Like smoking and seat belts, gun violence in America is becoming an urgent public health mission.
Healthcare providers have helped convince smokers to quit and drivers to buckle up. "Now they're saying, `Why can't we do the same thing with guns?"' said Gwen Fitzgerald, a spokeswoman for the Center to Prevent Handgun Violence in Washington.
From California to the nation's capital, nurses, physicians and hospital administrators are launching gun-injury prevention efforts, organizing gun buy-back programs and spreading the gospel of gun control.
As president of Denver's Children's Hospital, Lua Blankenship brought the issue of gun violence to his board's attention. He saw kids getting injured or killed and coming to the emergency room, and he believed it was part of the hospital's mission to respond.
Guns aren't the problem, "It's the fact that kids use them," he said. Hospital chief executives "ought to be involved in issues impacting their community, and violence is one of them."
Others are even more emphatic. "Probably the most pressing domestic issue facing us today is violence; it's not healthcare reform," said James A. Surrell, M.D., immediate past president of the Kent County (Mich.) Medical Society and a colorectal surgeon in Grand Rapids, Mich.
Dr. Surrell said he's fed up with gun violence and is planning to start a grass-roots coalition called BANG-"ban all nonsense guns." He wants lawmakers to ban assault weapons and handguns but protect the rights of hunters to own rifles and shotguns.
But some healthcare providers fear that such efforts will impinge on the rights of gun collectors, hunters and law-abiding citizens.
Kids have no business having guns, but "don't just put (gun owners) all in one category," said Delbert Fuller, an X-ray technologist at Kanabec Hospital in Mora, Minn. He'd like to see healthcare providers and lawmakers work with the National Rifle Association, which teaches gun safety. Existing laws against gun violence also need to be enforced, he said.
The anti-gun-violence movement within the healthcare community is in its infancy but growing rapidly. Washington-based lobbies dedicated to the cause are actively recruiting healthcare providers and helping them produce educational campaigns.
"After the police, the healthcare community will be the second biggest group to make a difference," said Joshua Horwitz, executive director of the Educational Fund to End Handgun Violence, a Washington-based gun-control group. "I'm very eager to get them involved. They bring legitimacy; they're seeing these patients (who are gunshot victims)," Mr. Horwitz said.
Touched off by the recent slaying of six passengers on a Long Island, N.Y., commuter train, the murder of 12-year-old Polly Klaas, kidnapped from her home in California, and Florida's bloody rash of carjackings, gun-control fervor has reached fever pitch (See related story, page 36).
State legislatures are expected to act on a flurry of gun-control bills this year. Governors in a handful of states, including Colorado's Roy Romer, called special sessions last year to consider anti-violence measures. Colorado's Legislature enacted a package of bills intended to curb teen-age violence, including one measure that would prohibit kids younger than 18 from possessing handguns.
Because of heightened state activity, the Intergovernmental Health Policy Project has started tracking gun-control and anti-violence bills this legislative session, said Dick Merritt, director the Washington-based research organization. An estimated 75 bills have been introduced in 25 state legislatures.
Mr. Merritt said violence has become a health policy issue because it's a major contributor to the cost of healthcare.
An estimated $1 billion is spent annually for hospital treatment of gunshot wounds, said Katherine Kaufer Christoffel, M.D., an attending physician at Children's Memorial Medical Center in Chicago and a leader in the anti-gun-violence movement.
In a study released last month by the University of California, San Francisco, the cost of firearms-related injuries in the United States was estimated to exceed $20 billion a year. That includes $1.4 billion in medical costs, $1.6 billion in lost productivity resulting from firearms-caused disabilities, and $17.4 billion in lost productivity from premature deaths, researchers said.
Firearm injuries are second only to motor vehicle crashes as the leading cause of injury death, the report said. Study results appear in the winter issue of the health policy journal Health Affairs. The 264-page issue is devoted entirely to the subject of violence.
To build momentum for passage of tougher laws, new grass-roots lobbying groups are cropping up nationwide.
Dr. Christoffel of Chicago's Children's Memorial recently founded a new organization aiming to change society's attitude toward guns. Nearly 100 organizations representing healthcare professionals, child advocates and policymakers attended the first meeting in October of the HELP Network of Concerned Professionals. HELP stands for Handgun Epidemic Lowering Plan, and describes the network's mission.
Another group, Physicians for a Violence-Free Society, held its first national conference in San Francisco this month. The group's mission is to bring together a coalition of physicians, healthcare providers and concerned citizens who will be leaders in violence prevention, raise public awareness and support the medical professionals who take care of violence victims, said Ellen Taliaferro, M.D., an associate professor of surgery at University of Texas Southwestern Medical Center, Dallas, and director of health policy and violence prevention at Parkland Memorial Hospital in Dallas.
Dr. Taliaferro, who serves as PVFS's executive director, founded the organization with Patricia Salber, M.D., an assistant professor of medicine at the University of California, San Francisco, who practices emergency medicine at Kaiser Foundation Hospital in South San Francisco. As emergency physicians, much of their professional work already involved violence intervention: Dr. Salber in domestic violence, and Dr. Taliaferro in elder abandonment.
The organization opposes gun violence and voted last week to support a total ban on assault weapons and handguns. "I, myself, being raised in NRA territory... believe we've got to regulate (guns)," Dr. Taliaferro said. "However we treat cars (is the way) we should treat guns," she said.
Getting more guns off the streets is one way the healthcare community hopes to reduce the national death toll.
With that goal in mind, Denver's Children's Hospital and the Denver Nuggets basketball team developed the nation's first guns-for-tickets exchange program last April. Under the program, kids can trade in their guns for Nuggets tickets and Adidas shoes. As part of the deal, Children's paid an undisclosed corporate sponsor fee to the Nuggets, which airs the hospital's anti-violence public service announcements during each televised game.
Susan Cohig, director of corporate sales and services for the Nuggets, said 52 guns were turned in last season; this season, 376 guns have been traded for tickets and shoes. Many other cities have implemented similar goods-for-guns programs.
In Paterson, N.J., St. Joseph's Foundation, the funding arm of St. Joseph's Hospital and Medical Center, initiated a similar program with the help of the local chamber of commerce. With enthusiastic support from the mayor, police chief and hospital administrators, the foundation recently provided $2,000 to launch the guns-for-goods program, and the chamber of commerce raised another $40,000 from other businesses. In six weeks of operation, 150 weapons have been turned in.
Children's Medical Center of Dallas has spent nearly $10,000 on publicity of guns-for-tickets, a program started last December with the Dallas Police Department and the Dallas Cowboys. A 30-second public service announcement features defensive tackle Tony Casillas warning about the dangers of guns. Children's program encourages people to exchange guns for tickets to this year's preseason games.
Unlike some other programs, participants must give their names and addresses and verify their ownership of the guns. Serial numbers are recorded and traced to determine if the weapons have been used in crimes.
Teaching physicians and parents about the danger of guns is another violence-prevention tactic.
The Center to Prevent Handgun Violence, the not-for-profit education and research arm of Handgun Control, a Washington-based organization chaired by Sarah Brady, is working with the American Academy of Pediatrics, Elk Grove Village, Ill., to help teach parents the potential dangers of having a gun at home. The groups say that when a gun is kept in the home, it's more likely to be used to kill a family member or friend than a criminal intruder.
Ms. Brady's husband, Jim, served as President Reagan's press secretary and is permanently disabled as a result of gunshot wounds sustained in the 1981 assassination attempt on the president. He is the namesake of a new federal law mandating a five-day waiting period on handgun sales.
As part of an education program tested last spring, Ms. Brady's group and the pediatrics academy are distributing an instructive audiotape to pediatricians featuring advice from C. Everett Koop, M.D., the former U.S. surgeon general, and other physician leaders. An American Academy of Pediatrics study recently found that one of every six pediatricians has treated a child for a gun-related injury.
Dr. Koop says physicians should tell parents to keep guns out of places where children live, play or visit, to keep guns unloaded and locked up, and to store bullets in a separate place. Children should be warned not to touch guns, he says.
The Washington-based Educational Fund to End Handgun Violence is organizing a public education campaign set to begin this spring in cooperation with Boston-area healthcare providers and injury-prevention groups. The campaign, called Hands Without Guns, aims to reduce the social acceptability of gun ownership. A series of television spots will target young people and parents. The group will seek grants to fund the campaign.
Most victims of gun violence know their attackers, and the availability of guns makes intentional violence more likely, said Robert Sege, M.D., an assistant professor of pediatrics at Tufts University School of Medicine and a member of the division of pediatrics at New England Medical Center, a participant in the Boston project. "That's why gun control will work and that's why gun ownership isn't a good idea," he said.
New England Medical Center also is recruiting physicians to get involved in an effort to lobby for gun-control legislation. Two weeks ago, Gov. William Weld, a Republican, reintroduced legislation he proposed last year to crack down on gun trafficking and violent crime. The package calls for banning military-style assault weapons and imposing mandatory jail terms for certain gun-related crimes.
Many healthcare providers are dealing with the issue of violence more broadly. For example, Harvard Community Health Plan, the Brookline, Mass.-based HMO, teaches physicians to recognize the symptoms of injuries resulting from any kind of violent behavior and to counsel parents on preventing such injuries.
When the Injury Prevention Project started three years ago, "providers looked at us like we were crazy," said Cary Perry, the project's coordinator. Since then, attitudes have changed; the general mood of the country has helped as well, she said.
As part of the project, physicians are talking to parents about the dangers of keeping guns at home.
According to the National Center for Health Statistics, 14 children ages 19 and younger are killed every day in this country in gun accidents, suicides and homicides.
But the epidemic runs much deeper, gun-ban advocates said. In New York's Time Square, a new billboard ticks off the number of gun deaths in America: one every 14 minutes.
Paul H. Blackman, the National Rifle Association's research coordinator, disputes claims that gun violence has reached epidemic proportions. Studies in the nation's top medical journals skew the picture by using numbers instead of rates, distorting data and ignoring relevant statistics, he said. He accused reviewers of having an anti-gun bias. "There's no peer review of the peer review," he said.
For the most part, gun violence has declined and gun ownership has remained stable, Mr. Blackman said. According to an NRA fact sheet, the rate of accidental firearm fatalities as a percentage of the population hasdecreased more than 85% since the turn of the century, making the current death rate of 0.5 per 100,000 the lowest in history. The one exception is inner-city minority youths, for whom the incidence of homicide and other violent crimes rose dramatically during the 1980s, he said.
In the NRA's view, there are two viable solutions to gun violence: mandatory penalties for using guns to commit violent crimes or drug trafficking offenses, and societal fixes for the problems of the ghetto, Mr. Blackman said.
Healthcare providers agree with those measures, but they want much more to be done.
While the medical community has helped many people stop smoking and start wearing seat belts, no one really knows if it can achieve the same level of success with guns.
"My guess is that the (American Medical Association) lobbyist working on Capitol Hill has more important things to do," said the NRA's Mr. Blackman. Medical groups may have difficulty convincing members to lobby for legislative remedies, he said. Mr. Blackman cited research showing that physician gun ownership rises with education and income.
Backed by gun-control groups, the healthcare community is "working very hard, and they're being fairly successful very easily," he admitted.
Dr. Taliaferro, a native Nebraskan who grew up hunting, sees both sides of the gun debate. Among responsible citizens, "the gun is seen as an institution of hunting or personal protection," she said. On the other hand, "if you view the bullet as a pathogen, then I think it would be foolish not to get involved (in gun control)," she said. "I think the healthcare community can be effective."
What if the healthcare community fails?
"Well, I think we have to try," said Dr. Surrell, the Grand Rapids, Mich., surgeon. "I think we absolutely have to try."
Ms. Pallarito is New York bureau chief. She was among a group of Brooklyn restaurant patrons robbed at gunpoint during the dinner hour Dec. 23, 1993. A shot was fired and a cook was pistol-whipped during the holdup, which netted the thieves about $1,400.