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Closing Comments
Joseph Sakran of Johns Hopkins Hospital concluded the workshop by first recounting his personal involvement with firearm injury. One autumn evening, he said, he went from being a healthy 17-year-old high school student to collateral damage and nearly being killed when he was shot in the throat with a .38 caliber bullet. For many years, he said, he never realized the power of his own story in mobilizing action on preventing firearm injury and death. Sakran said:
Being able to tell your story, or in some cases the story of your patients or the story of your community, allows us to develop a narrative, a narrative that can change the hearts and minds of people from all walks of life.
In fact, he said that as trusted public messengers, health care professionals have a critical role to play in improving this public health problem.
Sakran then provided his highlights from the workshop. Houry, he said, provided a broad overview of this public health crisis, the importance of the data that the Centers for Disease Control and Prevention is collecting of firearm injury and death, and the need for researchers and communities to collaborate on finding solutions to this public health problem. James then discussed the need to understand how disparities have perpetuated over time and serve as the root causes of firearm violence, and Dicker continued on that theme by addressing structural racism, its connection to the social determinants of health, and the need to address unmet social needs to have a chance at changing the trajectory of firearm violence in underserved communities. Dicker also discussed the work that the American College of Surgeons is doing on trauma-informed care and the pilot program it is starting in 15 trauma
centers across the country. The first session ended with Barnhorst’s description of the BulletPoints Project’s work developing firearm programs for health care professionals. “I think it’s important to recognize that many of us often do not know how to ask or even answer some of the questions as it relates to firearm injury prevention with our patients,” said Sakran.
The next panel focused on barriers and facilitators to implementing hospital-based firearm injury prevention strategies in urban and rural communities. Beidas started the discussion by addressing the importance of implementation science and providing some examples of how implementation science has been used to deploy firearm injury prevention programs. Hink then spoke about the hospital- and community-based violence intervention program her team created from scratch and the importance of telling the local story and demonstrating the regional disparities that are critical to the success of this process.
The highlights of Charles’s presentation on the Cradle to Grave program described the need to be innovative and imaginative when approaching this problem, and to sometimes make people uncomfortable. He added that, perhaps most importantly, it is critical to understand that the real experts who understand the solutions needed are the people in the community. Stone and Regan concluded the session by raising the importance of authentic voices and linking the hospital as a true partner with the community.
The third panel, continued Sakran, focused on collaborating with the community to improve successful health care system implementation and to destigmatize gun violence prevention. Punch discussed the importance of taking a comprehensive approach to caring for an injured patient that moves beyond physical care to include emotional, mental, and spiritual care. Wiskerchen noted the important aspects of improving cultural competence and engaging firearm owners in a nonjudgmental way. McBride then discussed the importance of health care systems and professionals developing a culturally competent, antiracist stance in a structured way to change the experience for the victims of firearm-related injuries and their families. For Sakran, the final panel underscored the importance of stories, with each of the four panelists using their experiences and talents to tackle this public health problem and build the necessary trust in the community.
In thinking about all of the presentations, Sakran identified six core themes:
- Eliminate inequity.
- Engage the community.
- Speak with authentic voices.
- Display cultural competence.
- Engage in advocacy.
- Develop policies.
He noted that the role that health care professionals play in reducing firearm injury and death cannot be overstated; the two-tier economic system that is intricately woven into the foundation of the United States is evident in the analysis of education, law, and health outcomes. Sakran said:
To effect maximal change, we must be able to understand and engage with the depth and breadth of the problem through targeted policy. This is critical because only policy can fix what policy created in the first place, and we heard today how for far too long, policy has been used as a tool of oppression.
Sakran said that as the nation faces dueling public health epidemics, it is now in a phase where it has both the opportunity and responsibility to eliminate health inequities that continue to decimate communities nationwide.1 Honoring the indiscretions of the past, he said, begins with implementing actionable solutions to chip away at the existing inequalities so that the country can finally realize a healthy, equitable, and inclusive society. In thinking about his and others’ successes as individuals, one thing remains clear to him. “None of us gets here alone,” he said. “It is a collective group of individuals that allows us to be the best version of ourselves possible, and to move the needle forward in a way that allows us to be truly effective.”
He noted that one of his colleagues, a fellow trauma surgeon, was shot recently, and it reinforced for him how difficult it is to care for injured patients, let alone when it is your friend and colleague. Sakran said:
This just reaffirmed the fact that none of us are immune, and we are all part of the fabric of our community, and we all need to participate in the change that needs to happen in our own backyards to make community safer.
On a final note, he requested that when the workshop ends, that everyone ask themselves two questions: “What is your story, and how are you using your story, the story of your patients, or the story of your community to impact and change what is happening in your own backyard?”
After expressing his gratitude to all the speakers, meeting participants, the workshop sponsors, both Northwell Health and PEACE Initiative, and the National Academies staff who supported this tremendous effort, he offered his thanks to his fellow planning committee members. He then adjourned the workshop.
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1 As of August 11, 2022, the National Academies Forum on Global Violence Prevention is not currently active. Previous publications are available at https://www.nationalacademies.org/our-work/forum-on-global-violence-prevention.
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