Gun violence survivors and witnesses could face lifetime of trauma and bad health

Chicago has been pummeled with near constant gun violence this year. An estimated 3,600 shootings have taken place, on average—that's about 10 shootings a day.

During the recent Halloween weekend alone, 17 people died and 41 were wounded.

And while politicians and policy makers struggle to find ways to create policies to address America's violence, another related crisis is slowing growing.

Most of the shootings are concentrated in impoverished communities. The virtual war zones are home to people who suffer from poor health and lower rates of insurance coverage, leaving them at a disadvantage when they are injured, either physically or tangentially, by gun violence. And oftentimes, the most vulnerable victims are young people who have a lifetime ahead.

“If you grow up in a world where you're not feeling safe, then you feel as though you're under attack whether or not you actually are,” said Dr. David Soglin, chief medical officer at La Rabida Children's Hospital, an acute-care pediatric center on Chicago's South Side that specializes in treating children who have been victims of abuse and trauma. “For some kids in our communities, they really are under attack.”

The trauma surrounding exposure to gun violence is not disputed, especially among children. In 1995, the Centers of Disease Control and Prevention reported that children who had four or more adverse childhood experiences, such as experiencing or witnessing a shooting, were more likely to smoke, drink, abuse drugs and engage in unsafe sex. Those behaviors often lead to chronic conditions such as cancer, heart disease, stroke, liver disease, diabetes and sexually transmitted diseases.

The growing number of people who survive living in the country's most violent neighborhoods is causing public health officials to respond by creating comprehensive violence prevention efforts.

The reasons for their involvement are clear. Young people with six or more adverse childhood experiences have an average lifespan that is 20 years shorter than children not exposed to violence. In 2010, the CDC reported that an average of 13 young people ages 10 to 24 are killed every day, with 82.8% of those deaths caused by guns.

Charles Ransford, senior director of science and policy with Cure Violence is one of the experts addressing the issue. His organization, originally known as CeaseFire, started in 2000 in the Chicago neighborhood of West Garfield Park, which has consistently had one of the city's highest murder rates.

Ransford said prevention efforts are key since violence spreads like a virus.

Cure Violence, based at the University of Illinois at Chicago School of Public Health, has since expanded to several cities in the U.S. and has been replicated in about a dozen countries.

For the healthcare community, the stakes are high. Each year, youth homicides and assault-related injuries result in an estimated $16 billion in combined medical and work loss costs, according to the CDC. Communities of color often face challenges getting healthcare because they lack insurance. While about 92% of white residents in the U.S. have health insurance, only 88% of blacks and 80% of Latinos are in any way covered, according to the U.S. Census Bureau.

Dr. Mirna Ballestas, a clinical psychologist with Sinai Health System on Chicago's west side, has worked for the past eight years as program manager of the system's “Under the Rainbow” program. UTR uses a multidisciplinary approach to help youth who have experienced traumas. The program includes psychiatric counseling and conflict resolution training to reduce the likelihood that victims of violence will become aggressors.

Located in one of Chicago's most violent neighborhoods, Sinai treated more than 1,700 trauma patients in 2015. In March, the main hospital began offering 24-hour counseling and a support services program through a partnership with CeaseFire Illinois where responders at the hospital help patients, families and friends who have been victims of, or witnessed, gun violence.

Advocates say the larger healthcare system in the U.S. should commit time and resources to preventing gun violence in order to stem the long-term health effects.

“I think we're moving in the right direction,” Ballestas said, adding that federal Medicare and Medicaid programs that offer incentives to providers who try to prevent diabetes and address other social determinants such as poverty and violence, are helpful.

Many health systems have attempted to address the effects of poverty within their surrounding communities by employing initiatives focused on alleviating the social determinants that lead to poor health outcomes. Efforts have included health screenings, food drives and programs aimed at preventing poor eating habits, smoking and gun violence.

Ransford, however, was less optimistic about healthcare's involvement.

Often times a patient's exposure to violence is not taken into consideration as a factor in their overall health or their risk for developing chronic conditions, he said. As a result, physicians don't develop treatment strategies that factor in emotional or mental distress.

And that's important, Ballestas said, because people living in these communities are often at a disadvantage.

“With increased socioeconomic status, there's going to be healthier protective factors,” Ballestas said. “If you have healthier protective factors, those are tools that are going to protect from social determinants of health. If you have mental illness, and you have resources such as a healthy family, access to tutoring, access to extracurricular activities that increase a sense of self-efficacy, these are all protective factors that will decrease long-term outcomes of mental illness.”

Even for facilities like La Rabida, which operates a pediatric trauma center, the health impact of violence is not always identified among all its patients, Soglin acknowledged.

“For those severely impacted kids, they need intensive therapy, and that's what our trauma center is for,” Soglin said. “But for the kids in the neighborhoods who have not necessarily been shot but know people who have been shot and have seen people be shot, we don't at this point have good resources for them.”

Part of the problem, Soglin said, is that many healthcare providers don't recognize the role that the stress of living in impoverished communities with high rates of violence can play in causing poorer health outcomes.

Soglin said talks were just underway at La Rabida to screen all kids who visit the hospital for signs of toxic stress regardless of whether they were in a trauma patient. He hopes to begin the testing in about a year.

“If there was a virus out there that you got as a child and it decreased your adult life span by 20 years, we would be all over it to look for a vaccine or whatever we needed to do,” Soglin said. “The adult world, to me, seems to be completely unaware of the impact of childhood experiences on the health of their patients.”