Gun Violence as a Public Health Issue

Gun violence is a public health problem, but we don’t approach it like one. The debate often gets framed as “guns or no guns” when it isn’t that black and white. In this episode we break down how and why to approach gun violence as a public health problem, what the current research has to say, and what we need to move forward.

Former patient kills his surgeon and three others at a Tulsa hospital

https://mailchi.mp/31b9e4f5100d/the-weekly-gist-june-03-2022?e=d1e747d2d8

On Wednesday afternoon, an aggrieved patient shot and killed four people, including his orthopedic surgeon and another doctor, at a Saint Francis Hospital outpatient clinic, before killing himself. The gunman, who blamed his surgeon for ongoing pain after a recent back surgery, reportedly purchased his AR-15-style rifle only hours before the mass shooting, which also injured 10 others. The same day as this horrific attack, an inmate receiving care at Miami Valley Hospital in Dayton, OH shot and killed a security guard, and then himself.

The Gist: On the heels of the horrendous mass shootings in Buffalo and Uvalde, we find ourselves grappling with yet more senseless gun violence. Last week, we called on health system leaders to play a greater role in calling for gun law reforms. This week’s events show they must also ensure that their providers, team members, and patients are safe. 

Of course, that’s a tall order, as hospital campuses are open for public access, and strive to be convenient and welcoming to patients. Most health systems already staff armed security guards or police officers, have a limited number of unlocked entrances, and provide active shooter training for staff.

This week’s events remind us that our healthcare workers are not just on the front lines of dealing with the horrific outcomes of gun violence, but may find themselves in the crosshairs—adding to already rising levels of workplace violence sparked by the pandemic.

Something must change.

Gun violence, the leading cause of death among US children, claims more victims

https://mailchi.mp/d73a73774303/the-weekly-gist-may-27-2022?e=d1e747d2d8

Only 10 days after a racially motivated mass shooting that killed 10 in a Buffalo, NY grocery store, 19 children and two teachers were murdered on Tuesday at an elementary school in Uvalde, TX. The Uvalde shooting was the 27th school shooting, and one of over 212 mass shootings, that have occurred this year alone.

Firearms recently overtook car accidents as the leading cause of childhood deaths in the US, and more than 45,000 Americans die from gun violence each year. 

The Gist: Gun violence is, and has long been, a serious public health crisis in this country. It is both important to remember, yet difficult for some to accept, that many mass shootings are preventable. 

Health systems, as stewards of health in their communities, can play a central role in preventing gun violence at its source, both by bolstering mental health services and advocating for the needed legislative actions—supported by a strong majority of American voters—to stem this public health crisis. 

As Northwell Health CEO Michael Dowling said this week, “Our job is to save lives and prevent people from illness and death. Gun violence is not an issue on the outside—it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is. If you were hesitant about getting involved the day before…May 24 should have changed your perspective. It’s time.”

Guns in Michigan Capitol: Defense of liberty or intimidation?

https://www.csmonitor.com/USA/Politics/2020/0504/Guns-in-Michigan-Capitol-Defense-of-liberty-or-intimidation

Guns in coronavirus protests: Defense of liberty or intimidation ...

WHY WE WROTE THIS

Bringing assault weapons to the Michigan Legislature for a protest against coronavirus restrictions? To one group, it’s why the Second Amendment exists. To many others, it’s unfathomable.

It was a first for Michigan state Sen. Sylvia Santana. Before heading to the statehouse in Lansing last Thursday, she slipped into a bulletproof vest.

Ms. Santana’s husband, a sheriff’s deputy, warned her about potential trouble at a rally to protest the decision to extend a coronavirus lockdown.

A group of armed white men entered the Capitol and shouted at lawmakers. To Ms. Santana, some were dressed like they were “going to war.” Several Confederate flags, a swastika, and a misogynistic sign aimed at Gov. Gretchen Whitmer could be seen outside.

“I thought that was very scary,” says Ms. Santana, an African American who represents parts of Detroit and all of neighboring Dearborn. “We’re there to do a job, and it’s not to dodge bullets as we try to do our jobs in a bipartisan fashion to make sure we’re keeping all Michiganders safe.”

Four days on from the protest, her concern lingers. The pandemic has intensified many societal fault lines – from health care inequities to political polarization – and gun control is no exception. Feeling that state officials are overreaching, a tiny minority of protesters are flexing their Second Amendment rights in Michigan and beyond.

But at a time of crisis, their crusade against the perceived tyranny of government is seen by many as tyrannical in its own right – recklessly using their liberties to intimidate others.

The core question is: Where should the line be drawn? For protesters, guns in statehouses is one of the purest expressions of the power the Second Amendment invests in citizens. But no constitutional right is absolute.

“Where do people who see no problem with guns downtown or near a hospital or in the legislature, where do they draw the line?” Sanford Levinson, co-author of “Fault Lines in the Constitution.” “That’s an interesting question both politically and legally, because courts are really receptive to line drawing. I don’t think you’d find any judge who says, ‘Yeah, I welcome guns in my courtroom.’”

In that way, the struggle over whether to allow firearms in legislatures “is part of the culture war,” he adds.

Are hard-line tactics effective?

Today, 21 state capitols allow guns in some form, according to a Wall Street Journal report. But only a few, including Michigan, allow citizens to openly carry under the rotunda. Many Republican-led states balk at open carry in the people’s hall for personal safety reasons, and courts have upheld bans in places like legislatures and polling places, holding that guns can chill other people’s rights.

Elements of race have long played a role. The modern gun control movement is linked to the signing of the Mulford Act in 1967, which banned open carry in California. The bill gained momentum after two dozen Black Panthers legally brought firearms to the state capitol to protest against it. The National Rifle Association backed the bill.

Incidents like the one in Michigan, however, could do more to damage gun rights than advance them. “It’s really now an open question to what extent hard-line pro-gun policies are politically advantageous,” says Mr. Levinson, also a visiting professor at Harvard Law School in Cambridge, Massachusetts.

Ms. Santana was certainly not persuaded. “I, as a state lawmaker, want to hear your concerns and your position on the issue. But I don’t feel that bringing assault weapons to the capitol and using symbols of hatred will make me understand your issue better.”

The scenes in Michigan, which has been hit hard by COVID-19, only make it harder to have already difficult conversations, others say. Part of self-defense is respecting the preferences other people have for their own security, which might mean leaving guns at home when overtones of intimidation are possible.

“When your eyes look at these pictures of groups of people … in a public building that is supposed to be a center of democratic exchange and debate, and you see a group of people carrying military weapons, that is not a vision of democracy,” says Hannah Friedman, a staff attorney at Giffords Law Center to Prevent Gun Violence in San Francisco. “That’s a vision of intimidation by a minority of people.”

Such concerns were heightened further this weekend, when employees at businesses in Stillwater, Oklahoma, faced a threat of violence with a gun while trying to force customers to wear masks, as mandated by the local government.

“I think we were heard”

But Ashley Phibbs has a different view.

Ms. Phibbs, a project manager and mother who helped organize the Michigan rally, acknowledged with regret that many in attendance didn’t abide by social distancing rules. She also confirmed the display of hate symbols. But she insisted those were agitators and not part of her group, Michigan United for Liberty, which has sprung up to oppose what members see as repressive COVID-19 restrictions.

“I know how it can seem to people who aren’t active in rallies and who are looking at it from the outside in, and I try to be very understanding of that,” says Ms. Phibbs. “But … I don’t think that anyone was there to really make anyone fearful. I didn’t see anything that would have really caused fear, aside from loud noises from the people yelling. But a lot of people are also sometimes afraid of guns in general.”

In the end, she says, “I think we were heard. I think overall [the rally] was positive.”

Knowing your audience

Other gun-rights advocates saw problems with the optics.

As he watched news from Michigan Thursday, Caleb Q. Dyer saw some familiar faces. The New Hampshire barista and former state legislator had been a keynote speaker at a Michigan Libertarian Party event last year.

But he worried that his friends in Michigan were sending “mixed messages” by failing to abide by public health rules.

In fact, he usually brings witty protest gear – such as a sign that says “arm the homeless” – to disarm fear. It’s a fine line, he says, between free speech and armed intimidation.

“People aren’t ready to have the discussion that a lot of these gun-carrying protesters want to have, which is that none of these laws are even remotely effective or just,” says Mr. Dyer. “But they’re not going to have that discussion if they cannot carry themselves in such a way that the opposition won’t think … that they’re murderous and violent.”

 

 

 

 

 

The Presidential Campaign, Policy Issues and the Public

https://news.gallup.com/opinion/polling-matters/269717/presidential-campaign-policy-issues-public.aspx

The Presidential Campaign, Policy Issues and the Public

The U.S. presidential campaign is ultimately a connection between candidates and the people of the country, but the development of the candidates’ policies and positions is largely asymmetric. Candidates develop and announce “plans” and policy positions that reflect their (the candidates’) philosophical underpinnings and (presumably) deep thinking. The people then get to react and make their views known through polling and, ultimately, through voting.

Candidates by definition assume they have unique wisdom and are unusually qualified to determine what the government should do if they are elected (otherwise, they wouldn’t be running). That may be so, but the people of the country also have collective wisdom and on-the-ground qualifications to figure out what government should be doing. That makes it useful to focus on what the people are telling us, rather than focusing exclusively on the candidates’ pronouncements. I’m biased, because I spend most of my time studying the public’s opinions rather than what the candidates are saying. But hopefully most of us would agree that it is worthwhile to get the public’s views of what they want from their government squarely into the mix of our election-year discourse.

So here are four areas where my review of public opinion indicates the American public has clear direction for its elected officials.

1. Fixing Government Itself.

I’ve written about this more than any other topic this year. The data are clear that the American people are in general disgusted (even more than usual) with the way their government is working and perceive that government and elected leaders constitute the most important problem facing the nation today.

The people themselves may be faulted here because they are the ones who give cable news channels high ratings for hyperpartisan programming, keep ideological radio talk shows alive, click on emotionally charged partisan blogs, and vote in primaries for hyperpartisan candidates. But regardless of the people’s own complicity in the problem, there isn’t much doubt that the government’s legitimacy in the eyes of the people is now at a critically negative stage.

“Fixing government” is a big, complex proposition, of course, but we do have some direction from the people. While Americans may agree that debate and differences are part of our political system, there has historically been widespread agreement on the need for elected representatives to do more compromising. Additionally, Americans favor term limitsrestricting the amount of money candidates can spend in campaigns and shifting to a 100% federally funded campaign system. (Pew Research polling shows that most Americans say big donors have inordinate influence based on their contributions, and a January Gallup poll found that only 20% of Americans were satisfied with the nation’s campaign finance laws.) Americans say a third major party is needed to help remedy the inadequate job that the two major parties are doing of representing the people of the country. Available polling shows that Americans favor the Supreme Court’s putting limits on partisan gerrymandering.

Additionally, a majority of Americans favor abolishing the Electoral College by amending the Constitution to dictate that the candidate who gets the most popular votes be declared the winner of the presidential election (even though Americans who identify as Republicans have become less interested in this proposition in recent years because the Republican candidate has lost the popular vote but has won in the Electoral College in two of the past five elections).

 

2. Fix the Backbone of the Nation by Initiating a Massive Government Infrastructure Program.

I have written about this at some length. The public wants its government to initiate massive programs to fix the nation’s infrastructure. Leaders of both parties agree, but nothing gets done. The failure of the Congress and the president to agree on infrastructure legislation is a major indictment of the efficacy of our current system of representative government.

 

3. Pass More Legislation Relating Directly to Jobs.

Jobs are the key to economic wellbeing for most pre-retirement-age Americans. Unemployment is now at or near record lows, to be sure, but there are changes afoot. Most Americans say artificial intelligence will eliminate more jobs than it creates. The sustainability of jobs with reasonably high pay in an era when unionized jobs are declining and contract “gig” jobs are increasing is problematic. Our Gallup data over the years show clear majority approval for a number of ideas focused on jobs: providing tax incentives for companies to teach workers to acquire new skills; initiating new federal programs to increase U.S. manufacturing jobs; creating new tax incentives for small businesses and entrepreneurs who start new businesses; providing $5.5 billion in federal monies for job training programs that would create 1 million jobs for disadvantaged young Americans; and providing tax credits and incentives for companies that hire the long-term unemployed.

My read of the data is that the public generally will support almost any government effort to increase the availability of high-paying, permanent jobs.

 

4. Pass Legislation Dealing With All Aspects of Immigration.

Americans rate immigration as one of the top problems facing the nation today. The majority of Americans favor their elected representatives taking action that deals with all aspects of the situation — the regulation of who gets to come into the country in the first place and the issue of dealing with individuals who are already in the country illegally. As I summarized in a review of the data earlier this year: “Americans overwhelmingly favor protecting the border, although with skepticism about the need for new border walls. Americans also overwhelmingly favor approaches for allowing undocumented immigrants already living in the U.S. to stay here.”

Recent surveys by Pew Research also reinforce the view that Americans have multiple goals for their elected representatives when it comes to immigration: border security, dealing with immigrants already in the country, and taking in refugees affected by war and violence.

 

More Direction From the People

What else do the people want their elected representatives to do? The answer can be extremely involved (and complex), but there are several additional areas I can highlight where the data show clear majority support for government policy actions.

 

Americans See Healthcare and Education as Important but Don’t Have a Clear Mandate

There are two areas of life to which the public attaches high importance, but about which there is no clear agreement on what the government should be doing. One is healthcare, an issue that consistently appears near the top of the list of most important problems facing the nation, and obviously an issue of great concern to presidential candidates. But, as I recently summarized, “Healthcare is clearly a complex and often mysterious part of most Americans’ lives, and public opinion on the issue reflects this underlying messiness and complexity. Americans have mixed views about almost all aspects of the healthcare system and clearly have not yet come to a firm collective judgment on suggested reforms.”

Education is another high priority for Americans, but one where the federal government’s role in the eyes of the public isn’t totally clear. Both the American people and school superintendents agree on the critical importance of teachers, so I presume the public would welcome efforts by the federal government to make the teaching profession more attractive and more rewarding. Americans also most likely recognize that education is a key to the future of the job market in a time of growing transition from manual labor to knowledge work. But the failure of the federal government’s massive effort to get involved in education with the No Child Left Behind legislation underscores the complexities of exactly what the federal government should or should not be doing in education, historically a locally controlled part of our American society.