and accidental injury. Community organizations receive mini-grants that may develop into longer-term funding to support education, training, and community programs on topics ranging from safe gun ownership practices to resources on mental health and behavioral health-related issues such as substance use. This allows for short-term capacity-building, which positions these organizations for future, more sustainable long-term funding.

Oregon’s Injury and Violence Prevention section of the Public Health Division aims to prevent firearm violence by collecting and tracking data and collaborating with partners. Through the Firearm Injury Surveillance Through Emergency Rooms (FASTER) grant, Oregon focuses efforts on youth and adult suicide prevention related to safe storage. In addition, their section got a new community violence prevention coordinator position and funding to expand hospital-based violence prevention programs during the 2022 legislative session.

Although Oregon doesn’t have a dedicated office at this time, they oversee their state’s firearm violence prevention work by providing leadership and combining various funding opportunities. Finally, they coordinate closely with academic and community partners, specifically Portland Opportunities Industrialization Center and the Oregon Health & Science University Violence Prevention Research Center.

Laura Chisholm, Oregon Health Authority Injury & Violence Prevention Section Manager, explains the important role the health agency plays: "In Oregon, we're working to maximize resources across programs and funders to support the important work of firearm injury prevention through the dual lenses of suicide prevention and community violence prevention. We are funding community-based and academic partners to convene a broad array of interested parties, and we are able to bring new data sources to the table. The vision is a comprehensive approach to prevention that addresses the immediate crisis while taking the long view to support protective factors like community greening, social cohesion and resilience. Although a focus on firearm injury is newer to state level public health due to historic funding limitations, there is no shortage of willing partners who can help us learn from communities how to best move forward together."

What’s Next?

Robust efforts are underway to influence and broaden a network of diverse partners (e.g., gun owners, veterans, communities impacted by firearm injury, healthcare professionals, justice system staff, educators, researchers, philanthropists, and grassroots community organizers) working collectively to identify the most effective violence-reduction strategies and create roadmaps for future policy development and action planning.

ASTHO joins these important initiatives by equipping health officials and their agencies with resources as they build the capacity to address firearm injury in their jurisdiction. In 2022, ASTHO established the Catalyst Center for Firearm Injury Prevention, which facilitates and strengthens cross-jurisdictional learning and collaboration about firearm injury prevention and developing strategies to address suicide, community violence, and accidental firearm injuries.

Through health agency engagement, ASTHO will curate resources and tools that reflect a wide range of perspectives necessary for addressing firearm injury and violence in all states, territories, and freely associated states. ASTHO recognizes and is committed to engaging public health leaders and their communities to identify a spectrum of approaches that prevent firearm suicide and violence most appropriately as it relates to meeting the unique needs of their jurisdiction.

Long-term firearm violence reduction in every community is attainable through more equitable and targeted research and investment, implementation of comprehensive cross-disciplinary violence-reduction strategies, and strengthening public trust.

ASTHO's Catalyst Center will provide health agency leadership and their staff, partners, and communities with:

• Meetings to learn from leading firearm injury prevention researchers.
• Peer-to-peer networking to strategize on how current community resilience building, health equity, and shared risk and protective work can, directly and indirectly, prevent firearm injuries.
• Resources on effective communication strategies and a public health roadmap to addressing and preventing firearm injury.

ASTHO thanks the Colorado Department of Health and Environment and the Oregon Health Authority for informing this publication.