Our health officer, Dr. Jeff Duchin, recently wrote a Seattle Times op-ed demanding more national and local effort to address gun violence. He wrote the article following the devastating mass shooting in Orlando, but gun violence is much more than mass shootings – it includes suicides, homicides, assaults and unintentional deaths that involve a firearm – which occur throughout our country and community in single incidents or small groupings, every day of the year.  Each of these types of gun violence occurs at its own unique intersection of risk factors, and in public health, we work to minimize risk factors to prevent disease and injury.

Traffic fatalities: a public health approach
But, despite what seemed like a daunting task, we’ve successfully mitigated deaths of another kind – traffic fatalities. First, the public health and public safety community looked at data to figure out what those risk factors were. We asked: Who died? Where did they die? How did they die? Was there anything that could have prevented the fatality? The answers to those questions allowed public health partners to develop multi-disciplinary strategies like the Click It or Ticket campaign, airbag and seat belt mandates, and car seat installation as a pre-requisite for taking a newborn home from the hospital. As you can guess, these strategies involved cooperation from public health agencies, law enforcement, healthcare providers, and car manufacturers.  And, ten years later, our traffic fatalities nationally have been reduced by 25 percent.

Now, we are trying to do the same for gun violence.
When it comes to gun violence, we’ve asked (and we need to ask more): Who died or was injured? Where did they die or where were they hurt? How did they die or how were they hurt?  What were the circumstances surrounding their injury or death that could have been prevented?  While many gaps in these initial questions remain, we know that, in King County:

• Firearm deaths among adults in our county are primarily suicides, with men at highest risk
• Firearm youth deaths are primarily homicide, and some communities bear a greater burden
• Despite these unique burdens that are different between youth and adults, far too many kids are also losing their lives from firearm suicides, and far too many young adults are dying in homicides
• Domestic violence is a risk factor for suicide, homicide and homicide-suicide
• In King County, approximately one quarter of households own firearms, and over half of those (approximately 64,000 households) report storing at least one unlocked firearm , a known risk according to research

And, in Washington, we know that in 2014, nearly $4 million worth of firearms were reported stolen to law enforcement agencies.

These are just a few of the risk factors that we can work to mitigate.

 

 

 

 

 

 

The next step is to think about solutions. In public health, we often use what is called the socio-ecological model to help frame our approach. The socio-ecological model acknowledges the dynamic interaction of individual, relationship, community, and societal factors in producing health and well-being. Our goal is to make sure we address a public health problem at each of the appropriate levels in the model.

LOK-IT-UP: A socio-ecological case study
What does this look like in real life? One example of work we are doing that aims to interact with appropriate levels of the socio-ecological model is a unique program promoting the safe storage of guns called LOK-IT-UP. This is an example of one risk factor – unsafely stored firearms – that plays a role in some homicides, suicides, and unintentional deaths.

Let’s take a look at LOK-IT-UP.

• Individual
  • At the individual level, the LOK-IT-UP campaign asks all gun-owners to take it upon themselves to know why it’s important to store their firearms safely and to take action to do so. The campaign provides incentives through giving individuals a discount on safe storage devices from participating retailers.
• Relationship
  • In the socio-ecological model, the relationship component is designed to address how interpersonal relationships can be a predictor of health outcomes. LOK-IT-UP partners with staff in law enforcement agencies so that they can provide a brief educational intervention to those who already own firearms when individuals are getting or renewing their Concealed Pistol License (CPL) (required in WA for personal carry of firearms), and encourage them to purchase and use safe storage devices, like a safe or lockbox.
• Community
  • Schools, workplaces and neighborhoods all contribute to how likely it is that a person will become a victim or perpetrator of gun violence. LOK-IT-UP promotes safe gun storage at the community level through billboard campaigns and education, such as social media posts. LOK-IT-UP encourages community partnerships, and seeks to build relationships between gun retailers and public health by promoting participating LOK-IT-UP retailers on the Public Health website. One community partnership that was recently co-launched, the new statewide Gun Tragedy Prevention Network, will  share information and resources about ‘what works’ related to preventing gun tragedies, including how to better promote safe storage. , we hope to equip those who interact with individuals at risk of suicide with the tools they need to reduce access to lethal means (firearms).
• Societal
  • Societal factors like economic and social policy, cultural attitudes and beliefs, and inequality between different groups within society can all contribute to an environment where gun violence can breed. Understanding which and what combinations of policies need to be in place to reduce gun fatalities and injuries is only just beginning.  For instance, only 11 states have laws regarding the safe storage of firearms, Washington is not yet on that list. Massachusetts is the only state that requires all firearms to be locked in place. Population health research can also help us to understand how attitudes around protective factors such as safe storage are changing, as well as general public awareness around particular risk factors for different types of gun .

The socio-ecological model lays a roadmap for public health approaches by the community. Yet, it acknowledges that as a local public health department, we have a unique and mission-driven role to continue to dig deeper, work harder, and look further for solutions to the persistent public health crisis that is so clearly before us.

We will continue to seek more comprehensive data to better evaluate potential prevention strategies, and encourage Congress to lift the ban on research into interventions at each of the target levels of the socio-ecological model. Addressing gun violence is a foundational service that all health departments should provide. With community collaboration and support, we can continue to break-down prevention into stronger evidence of what works, one step at a time.