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Foreign Policy Analysis
Policies That Work to Reduce Gun Violence

Policies That Work to Reduce Gun Violence

Well good morning, everyone. That’s kind of weak. Monday morning, good morning. Thank you very much. I’m Georges Benjamin and I’m the executive
director at the American Public Health Association here in Washington D.C. And I just want to start by welcoming you
all here to our great forum. As you know, the occasion today is that the
U.S. firearm injuries are at epidemic proportions. And we have over 100,000 people who are shot
annually, over 270 per day on average. Almost 40,000 people die each year from these
firearm injuries. In 2017, the CDC actually counted 39,377. It’s also in addition to the human toll involved
in this and the heartbreak. Costs our nation over $229 billion. So it’s not just the deaths and injuries,
but it has an extraordinary fiscal toll on our nation. These are complex issues. And of course everything involving people
is complex. But I want to just point out the solutions
are also very complex. And no single policy solution despite many
of our policy makers who want to have that one policy that’s going to fix all this — no
single policy solution is going to solve itall. So today, we’re going to have a series of
discussions around policies that we believe work. It’s important to build that on a solid framework. And I think we all believe that universal
background checks are the core foundation for effective policy. And so you’re going to hear us talk about
this, but through the context of all the policies that we’re having today. We’ve brought together some of the world’s
leading experts to discuss a series of policies that have a strong evidence base. Again, we call these policies that work. And our goal is to inform the leaders that
are having this debate on the Hill right now and down in the White House to enable them
to take action. Now the format today is that we’re going to
basically have two panels. And those speakers will get up, make their
presentations. And then of course, we’ll have hopefully a
vigorous Q&A following each panel. So I’m going to get an opportunity to moderate
the first panel where we’re going to talk about Extreme Risk Protection Orders, stronger
protections for victims of domestic violence, licensing, also that in the context of background
checks, and restricting assault weapons and large capacity magazines. With that, I want to bring up very quickly,
my colleague, Josh Sharfstein, who’s going to just run through the second panel’s program
and a couple other announcements. Josh? Thank you very much, Georges. My name is Josh Sharfstein. I am a Professor in the Department of Health
Policy and Management at Johns Hopkins and the Director of the Bloomberg American Health
Initiative, which is co-sponsored with the American Public Health Association of this
great forum. So the second panel will cover a different
set of policies that were including interventions with high risk individuals, hospital-based
interventions, projects to reduce blight in urban areas and their impact on violence. And finally, we’ll talk about the importance
of gun violence research. And for each of these topics, as Dr. Benjamin
said, we have brought in from around the country, one of the top experts to go through the evidence. Let me just say that the American Health Initiative
is proud to sponsor this event. We are initiative-focused on major challenges
to health in the United States including violence. And you can find more about the work that
we do including fellowship opportunities at Johns Hopkins at We also want to make today participatory. So we know that we have a lot of people watching
the web cast right now, so thank you. And second of all, we’re going to be on Twitter
with a #gunpoliciesthatwork. And you can follow at Public Health for the
American Public Health Association and at American Health for the Bloomberg American
Health Initiative. So I thank you and I’ll turn it back over
to you, Dr. Benjamin for the first panel. So for our first panel, which is going to
talk about Extreme Risk Protection Orders, we’re going to have two speakers; Dr. Jeffrey
Swanson who’s a Professor of Psychiatry and Behavioral Sciences at the Duke University
School of Medicine and a visiting scholar at the Johns Hopkins Center for Gun Policy
and Research. And he’s going to be followed by Shannon Frattaroli. Dr. Frattaroli is an Associate Professor at
the Johns Hopkins Bloomberg School of Public Health and is core faculty of the Johns Hopkins
Center for Gun Policy and Research. If you want to know a little bit more about
them, their bios are in your folders. With that, I’ll turn it over to you, Jeff. Thank you. Good morning, everyone. So I think of gun violence in America as a
puzzle. And one of the missing pieces in that puzzle
of gun violence prevention has been what to do about people who clearly pose a serious
risk of misusing a firearm, of harming someone else or themselves, but they can legally possess
guns. They can legally purchase guns. They don’t have any of the — They don’t fall
into any of the categories that would prohibit them from purchasing or possessing a gun such
as having a felony criminal record or having a history of involuntary commitment. But people around them know that they pose
a risk. I mean this could be your Uncle Floyd who,
you know, served his country honorably in the Air Force but he’s just had a really bad
year and now he’s drinking heavily. And one night, he takes his own deer rifle
and ends his life. It is a horrible tragedy for everybody and
people knew this. So Extreme Risk Protection Orders are designed
for situations like that, among others. Uncle Floyd would have passed a background
check. You know, background checks are necessary,
they’re important. But they wouldn’t necessarily deter someone
from misusing a gun in a situation like that. So you know, Uncle Floyd isn’t necessarily
— he wouldn’t always pose a risk. Maybe he would have gotten over it. He would have gotten some help. And so the features of a Risk Protection Order
are as follows: They are time limited. They’re not forever. They give police officers the clear legal
authority to search for and remove firearms from a risky person at a risky time. And it’s a Civil Court process. It’s not criminalizing. And you know, a person — there’s legal due
process that’s built in at the front end. Typically what would happen is if you live
in a state like this, you can call the police. The police look into it. And they get an order — an ex parte — Parties
not Present order from a judge who removes the guns. And the police officers can then remove the
guns. And then within two weeks, there’s a hearing. And all the parties can be heard. And at that point, the State has the burden
of proving by clear and convincing evidence typically that this individual continues to
pose a risk of harm to others or self. And then the guns can be retained for up to
a year. So let’s flash back to the year 2013, right
after the Sandy Hook shooting. And I’m going to show you a map of all the
states that a law like this. There were two; Connecticut and Indiana. It’s kind of interesting these two states. Right? I mean Connecticut, the Democrats are in charge
of State legislature. And in Indiana, the Republicans have a super
majority. These states differ on a lot of parameters
that have to do with possession of guns, the strength of other gun laws and so on. But they were both passed after a concern
about a mass shooting. And it was a response to the State Legislature
to a concern and public outrage over that. Now let’s flash forward to 2019, that’s the
map. All those dark blue shaded states have some
version of an Extreme Risk Protection Order law. The first one after Connecticut and Indiana
was in California after the consortium for Risk Based Firearms Policy thought about this
and developed this idea a little bit further where family member would be able to go directly
to a judge and petition for a removal of guns. And the light shaded ones are states that
have proposed this. And this is already out of date. There are other states that are not even on
there. You know, so if you think nothing has happened
— nothing happens at all in terms of gun violence prevention laws, take a look at this. A lot is happening at the state level. So what do we know from research about whether
these work? Well our research group has conducted studies
in both Connecticut and Indiana. And what we found was not withstanding, the
laws were passed out of concerns for mass shootings as they have been used most of the
time — two thirds of the time, they’re used for a suicide concern across the age span,
mostly men. About you know, one in four or one in five
times, there’s a homicidal ideation or threat. About the same for alcohol or drug intoxication. Acute mental illness or dementia is the minority
of those. So this is not about mental illness diagnosis,
although it’s going to capture the proportion of people who might have a mental health problem
who are posing a risk, at least for a period of time. The average number of guns removed per person,
seven guns per person in Connecticut and three in Indiana. So these are people who have a lot of guns
typically. The average in — What happens typically if
the police go in and they find someone to serve this risk warrant to take the guns away
is they find someone in a crisis. And over half the time, they transport that
individual to a hospital emergency department for evaluation. And in Connecticut the proportion of people
actually receiving treatment for a mental health problem in the community doubled from
12 percent to 24 percent in the year before to the year after the gun removal action. So sometimes it actually provides a portal
into treatment and people getting help. So does it actually save lives? Well, it’s hard to tell in terms of you know,
mass shootings. We didn’t have any homicides. But when we followed up these cases and looked
at the death records, we found a very high rate of suicide. Thirty to forty times higher than the general
population rate of suicide. I think that’s important politically and legally
because it shows that the law is not being applied willy nilly to everybody. It’s being applied to a group of people who
actually are at high risk of misusing a firearm. So if finding that person, you know, who is
going to do this is a needle in a haystack, this gives you a much smaller needle with
more haystack — much smaller haystack with more needles in it. And so you know, what we were finally able
to do is estimate because, you know, very few of these actually use guns — these suicides. And none of them happened except for a couple
cases within the year when the guns were removed. They all happened after the person became
eligible to get their guns back, but they used other methods. And so we were able to calculate to do this
kind of what if. What if the guns had not been removed, how
many more people would have died? Because the case fatality rate for using a
gun in suicide is incredibly high. And the answer was for every ten to 20 of
these gun removal actions, one life was saved by averting a suicide. By moving it to some other method of suicide
that is much more survivable. And there is emerging evidence from a number
of the new states that have enacted these laws that actually there is — that some of
the mass shootings have been for people that have intended to commit a mass shooting. And they have been stopped by this process. So that’s kind of the information that we
want to be in the hands of law makers about what’s in the balance of risk and rights. You know, is this high or low, you know, ten
gun removal actions to save one life. Well if you care more about the Second Amendment
right than anything else, maybe it’s unacceptable. But if you’re like many people, you know like
me in particular, you have a gun suicide story in your own family, maybe that’s an acceptable
balance. And this is a policy that works. Now I’ll turn it over to Shannon. Thank you, Jeff. And good morning, everyone. Thanks so much for being here on an early
Monday morning. I want to start off by just picking up on
two things that Jeff said. Because two of the things that he said really
run counter to the narrative about gun violence and opportunities for prevention in this 1
country. And the first thing is with regard to what
Extreme Risk Protection Order laws do. These laws are really focused on intervening
when people are behaving dangerously. When people are making threats about what
they’re likely to do. This is a behavior-oriented type of intervention. It’s not about mental illness. And the reason for that is because we know
from the research that the best predictors of future violence really are those dangerous
behaviors. So the way that these Extreme Risk laws are
set up is to be put in effect when people are acting in ways that suggest that they
are going to commit violence or are threatening that they are going to commit violence. Again, either against people, against others,
or when it comes to suicidal ideation and harm to themselves. So that’s the first point that I just want
to emphasize from Jeff’s overview. The second point goes to those wonderful maps
that he showed you. You know, we have an ongoing dialogue in this
country that gun violence prevention policy is something that we can’t do. It’s unattainable. But when you look at what’s been going on
in the states over the past six years — and there’s a lot of policy people in the audience. We can all appreciate that six years is not
a lot of time in the policy world. Over the past six years, 15 states and the
District have passed Extreme Risk Protective Order bills into law. That’s incredible. Change is possible here in this country. And this case example proves just that. So I’d just like you to keep that in mind
as we talk about the opportunities that exist with regard to Extreme Risk Protection Order
laws in this country. And the recommendations that we have with
regard to these laws in particular. So with regard to the opportunities, the first
thing that I’d like to just emphasize is the importance of implementation and the real
need to focus on implementation of these laws. So these laws have come on line in very short
order. And there’s a lot of different ways that states
and localities are working to implement them. We at our center with the help from the educational
fund to stop gun violence have been working with states and localities to identify those
places where model implementation efforts are occurring. And there’s some great work going on out there. Work like in Maryland where we have the sheriffs
who have really taken the lead to prior to our law in Maryland going online in October
of 2018, making sure that there was solid law enforcement training that was offered
to law enforcement statewide. What do we see around the state as a result? We see Extreme Risk Protection Order laws
being used statewide. We see them being used in a way that’s fair
and just and consistent across the states. What else do we see? Local jurisdictions like King County where
Seattle is located in Washington State are doing a tremendous job of bringing together
multi-agency teams of law enforcement people to work together to make sure that whether
you’re in the police department, whether you’re in the sheriff’s department, whether you’re
a prosecutor, whether you’re a judge, you know what the law is. You know how it works. And Extreme Risk Protection Order laws are
being issued in a way that’s consistent, fair, and in the best interest of community safety. So we’ve got good models out there with regard
to how implementation should work. And we need to really focus on implementation
for those states where Extreme Risk Protection Order laws exist. And the good news is, is that we’ve documented
and collected a lot of information with regard to some of these model jurisdictions on a
website that’s shown here on the slides. So if you Google Johns Hopkins American Health
ERPO implementation, you’ll come our website and you’ll see video interviews with the front
line law enforcement people who are making these laws happen again in a fair, consistent
way that’s making a difference for community safety in the places where they’re involved. The second thing that I would mention with
regard to opportunities is that while we have 17 states in the District where Extreme Risk
Protection Order laws are in place, there are 33 laws in this country that don’t yet
have the benefit of these laws. Now most of those states have actually introduced
bills and they’re working their ways through conversations in those places. But this is a real opportunity to bring this
lifesaving policy intervention to places where it doesn’t yet exist. To places where there are lots of Uncle Floyds
like what Jeff mentioned who could benefit from the type of intervention that Extreme
Risk Protection Order laws give. And the final thing that I’ll just mention
with regard to opportunities here is the opportunity for research. We have these laws that are rolling out all
across the country in states like in California and Massachusetts. And states like Nevada, Hawaii, and Florida. You know this is a policy intervention that
diverse states have really taken up. And there’s a real opportunity to figure out
through research how we can best implement these laws to assure that they have the maximum
benefit on the public’s health. So given that, what do we have to say with
regard to specific recommendations here today? Because we want you to walk away with some
very tangible things that can be done in response to the evidence that we have about these laws. So a few things. So first of all, while Extreme Risk Protection
Order laws are really a state level intervention, I don’t want to leave you with the impression
that there’s nothing that we at the federal level can do. Because there’s lots that Congress can do. And perhaps the most important thing that
Congress can do at this point in time is to really support the state implementation efforts
through federal funding. So federal funding can do a number of things
to support good implementation at the state level. Federal funding can support training of law
enforcement. Law enforcement like what I witnessed happen
in my home state of Maryland so that law enforcement officers when they are on scene and identify
a case that would benefit from a temporary gun removal, know how to approach the court. Know how to serve that order. Know how to safely remove those guns. Training’s essential and the federal government
can play a good role in assuring that, that happens around the country. We also want to point out that federal funding
can go a long way toward incentivising the type of multi-agency collaborations that I
described happening in places like King County Washington. Having the benefit of law enforcement teams
of front line law enforcement officers working together with prosecutors and judges to assure
that everybody who’s involved in the decisions around Extreme Risk Orders and the service
of those orders knows the law and is working together well, again to assure that these
laws are being issued in a consistent and fair way that will benefit the community safety. There’s also a need to make sure that there
is education for allied professionals like clinicians, like school administrators, and
community leaders in these laws. As Jeff mentioned, it’s not only law enforcement
that can initiate these petitions, but in most states — the overwhelming majority of
these states, family members and intimate partners can also initiate these petitions. So the importance of people understanding
when these laws can be used and the processes that are involved is really key. I want to also mention the importance of assuring
that the systems that are in place to support the Extreme Risk Order infrastructure are
working is really very important. So Extreme Risk Protection Order laws temporarily
prohibit the respondent to those order from purchasing and possessing guns. So in order for that purchase prohibition
to work, we need to make sure that our national instant criminal background check system is
up and receiving the people who are prohibited temporarily under these orders. So attention to making sure that once those
orders are issued, that they can get in to the NIC system is really important or else
those laws aren’t going to be effective in prohibiting those gun purchases from happening. And finally, the last important role that
the federal government can have in terms of supporting these Extreme Risk laws is to make
sure that researchers are adequately funded and supported to identify best practices for
implementation, to identify how best different jurisdictions can implement and enforce these
Extreme Risk Order laws, and to assure that the impacts that are being realized through
these laws are being measured and shared with the practitioners involved so that we can
inform those implementation efforts going forward. So that’s a lot of tasks for the federal government
to accomplish, but I have every confidence that Congress is up to that challenge. At the state level, there’s a number of things
that the states can do as well. For those 17 states in the District that already
have Extreme Risk Protection Order laws in place, pay attention to implementation. You’ve got a wonderful tool at your disposal. Let’s make sure that you use them well. We here at the Johns Hopkins School of Public
Health — Bloomberg School of Public Health are ready and willing to support implementation
efforts. Again, look to our website for guidance with
regard how to implement these laws as well. And for those 33 states that don’t have Extreme
Risk Protection Order laws on the books yet, work hard with the stakeholders in your community
to get those laws passed. And then work with us to figure out how they
can best be implemented. Again, thank you so much for tuning in this
morning. And I will now turn it over to Dr. Benjamin
to introduce our next panelist. Thank you very, very much. So our next panelist is Dr. April Zeoli. Dr. Zeoli is the Associate Professor at the
School of Criminal Justice at the Michigan State University. And she’s going to talk about stronger protections
for victims of domestic violence. 3.4 percent of non-fatal intimate partner
violence events involve a firearm. 3.4 percent may not sound like much, but that
amounts to roughly 32,900 a year in the United States or just over 90 per day. Guns are used nonfatally to threaten, to intimidate,
to coerce, to pistol whip, and to shoot at victims of intimate partner violence and sometimes
their children or loved ones. We often mostly hear about fatal events that
involve guns. And for intimate partner homicide in 2017,
about 58 percent of them were committed with a gun. And that does represent an increasing upward
trend of the percentage of intimate partner homicides that involve a gun over the past
few years in the United States. And that upward trend and the percentage that
involves guns coincides with an uptrend in the number of intimate partner homicides as
well. So this is a very concerning trend in the
United States. Between 6 and 20 percent of intimate partner
homicides involve at least one additional victim. Those victims are most often children of the
targeted intimate partner, other family members, sometimes they are police officers. And the majority of intimate partner homicides
that involve more than one victim are committed with guns. You may have heard that 53 percent of mass
shootings in this country involve the killing of an intimate partner or family member victim. Now there are two ways that specify that domestic
violence perpetrators are not allowed to have guns. And those are through domestic violence restraining
orders that carry firearm restrictions. And also convictions for misdemeanor crimes
of domestic violence. And let’s talk about the domestic violence
restraining order, firearm restrictions first. And I’m going to refer to domestic violence
restraining orders as DVROs, so I don’t have to say that phrase over and over again. DVRO firearm restrictions are incredibly important
because they are initiated by the victim. The victim applies for a DVRO. The victim doesn’t have to wait for a police
report, for prosecuting attorneys to decide to charge the batterer. They don’t need to wait for a conviction. They just have to petition and very quickly
a judge will make a decision about the petition. They also don’t have to wait the amount of
time it takes for a case to make its way through the criminal justice system from arrests and
charges through to conviction. A DVRO goes into place relatively quickly. So there can be a way for someone who is in
crisis, who is in danger right now to find safety. Four longitudinal ecological level studies
of the impact of state level DVRO firearm restriction laws have found that they are
associated with decreases in intimate partner homicides committed with firearms and with
decreases in total intimate partner homicide. And this is important because we’re not just
changing the method of death. We’re not just decreasing intimate partner
homicides with firearms. We’re seeing associated reductions with the
total number of intimate partner homicides suggesting that these laws save lives. But there are some from variations from state
to state in these DVRO firearm restrictions. And one of them is whether dating partners
can be covered. Under the federal DVRO firearm restriction
law, dating partners are not covered. Current and former spouses are covered. Those who share a child are covered. And people who live or used to live together
are covered. Some states don’t have their own state level
DVRO firearm restriction, so they rely on the federal law and don’t cover dating partners. Some states have their own DVRO firearm restriction,
but still don’t cover dating partners. But some have their own law and do cover dating
partners. So there’s a lot of variation. The next source of variation is whether ex
parte or emergency restraining orders are covered. And ex parte orders are those orders that
go into place very quickly. Someone petitions for the DVRO and a judge
decides if their case warrants the protection a DVRO would provide right away before a hearing
that the respondent had the opportunity to attend. And some states cover those. But the federal government doesn’t and some
states don’t. The third variation is whether a state requires
a judge — allows a judge to require a person who is now prohibited from possessing a gun
under a DVRO to relinquish their guns. So this is an implementation step. If somebody already possesses a gun and now
they’re prohibited — they possess the gun illegally now and need to get rid of it in
order to not have one, to be in the spirit of the law. So I and many of the people in this room or
at least some of the people in this room did a study last year and we looked at these three
differences in the DVRO firearm restrictions laws. And the first one we looked at was coverage
of dating partners. And we found that in comparisons to states
that didn’t have their own DVRO firearm restriction law, so just relied on the federal law, states
that covered dating partners under DVRO firearm restrictions had an associated 13 percent
reduction in intimate partner homicide. And an associated 16 percent reduction in
intimate partner homicide committed with firearms. And this kind of makes sense because roughly
50 percent of intimate partner homicides right now are committed by dating partners. We spend a lot more time dating these days
than we used to. We get married later, divorce is relatively
common. So you spend a lot more time exposed to dating
partners and they can pose a greater risk. The second thing we looked at was the coverage
of those ex parte orders. And similar to the finding with dating partners,
we found that coverage of ex parte orders was associated with a 13 percent decrease
in intimate partner homicide and a 16 percent decrease in intimate partner homicide committed
with guns. And again, the logic here makes sense. If someone is in danger now — if a judge
decides looking at their petition that they need the protections a domestic violence restraining
order will bring now, waiting ten days, two weeks, and some places a month for that full
hearing so that a firearm restriction can be put on after the full hearing, may leave
them exposed to a great amount of risk for a relatively long period of time. So using that period — having firearm restrictions
in that period may save lives. Two studies looked at whether those relinquishment
provisions were associated with intimate partner homicide. And they found a ten to 12 percent reduction
in intimate partner homicide and a 14 to 16 percent reduction in intimate partner homicide
committed with guns. And again, this about implementation. You can say that someone is restricted from
having a firearm, but if they have one and law enforcement does not remove it from them
or they do not relinquish it in some way, then you haven’t really safeguarded their
victims. Next on to the misdemeanor firearm restrictions. The federal government also has this domestic
violence misdemeanor firearm restriction. And two studies that have looked at that have
found reductions in intimate partner homicide, about 9 to 10 percent reduction across states
in intimate partner homicide. And the studies that have looked at the state
level restrictions in comparison with states that don’t have their own law, so they rely
on the federal law, have not found an association with intimate partner homicide. Again, comparing them with that federal law,
which does have an associated reduction. But some states have gone further than that
and have said if you’re convicted of a violent misdemeanor crime, it doesn’t matter who that
victim was. It doesn’t matter what your relationship to
them was; stranger, wife, dating partner, you are not allowed to have a gun for five
years, ten years, for some amount of time. And states that have done this — that have
done away with that relationship requirement have found a 23 percent reduction in intimate
partner homicide. Twenty-three percent is really big. So why might we see such a large reduction
in intimate partner homicide in association with those laws that are not specific to intimate
partner violence? Well one reason we think is because those
people who are committing severe and potentially fatal intimate partner violence don’t just
specialize in intimate partner violence, they’re committing other violent crimes as well. So they may be prohibited already from gun
ownership under these violent misdemeanor prohibitions. We may be safeguarding victims that way. The other reason is the way the background
check works. If someone is convicted of a domestic violence
misdemeanor crime, they could be convicted under any number of statutes; assault, battery. It may not be specific in the statute that
this is domestic violence and has that required relationship needed in states or the federal
government to quality for the domestic violence misdemeanor prohibition. So it could be difficult to identify them
in the background check or at least more difficult to identify them than it is if you’re just
saying if you’re convicted of a violent crime, you can’t have a gun. So if assault shows up, it doesn’t matter
what the relationship is. The person doing the background check doesn’t
have to check and find out what the relationship is. They’re just prohibited from having a gun. So it may be easier to implement the purchase
prohibition. Because implementation is important and Shannon
gave us really a wonderful overview of implementation. And I think these aspects are going to be
echoed quite a bit today, but we need to implement these restrictions. The possession restriction, we have some counties
— some places that are really doing a good job with, you know, creative planning on how
to legally and safely remove guns from those who now possess them illegally. But we need more jurisdictions to get to work
on that. The purchase restriction, it requires those
disqualifying records to go into the Background Check System fairly immediately and for it
to be obvious that these are disqualifying restrictions. So that when a background check is conducted,
the person isn’t allowed to buy a gun. It also requires a background check to occur. In states where you can buy from a private
seller without a background check, the purchase restriction is much harder to enforce because
you have that group of people who simply don’t have to do one. So my recommendations are that Congress and
state legislatures extend domestic violence restraining order firearm restrictions to
cover dating partners and to cover those ex parte orders. If we cover this broader group of people,
we may be covering more people who are potential intimate partner homicide perpetrators. And even if they’re not, people who are potential
nonfatal gun use perpetrators. We also need Congress and state legislators
to potentially extend firearm restrictions to people convicted of violent misdemeanors
and not just domestic violence misdemeanors. Again, the research suggests that this is
associated with reductions in intimate partner homicide. And we also have research to suggest that
people convicted of violent misdemeanor crimes are likely to commit more violent crimes in
the future. So this is a risky group of people that we
probably want to remove guns from to safeguard the public. And finally, Congress, state legislatures,
implementing organizations, everybody needs to get together on implementation of these
restrictions. The relinquishment laws need to be passed
in states that don’t have them. Jurisdictions need to have written protocols
and resources dedicated to implementation. So we do need those resources to go to implementation
of the possession restriction. And we also need to work on the purchase restriction. Purchaser licensing laws, which we’ll hear
more about in just a moment, are found to be an effective way to reduce gun violence. And I’ll save that for our next speaker. But we also need to remove private sellers
ability to sell without a background check. And if we do that, we may save more lives. Thank you. Thank you. So our next speaker is DR. Cassandra Crifasi. She is the Deputy Director of the Johns Hopkins
Center for Gun Policy and Research. She’s an Assistant Professor at the Johns
Hopkins Bloomberg School of Public Health. And she’s going to talk about background checks
and firearm purchaser licensing. Hi, welcome. Thank you, everybody for being here. I’m sure many of you are familiar with the
Background Check System. But I want to spend just a few minutes talking
about it, so that when I talk about licensing, we’re all sort of on the same page and have
some important context. So the federal Background Check System was
established as part of the Brady Handgun Violent Prevention Act. And that’s what created this requirement for
background checks by licensed dealers. When a purchaser wants to buy a gun from a
licensed seller, they go and submit themselves for a background check. And they get run through this instant check
system. And it really is instant. The vast majority of background checks come
back in about two minutes. And one of three things happen when a purchaser
submits themselves for a background check. The seller can be alerted that the sale can
proceed immediately or they can be immediately denied if the purchaser is prohibited. But there’s a third thing that can happen
and that can be a delay. And perhaps more time is needed to complete
that background check, to look through some of the records that April had mentioned. And law enforcement has three days to complete
that background check. If it doesn’t come back in the three days,
the default under federal law is that the seller can proceed with that sale even if
the purchaser is prohibited. If after those three days and the sale is
completed, the background check comes back as prohibited, then law enforcement has to
go and take guns away from people who never should have gotten them in the first place. A challenge with the Federal Background Check
System is that states and local law enforcement agencies don’t always report prohibiting conditions
in a timely manner. And this also applies to mental health prohibitions. So this creates gaps where people who are
prohibited — maybe their records haven’t yet been reported in the federal system, can
obtain firearms even if they shouldn’t have them. Another issue with the federal system is that
it relies on name and birthday checks, which can miss, some researchers found, as many
as 10 percent of prohibiting conditions. Federal laws as we, I’m sure are all aware,
doesn’t extend this background check requirement for private sales. It only applies to licensed dealers. Sellers aren’t allowed to sell to someone
that they know is prohibited, but if sellers don’t ask and buyers don’t tell, then there’s
really no way to know that, that person is prohibited without conducting a background
check. Recognizing this gap, 21 states and the District
of Columbia have extended background checks for private sales of guns. The other policy that I want to talk to you
about is firearm purchaser licensing. So these laws require that anyone who wants
to buy a gun, apply to state or local law enforcement to get a license. As part of the process, applicants often get
their photograph taken. They usually submit fingerprints at least
on that first application. And the use of fingerprints increases the
likelihood that someone will be properly identified and screened out from purchasing a firearm
if they’re prohibited. In fact, fingerprinting is required for most
occupational licensing because of the higher quality of a background check and ability
to identify those records. Law enforcement has on average, 30 days to
complete that background check, giving them more time to better identify records and again,
screen out those people who have those dangerous conditions. And we’ve agreed that they shouldn’t have
firearms. That additional time is really key to make
sure that we’re not missing 1 records. So if you think back to the Charleston church
shooting, the inability to complete that background check in three days is what facilitated that
individual obtaining that firearm and committing that shooting. That extra time also can delay impulsive acquisitions. So if someone is thinking about acquiring
a firearm to harm self or others, that delay in time to get the licenses processed can
delay that impulsive acquisition. Importantly, people who want to buy guns in
states with licensing have to show their license to every seller regardless of whether they’re
licensed or not. And this is really important for increasing
accountability. If I’m in a state with licensing and I sell
to someone without a license and that gun is then recovered in crime, it’s a lot easier
to prove that I violated the law because that person didn’t have a license and wasn’t an
eligible purchaser. So there’s some variation across the states
that have licensing laws. There are nine that require a license for
all handgun purchasers. Some also require safety training. Some give discretion to law enforcement. And some of the permits last or licenses last
for different durations. But the core components are an application
to law enforcement and more time to conduct a thorough background check. So what do we know about these policies? So requiring background check for private
sales is associated with lower rates of guns being brought illegally across state lines. So meaning that if a state has a background
check law for private sales, it’s less likely that those guns are going to end up in crime
in another state. And background checks are a really important
foundation for other policies to work. We heard about the importance of background
checks for domestic violence prohibitions. If a state has other prohibitions like Florida
has a minimum age law, if you don’t require background checks for private sales, you create
an avenue where people can avoid undergoing a background check and get around those prohibiting
conditions. However while background checks are a really
important foundation and they’re necessary as a robust part of a functioning policy set
for identifying prohibited individuals, they haven’t yet been enough on their own to reduce
gun violence unless they’re paired with this licensing system. This is really due in large part to issues
with records reporting and enforcement. It’s uncommon for people who violate a background
check law to be held accountable for that action. This gap is really creating harms to the public’s
health and contributing to our burden of gun violence in this country. A primary focus really needs to be on strengthening
this system. We need to have better reporting of records,
timely reporting. We need to have all purchasers regardless
of from whom they’re buying the gun, undergoing a background check. And then we could further strengthen this
system by pairing it with a licensing law. So what we know about firearm purchaser licensing
laws is that they’re very, very good for public safety. These laws are associated with fewer crime
guns being traced to within state sales. So often individuals who are committing crimes
in states with licensing get those guns from states with weaker laws. This means that the local source of crime
guns are restricted. And it’s harder to get a gun within your state. You have to go across state lines. We hear a lot about gun laws don’t work. Look at Illinois. Look at Chicago. They have high rates of gun violence. And so obviously these laws aren’t working. But of the crime guns — there were about
10,000 crime guns recovered in Illinois last year, about half of them came from sales that
originated in Illinois. About half, which is average for a state that
has licensing. Of the guns that didn’t come from Illinois,
most of them came from Indiana, which doesn’t have background checks. They don’t have licensing laws. So even when a state has strong gun laws,
they are at the mercy of states around them that have weaker laws. And in contrast to what we found for background
checks, the research on licensing is really strong. And it shows again, these public safety benefits. Connecticut passed a purchaser licensing law
in 1995. They had an in-person application and fingerprinting. And they saw a 40 percent reduction in firearm
suicide. And a 15 percent reduction in firearm suicide
in the first ten years that the law was in place. Missouri repealed a similar law in 2007. They had required an in-person application
and had a permit that was good for 30 days. They had a 17 to 27 percent increase in firearm
homicide and a 16 percent increase in firearm suicide. Additionally because the repeal of this law
freed up their local sources of guns, they saw a dramatic increase in, in-state crime
gun recoveries. In 2006, about 50 percent of their guns originated
in Missouri. And as of 2018, it was almost 80 percent. In large urban counties where firearm homicide
tends to concentrate, these larger counties that were in states with licensing had 11
percent lower rates of firearm homicide. And in the context of mass shootings, that’s
a common outcome that we talk about. And while it’s exceeding rare, it tends to
drive the policy conversation. We have some new research that’s forthcoming
that found that purchaser licensing laws that had an in-person application and fingerprinting,
reduced the incidents of mass shootings by 56 percent and reduced the victims in these
incidents by 57 percent. Because again the process of applying for
and obtaining this license can delay impulsive acquisition, that can reduce the likelihood
that someone can obtain that firearm to harm themselves or others. Backgrounds checks enjoy really broad public
support. Consistently they are supported by over 85
percent of U.S. adults with very little difference between gun owners and non-gun owners or across
the political spectrum. While purchaser licensing laws don’t have
quite that same level of support, still 75 percent of U.S. adults support licensing. That includes more than 60 percent of gun
owners who support being required to apply to state or local law enforcement before they
can buy a gun. And when you look at gun owners who live in
states that already have a licensing law, that support is over 75 percent. Among African- American individuals who live
in metropolitan areas, those who are among experiencing the greatest burden of gun violence,
they’re support for licensing is 80 percent. So we often hear that gun laws are in violation
of the Second Amendment. And that licensing is going to create this
big owners burden and prevent people from exercising their Second Amendment rights. If that were true, we would expect to see
lower levels of support among gun owners who have gone through the process of obtaining
a license. But in fact, we see quite high levels of support
for this evidence-based policy. So I’m going to wrap up with some recommendations. Congress needs to pass legislation requiring
background checks for all gun sales. Individuals should not have an opportunity
to buy a gun from a private seller without being subjected to a background check. And unless we close this policy gap, we’re
going to continue to experience harms to our public’s health. Congress should also explore the feasibility
of establishing a federally licensing system to make sure that all gun owners are thoroughly
vetted before buying a gun. In the absence of a federal system, states
should complement their background check requirements with a licensing law that includes fingerprinting,
an in-person application, and safety training. A really important piece of any policy’s functioning
is accountability. Are you enforcing it? We’ve heard about implementation from other
speakers. So state and federal law enforcement agencies
need to be holding individuals accountable when they violate the law. People who lie and try, people who engage
in (inaudible) purchase or otherwise make guns available for use in crime need to be
held accountable so that we encourage responsible behaviors. And finally, Congress needs to provide incentives
to states so that they can support their activities, whether it’s policy or some of the community
level interventions that we’re going to hear about in the second panel. There needs to be resources dedicated to reducing
the burden of gun violence through both policy and programs. Thank you. And our next speaker is DR. Daniel Webster. DR. Webster is a Director of the Johns Hopkins
Center for Gun Policy and Research and a Bloomberg Professor of the American Health — the Johns
Hopkins Bloomberg School of Public Health. Dan. MR. WEBSTER: Hi, good morning. The policy I’m going to discuss today addresses
assault weapons and large capacity magazines that I’ll define in just a moment. Not surprising, the reason that this is part
of this panel — why we’re having this discussion is that these are the type of weapons that
are most commonly used in the most high profile public mass shootings. There’s no category of gun deaths that is
rising as rapidly as are those types of shootings — the public mass shootings. And in variably, those events with the highest
casualty counts involve the use of an assault style rifle and large capacity magazines. So let me define that very specifically. While large capacity magazines are relatively
straight forward to define, at least in terms of policy. Most state policies that ban — I’ll use the
term LCMs for short — define that as more than ten rounds of ammunition in the ammunition
feeding device or magazine. Assault weapons are defined as semi-automatic
firearms that are able to accept these large capacity magazines and typically have one
or more other features that are commonly associated or more designed for military or criminal
purposes. These may include pistol grips, folding stocks,
barrel shrouds, other types of characteristics that sort of facilitate a large — a very
rapid fire of the gun in a very short period of time. So the policies in question have banned the
sale and manufacturing of these firearms. And for the period of 1994 to 2004, we had
a federal ban of assault style weapons and LCMs. Several states also regulate or ban these
types of weapons. Seven states in the District of Columbia — I’m
not advancing my slides, I apologize — banned assault weapons and large capacity magazines. And two states, Colorado and Vermont, just
restrict large capacity magazines. Now in some of these instance, they also address
pre-banned or the grandfathered types of guns. The District of Columbia prohibits assault
weapons all together. Two states limit where you can have them and
require licensing of those firearms. What do we know first about the use of these
types of weapons and crime? Well shockingly, none of our systems truly
track the use of these types of firearms in violent crime in the United States. What we have to go on is the Bureau of Alcohol,
Tobacco, and Firearms Gun Trace Data. We know that 5 percent of guns traced to crime,
recovered by law enforcement are categorized as assault weapons. If you look at the weapons used in instances
when law enforcement officers are shot and killed in the line of duty, those represent
13 percent of those cases have assault weapons. And the other estimates and much of this research,
I should acknowledge, Christopher Koper who’s done some of landmark research on the use
of these weapons and crime, find that they’re used in anywhere from 10 percent to 30 percent
of fatal mass shootings. Now what about large capacity magazines? Again, the only thing we have to go on now
is the handful of cities that track such things. And from those cities, we see 22 to 36 percent
of firearms recovered by law enforcement involve a large capacity magazine. And if you look at their use in fatal mass
shootings, large capacity magazines involved in 20 to 67 percent of these fatal mass shootings. And the reason for these ranges in this study
is defined based on the victim count or the circumstances, how restricted they are in
their studies. Now Dr. Koper has a paper coming out that
compares the fatalities and injuries and instances of fatal mass shooting with and without these
types of weapons. What he finds is that fatal mass shootings
with LCMs have 60 to 67 percent higher fatality counts. And about two to three times the number of
nonfatal wounding counts in fatal mass shootings. In a study that looked at what we call active
shooter scenarios, these are cases in which people come into a crowd of people to try
to shoot large numbers of people and looked at a number of factors that may play into
the casualty counts. In that research, they estimate that having
a large capacity magazine roughly doubled the — I’m sorry, it was a semi-automatic
gun, usually assault style rifle with an LCM that doubled fatality counts and increased
nonfatal woundings to 81 percent. Now there have been a very limited number
of studies that have been designed to look at very specific gun laws and their association
with fatal mass shootings. And I should say that Dr. Koper also looked
at the federal assault weapons ban and found no association with overall rates of violent
crime, which should not be surprising since really the issue is principally in fatal mass
shootings. But these studies have had mixed results and
have a variety of limitations. One study just looked at FBI data and focused
exclusively on the federal and state assault weapons bans, but not other types of gun laws
and found no evidence of protective effects. Another study conversely published earlier
this year looked at fatal mass shootings and found the opposite conclusion and estimate
that as many as 70 percent reduction might be attributable to the Federal Assault Weapons
Ban. This also had important limitations on their
data that they used and definitions of — basically they excluded a very large number of fatal
mass shootings in this study. And yet, another study also published in 2015
looked exclusively again only at assault weapon bans and did not look at other state laws. The estimate from that study suggested a protective
effect. So you have mixed findings across these studies,
but they have very important limitations. That motivated our team at Johns Hopkins to
do a new study looking at the association between these firearm policies and fatal mass
shootings. And I’ll summarize our findings here. So first of all, we identified over 600 fatal
mass shootings from 1985 to 2017. Interestingly we identified some of the biggest
mass shootings that have driven policy discussions were actually excluded from the FBI system. That’s a separate discussion. What we found and what we do, we comprehensively
look at a number of state laws and a number of covariates that are associated or theoretically
connected to fatal mass shootings in our study. We found no association between — no statistically
significant association between the Federal Assault Weapon Ban and this outcome. Nor did we find a statistically significant
effect for state bans of assault weapons. Now the point estimate did suggest a 29 percent
lower rate associated with those state bans of assault weapons, but not statistically
significant. We think a reason that we’re not seeing this
impact from the federal and state laws is that there are many different alternatives. And if these types of weapons are banned,
for grandfathered guns, from guns coming from other states and other ways to basically get
around these laws. But we found very different encouraging effects
when we looked at restrictions on large capacity magazines. Our estimate was that these laws that ban
large capacity magazines are associated with a 49 percent lower rate of fatal mass shootings. And if you look at this on a per capita basis,
the number of fatalities from fatal mass shootings, we see a 70 percent lower rate of individuals
killed in these shootings associated with bans of large capacity magazines. Now we looked at a number of different ways
to sort of look at the sensitivity of our findings to different model assumptions. We even did some studies where we excluded
certain mass shootings like the Aurora shooting in Colorado in Newtown that soon afterwards
led to a large capacity magazine restriction. And we sort of set those observations aside
to see if our results were consistent. And largely they were. The one exception is if you assume that these
laws have a gradual impact, rather than a more immediate impact, our estimates are lower
and not statistically significant. So most of our tests are highly robust to
a variety of model assumptions. So this leads to what I think are some clear
policy recommendations relevant to these questions that are so important to fatal mass shootings. I think very clearly the evidence indicates
that we should ban both the sale and possession of large capacity magazines. That will reduce the number of fatalities
quite substantially. We might consider having stiff penalties for
possession of these firearms if we want to take this seriously. And think carefully about ways that we recover
or encourage people to get rid of any large capacity magazine that they might possess
when a ban goes into effect. A more challenging question really is what
do we do about assault weapons? I believe the available evidence right now
suggests that yes, they are very clearly highly involved in these fatal mass shootings. I would say there’s not a justifiable reason
for civilians to have military style weapons like assault weapons. But right now, we’re not seeing — the policy
solutions that are being proposed are not having the effect, I believe that a very prudent
policy recommendation would be. We need to highly regulate these types of
firearms. Require licensing, as Dr. Crifasi told us
the many benefits of that. And I should say that the other policy most
strongly associated with reductions in fatal mass shootings was licensing for firearm purchasers. I believe a 44 percent statistically significant
reduction associated for fatal mass shootings connected to purchaser licensing. So we need to tightly regulate and restrict
these types of firearms that are already available that are very challenging to address in a
practical way of how you restrict that type of firearm, given how many that we already
have. So that concludes my presentation. So we’re going to go and have Q&A and just
I’ll take my seat back and we’ll do that from that. We’ll certainly have some mics in the room
up here, I think on the right for people who are in the room who want to ask a question. And I know that hopefully we’ll have some
questions that are coming in from our social media feed. With that, let me just start the first question
just to get things rolling. You know, for me as I listen to the various
policies, in many ways, it seems like helping to identify people who are at risk is the
core of what we’re talking about. And then using a variety of tools to decide
who and who should not have a firearm for a variety of periods. Some people should never have one. And certainly some people should have it removed
because for some period of time, they’re at risk. Dr. Crifasi, could you talk a little bit more
about licensing and how — again just reiterate some of that important work. And then in fact, if you could follow that,
Dr. Zeoli, talking about that in the context of domestic violence again. Can you hear me? Good. Oh, I can hear myself now. Okay. Yes, so one of the really important elements
of a licensing system is that state and local law enforcement are conducting a background
check in addition to federal law. So they have access to state records, local
records for criminal prohibitions, but also mental health records that haven’t yet perhaps
been reported into the federal system. And so you have sort of a multi- layered approach
to the Background Check System and that interaction with law enforcement going in, submitting
fingerprints, having that conversation can change your relationship to purchasing that
firearm. It’s not the same things as walking up to
a garage sale or a pawn shop or even going to a licensed dealer and just having the individual
who is interested in selling you the firearm, conducting the background check. So adding that extra layer of accountability,
more records, more time, sort of better identifying and screen out those people who have a risky
condition or risky behaviors that, you know, we’ve decided they shouldn’t own firearms. And to bring to — And to bring it to domestic
violence perpetrators, it is incredibly important that those records get into the Background
Check System. There is an incredibly — and unfortunately,
you know, a famous case of a shooter who had been convicted of domestic violence through
the military, but the military didn’t put those records into the Background Check System. And so he committed a mass shooting at a small
church in Sutherland Springs, Texas. So just restricting somebody isn’t enough. We need to actually make sure through that
purchase restriction and purchaser licensing laws and through removing guns from those
who already had them, that they don’t have access to guns. If we don’t work on implementation, than it’s
just words on a piece of paper. Let me ask Shannon and Jeff if you can pipe
in on that same point. Well I would just say in apropos of the risk-based
approach that, that is true. It’s challenging. You know, there are other countries that take
a different approach and say well, let’s broadly limit legal access to guns. And the default is people don’t have access
to guns. And then on the margins they make exceptions. And in our country, it’s kind of the opposite
because of the way our Supreme Court has interpreted the Second Amendment to the Constitution. So the default is people have this right and
we’re talking about risk. We’re actually talking about trying to identify
people who pose such a high risk or category of individuals who pose a risk that it’s justified
to limit that person’s Second Amendment right. And that’s very difficult to do scientifically
because the risk factors for violent behavior and misusing firearms are many and they often
are nonspecific. They tend to apply to many more people who
aren’t going to do the thing you’re trying to prevent. So that’s why we, I think need, the kind of
research that we’re doing to bring to bare to those policy decisions to help strike this
balance of risk and rights. And you know, because — and the evidence
base needs to be developed as we go along. And having this conversation between evidence-based
policy and policy informed research. So we as researchers are actually doing studies
that matter. If we get the answer to that question, it’s
going to help us to enact a policy that will save lives. Yeah, and I would say that one of the most
exciting things about Extreme Risk Protection Orders from my perspective, is it gives us
an opportunity to go further back in the trajectory of violence. Right? So we don’t need to wait for someone to be
convicted of a crime in order for them to be ineligible to purchase or possess a firearm. We can look to our communities. We can look to family members, intimate partners,
law enforcement who are often times on the front lines of seeing crisis unfold to say
you know what, this isn’t a good time for this person to be owning/possessing a gun. Let’s go to the court. Let’s talk about what this crisis looks like
from the perspective of a loved one. And assess whether it’s a good time to temporarily
step in and remove that person’s ability to purchase and possess firearms. So what we’re doing with these sets of policies
is moving from, you know, the licensing and registration which really looks at an important
indicator of risk with past criminal behavior, past criminal convictions. We’re looking at domestic violence behavior,
which is incredibly predictive of future violence and thinking about ways to intervene through
those behaviors. And then with Extreme Risk Orders, we’re looking
at what family members and law enforcement — Again, the people are on the front lines
of seeing these trajectories begin have the authority to go to the court and with a due
process system in place, really make the case for why someone should be temporarily prohibited
from purchasing and possessing guns based on dangerous behaviors. So we’re getting more and more comprehensive
with regard to how to, as Jeff likes to say, you know, identify the many needles in a small
haystack as opposed to where we were maybe five, ten years ago. And where we really didn’t have a lot of those
good risk factors at our disposal or the tools to act once we identified those risk factors. I think it’s an exciting time in our country
with regard to where the evidence has taken us and the opportunities for good policy. You know, one of the interesting things of
course is that we’ve had all these tragic mass shootings that have gotten the nation’s
attention. And one of the interesting things to me — and
I think I hear that from every one of your presentations — when you do the look back,
you always find oh, we missed this or we missed that. And I know Jeff, you don’t like the term “red
flag laws”, but you know, for us more colorful people like me, you know, there was something
we missed. And I think what I’m hearing is that we’re
learning a lot more about what those opportunities are and how we can narrow in on what those
risks are, identify them, raise them to this ability, and then act on them. But it does require an infrastructure and
a knowledgeable public and system to do that. Would you all agree on that? Absolutely. Yeah Yes. Dan, you know, your issues around assault
weapons. In the back room, we were talking about the
challenges of actually identifying an assault weapon and the whole process of peoples ability
to buy them and how they buy them in sections. Can you talk a little bit about that because
you didn’t bring it up in your talk. Well one way to get around some of these restrictions
— I should be clear again that the way assault weapons tend to be defined is based upon a
set of characteristics. And what actually is the heart of our regulatory
process is sort of the guts of the firing mechanisms for the firearms. But you can now acquire these different components
to make yourself an assault weapon and buying those parts separately now. And the manufacturers know that very well. The manufacturers have really frankly created
a different environment to get around the type of restrictions that we’ve had on assault
weapons. So I believe that is why we see the pattern
of the findings that we see so clearly. That the bans that are based upon those characteristics
have not had measurable impacts. I’m not saying they have none, but it’s hard
to identify it statistically. But the thing that you cannot sort of get
around is the capacity of the ammunition feeding device or magazine. And that is — I think anybody who studies
mass shootings and the role of firearms will say that its ammo capacity is really the most
critical feature here. So unless you want to try to create an environment
in which there are no semi-automatic firearms, which I don’t think that’s going to happen,
the very logical and most impactful way we can address this is by restricting the ammunition
feeding device. Interesting, interesting. So the guts is the number of bullets. Yes, absolutely. There’s a question over here. 4 We’ve had some great questions coming in
on Twitter. The first is they’ve talked about all these
great policies that are working, but why aren’t they being placed into effect everywhere? What’s standing in our way? Daniel Webster. It has a lot to do with the very powerful
gun lobby. And they have been a dominant presence in
making policy at the federal level certainly and in many states as well. And what’s most troubling really is that we’ve
compiled an incredible amount of public opinion data. We like to say that gun control or gun policy
is a highly controversial topic. The truth of the matter is that the most important
policies that we’re talking about; universal background checks, licensing, a lot of regulations
over dealers, the domestic violence Good morning. restrictions, the Extreme Risk Protection
Order laws, all of them have incredibly high public support in both parties in terms of
when you talk to the people. So I think the reason that we don’t have this
is purely a political problem — a structural problem that has to do in part with a great
deal of influence that single issue lobby groups can have. But just on a hopeful note is I truly think
that, that is changing. I’ve been studying this area for almost 30
years — roughly 30 years. And we’ve never been in a time with such strong
grasp of support for addressing these weaknesses in our gun policies. So I do think — and we’re certainly seeing
in Extreme Risk Protection Order laws, domestic violence laws as well, a lot of policies are
being enacted. So I’m optimistic. Yes? Yeah, I would also add — I totally agree
with Daniel’s points. But for the last few years, mass shootings
have really dominated the policy conversation. When a mass shooting happens, that’s when
people want to talk about policy solutions, particularly at the federal level. And until very recently, we haven’t had the
policy prescriptions to talk about how to prevent mass shootings. We have you know, policies that we know are
effective for suicide and homicide and diversions of guns for use in crime. But now with ERPOs and you know, emerging
evidence we have on licensing related to mass shootings and domestic violence, the role
of that in mass shootings, we’re able to, when a mass shooting occurs, pivot to the
larger burden of gun violence with these effective policy solutions. And I hope given the broad public support
and the effectiveness of these policies, that we can really start to see more movement forward. Another question from the net. Yes. Our next question is what communications or
advocacy strategies do you recommend to help legislators, Republics in particular, credibly
counter their stakeholders argument that the Second Amendment prevents popular firearm
safety policies? So the excuse is the Second Amendment’s in
our way. I remember when Scalia talked about that. He was real clear that there were limits to
the Second Amendment. You’re actually right, Dr. Benjamin. And sort of who will be credible to the Republican
constituents, well Anthony Scalia. So I would quote directly from Judge Scalia
to say that actually the Second Amendment allows a great deal of regulation as courts
have interpreted it to date. And that many of the policy prescriptions
we’re talking about really do not disarm law abiding people. The whole second amendment issue — really
the core of that is are you going to take my gun away? And the policies and the evidence that we
have available right now indicate that you can do that in a very narrow, legally, defensible
way that does not affect law abiding citizens. So I think those are really the talking points
is look at Judge Scalia to tell you about the Second Amendment, not the NRA. And that the policy prescriptions that really
work, do not disarm law abiding citizens. Thank you. Did you want to � I just wanted to add I agree with that 100
percent with respect to risk protection order laws. I think there’s also a way of talking about
them in a way that people on both sides of the debate about gun rights and gun control
can agree with. I mean for example, you could say — and I
think many gun owners would agree — that risk protection order laws do not represent
an expansion of gun control. They don’t affect law abiding gun owners. And you could even say that if you think that
it’s people and not guns who are responsible for gun violence, this is really an effective
tool to help you identify who those people are. And I think it does give a common place to
stand. You know if we start with this question, well
should someone who is at manifestly high risk of harming someone else or themselves, at
that time, should they have legal access to a gun? Overwhelmingly people across the political
spectrum, guns owners, non-gun owners are going to agree with that. And then you could say okay, well let’s start
here and maybe that’s a place to build from. Yeah, and if I may? Please, Dr. Zeoli. To add to that, you know we’re at a point
unfortunately in our country where it’s not hard for anyone, albeit a policy maker or
a scientist, or an advocate to have a person experience with a gun tragedy in your family. And it’s certainly not hard for people to
sort of call up a personal experience when a loved one was in crisis. And to imagine that during that crisis, it’s
a particularly bad time to have access to a gun. So in conversations with policy makers, with
other stakeholders around Extreme Risk laws with regard to domestic violence laws, we’ve
had great success in terms of that communication strategy with personalizing the issue. Because again unfortunately, we all experience
loved ones who go through crisis and are at points in time when it’s just simply not a
good idea to have ready access to lethal means. You know, it’s funny. We do this with everything else. You know, we have a family member in crisis,
we go in the house and we take away the pills. We take away the knives. If we’ve got kids coming over, we lock up
cabinets. Why shouldn’t we do this with firearms as
well? It’s really a safety issue more than anything
else. What about the role of law enforcement? Obviously law enforcement certainly generally
supports most of these kinds of things. Would you like to talk a little bit about
that? I’ll just say one thing again about the risk
protection order laws as a context. I think that we have found in many conversations
with law enforcement that they see this as an important tool. You know, to be in a situation where there
is knowledge that someone poses a risk and not to be able to act until something happens,
puts law enforcement in a bad place. And so I think even if they might differ on,
you know, larger issues with respect to guns, we have found law enforcement are very much
in favor — particularly, you know, when you think about the implementation context. Once they have experience with using this
tool and have kind of worked out some of the kinks of how you do it and how the guns are
stored and so on. And I also think it’s very important with
regard to enacting these laws in the states that haven’t done so, to have strong support
from law enforcement. And I think this has been the case in almost
all of the states where they’ve been enacted, is they have been a strong voice at the table
advocating for these laws. And so I mean, that’s an answer from you know,
one context. I think if the focus is really on the problem,
how we understand it, the people, the stories, the people affected, and the logic that this
solution has in terms of how it connects to the problem, that’s where you get lots of
support. When the context moves over into the politics
of winning and losing, that’s when you run into trouble because then it becomes much
more adversarial. And even people who might support it in the
context of thinking hey this makes sense, once its over — And so I think trying not
to shift into this, you know, political space of who’s winning and who’s losing? But rather, this is something that could save
lives. And I think these are policies that can work
together to save even more lives than one individually. Dr. Zeoli. And you know, in terms of law enforcement
and domestic violence, it’s fairly well known that domestic violence calls are some of the
most dangerous calls that law enforcement will go out on. Compared to other types of calls, they have
a very high rate of being shot and killed on domestic violence calls. So they’re also in favor of removing guns
from domestic violence abusers, not only for intimate partner safety, the children in the
household’s safety, but their own safety and the safety of their colleagues. And they have a great role to play in implementation
of you know, those laws as well in terms of cataloging, you know, which abusers have guns. So that when it comes time for relinquishment,
if the person is prohibited from having a gun, they have a record of you know, who they
need to go to. Who they need to remove a gun from legally
and safely. And in the context again of officer safety,
licensing has been associated with reductions in officers being shot in the line of duty. So there’s some occupational safety benefits
as well. Yes? And I’ll just say, you know, we’re here with
the American Public Health Association. And I’ve had many conversations like Jeff,
with law enforcement around Extreme Risk Protection Order laws. And quite frankly as a public health person,
it warms my heart to hear them get excited about prevention for the first time in their
career. So we’ve set up law enforcement in a very
difficult situation in which the tools that they have by and large are reactive. With Extreme Risk Protection Order laws, what
we’re giving them is an opportunity to get ahead of the tragedy and they recognize that
immediately. And it’s very exciting, I think from a 30,000
foot perspective to think about having law enforcement as a new partner in prevention
in a way that previously we haven’t had. And quite frankly at a time in our country
when we need law enforcement to be thinking about their roles in community in a different
way. Another question in the room over here, Hi, I was — my name is Eugenio Weigend from
the Center for American Progress. My question is if you have explored licensing
and perhaps the assault weapons on the level of gun robberies across the state here in
the United States. And in terms of the assault weapons, I have
two additional questions. One is pertaining to the international trafficking
as well, if, like assault weapons there has a very important role to play that we might
consider to advocate for that particular law. And if you are one of, when you say regulate
assault weapons you mean regulate them as we do automatic weapons right now. Or what, what, if you could be more specific
than that. Sure. Do you want to first talk about the robbery,
the robbery issue first? Yes, so, the vast majority of states don’t
require gun owners to report when a gun is stolen, and so getting really good data on
robberies can be challenging. I don’t, I know that some researcher sat Harvard
have done national surveys and they�ve asked folks who, who have had guns stolen, et cetera. I don’t know that anyone has looked at the
licensing of gun purchasers and the association with stolen guns. But we do know that licensing is associated
with fewer guns being diverted into crime, and so, logically, it could potentially contribute
to some reductions in, in gun theft. So, excellent questions relevant to assault
weapons. Clearly, assault weapons play a very important
role in not only in mass shootings in our own country, they are actually having a very
detrimental effect in, in Mexico and Central America and other countries. Guns that are made and — and initially purchased
in the United States, because of our weak laws, are able to be trafficked to these other
countries and cause an enormous amount of harm. So, we should definitely recognize that. The, the other reference I think had to do
with regulating assault-style weapons in a way that we currently regulate fully automatic
firearms. Dating back to the 1930s, there’s a law that
basically heavily, heavily regulates and, and restricts fully automatic weapons, and
that would be a tool that we could consider, certainly, to address semi-automatic weapons
as well. So, I think, in essence, the policy choice
before us that I think makes sense is either, you know, not focus on the way we’ve banned
them before, because they’re so easily, get around them, but have stronger ways to, to
regulate and restrict that, that require licensing, registration, taxes, those types of things. So, that certainly is a, is a direction for
consideration as well. Okay. Let me, let me, you know, every time we have
one of these tragedies that hits the news, because as you know, these tragedies are occurring
each and every day in the nation, but the ones when they hit the news, we all run to
the mental health corner and say, boy, if we simply strengthen mental health services
in this country, you know, we will solve the firearm problem. Now, let’s just recognize the fact that we
have people with mental illness holding up beds in the hospital emergency departments,
sleeping on the streets of our cities, tragically losing everything that they have, and we have
not yet invested in mental health for those problems at all, but as soon as there’s a
shooting, we, we run to, to at least express desire to do that. And then, of course, we don’t. Can we talk about the, the role of both mental
illness as a contributor to violence? And then let’s talk about the benefit for
those people who are mentally ill, since 60 percent of suicides certainly occur with,
with guns. Well, I’ll take a crack at that. Well, that’s something I’ve thought about
quite, for a long time, and, and I think what happens is when there’s a mass shooting, that’s
when we start paying attention to what actually is, is not just one but two different public
health problems that sort of intersect on their edges. The idea that this is all about mental health,
if we could somehow fix the mental health system, that will reduce mass shootings or
end gun violence in general, is in part, I think, a dodge to not focus on issues regarding
the role of guns in shootings and in violence. In part it’s, it’s kind of a scapegoating
mechanism, because a mass shooting is so troubling, it’s so irrational, it’s so 1 scary. We want to, a solution or an answer. Why’d this happen? And mental illness is a, is a, is an easy
out and it resonates with what lots of people already believe, that, that, that mentally
ill people are dangerous. But when we bring science to that narrative,
we have to debunk it in one big way, which is that the overwhelming majority of people
with serious mental illnesses like schizophrenia and bipolar disorder and major depression,
are not violent towards other people and never will be. And the majority of, of gun crimes are, are,
are committed by people who don’t have one of those mental illnesses. Now, you know, with regard to mass shootings,
it, it’s easy to say, well, someone has to have been crazy to do that. That’s not the act of a healthy mind. What we actually know from the research that
we’ve done is that the, and it’s kind of hard to tell, but the majority of mass shooters
do not have one of these major kinds of psychiatric disorders, and in particular, the increase
that we’ve seen in recent years tends to be in the category of people who don’t have one
of those mental illnesses. They’re following some kind of a very deviant
cultural script, and are, are very aggrieved young men who have access to this incredibly
efficient technology to take a lot of lives. So, there certainly is a problem with untreated
mental illness in our country. The mental health system we have is fragmented. It’s overburdened. It’s under-sourced and it doesn’t work very
well for lots of people. Tens of millions of people have mental illnesses
in this country. And we do need to reform that system and invest
in it. But that’s a, a solution to a different problem,
and I think conflating those two is very important to, to separate those issues. Now, suicide, of course, is responsible for
two-thirds of the gun deaths and mental illness is a strong vector in, in suicide. So, that, I think suggests that we should
have a conversation about mental illness and, and, and firearm injury and mortality in the
context of suicide, suicide. And I think that’s where a lot of people can
come together who otherwise might be in different camps. Because it’s very stigmatizing to only talk
about mental illness after a mass shooting. The web. Another question from Is this on? No. Is it? Yes. Go ahead. This is from, this is from one of our livestream
viewers. A piece in the L.A. Times noted that an overwhelming
majority of mass shooters have very high ACE scores, A-C-E. This is much more complex than an issue of
mental illness. In terms of policy, what can be done? Can, can we describe the, the ACE scoring
system? It’s, it’s the Adverse Childhood Trauma and
Injury, and certainly, we, we know for sure that early in life, many children experience
a range of both physical, emotional, psychological traumas that ultimately result in a range
of behaviors that cause them to have troubles in school, have short attention spans, can
be more aggressive. But they don’t produce as well and, in society,
and, you know, some of them have been exposed to alcohol in utero. A whole range of, of things, but one of the,
the, the thoughts of course is that some of these folks are more prone to be more violent
as they get older. Well, I’ll just say that yes, those early
traumas and, and challenges that individuals face often very early in their lives, there’s
tons of research showing that that elevates risk for being, being involved in serious
violence. And so, the violence both causes those traumas,
right, and, and, and there’s sort of a circular process here. But it, I, I think our next panel will actually
be able to speak to some of these things because they, they underlie some of the intervention
models that are, that are designed not only, I mean, we, we don’t have just one thing in
our tool bag of just focusing on guns. There are behavioral dimensions to this that
really will be exciting to hear about in our next panel. With that, I know that the, the clock is coming
down. Let me just ask each one of our panelists
if they could just give me a, just a quick one or two word thought, and we’ll close this
panel out. I, I’ll just say, you know, there’s general
agreement that individuals who have histories of violence and dangerous behaviors should
not have firearms. There really is not much debate about that. The question really is, how do you effectively
do that? I think our panel today really provided some
great examples of how you can do that. Licensing for, without a doubt, we see so
consistently playing this effective role in that fundamental thing that again is not,
not debatable, right? We don’t want people with histories of violence
to have guns. So we, so we have tools. We’re expanding them with extreme risk protection,
order laws. And, and so, basically, in my mind it is,
are we actually going to take this seriously? I, I feel like some of our policies are kind
of just around the edges, and they aren’t really investing in creating systems that
actually achieve that critical objective and, including the enforcement part. So, that’s the theme that I see is there are
policy tools that work. You can’t do them on the cheap. You actually have to create systems that they
work. Dr. Crifasi, did you have any final thoughts? I would just add, as we�ve heard today and
this morning and we’ll hear a little bit later, it’s not one thing. Gun, gun violence is not a one solution problem. It’s going to take a multi-faceted approach
and it can’t just be policy. It has to be resource investment. It has to be individual and community level
interventions as well as policy implement. Relinquishment of guns for those who are now
prohibited from having them can be Dr. Zeoli? Yes, I, I would add to, to that, that, you
know, the policies really do need to be implemented. We cannot stop with just the passage of the
policies. And some of these are pretty, you know, difficult
and complicated to complicated, but we have a number of communities that are getting it
done safely and legally, and we need to look to those models. (inaudible) And I would say, looking to those models,
there’s no better way to do that through, than through research, than through rigorous
research that can really light the way as to how we can be most effective with regard
to our implementation and enforcement efforts. And Dr. Swanson? So, we’re here today speaking to a debate
at the national level that has come to the floor because of concern out of mass shootings. But every day that there’s a mass shooting,
a hundred other people die all around the United States, and the circumstances are diverse. Suicides, domestic violence incidents, arguments
gone bad between impulsive young men in the middle of the night who happen to have a gun. The problem is very complex, and with lots
of diverse factors, everything from downstream solutions to trying to remove access to a
gun of a person in a moment in crisis, to moving way upstream in trying to figure out
how we have healthier communities with fewer kids exposed to trauma who might grow up to
be perpetrators. All of those things need to work together,
and they’re going to take a long time. There’s not a way to wave a wand and suddenly
make this problem go away. We have to, and I think all of us are in it
for the long haul, and we hope that we’ve been able to communicate that today. Can we give our panel a round of applause? We’re going to take a, a 10-minute break to
switch panels. So, we’ll be with you in about 10 minutes. Great. I think we are back. So, thank you for tuning in to Policies That
Work to Reduce Gun Violence. I am Josh Sharfstein from the Johns Hopkins
Bloomberg School of Public Health, and we’re here for the second half of this morning’s
event. I want to particularly thank our partners
at the American Public Health Association for working with us in putting this on. And I want to say thank you to the people
who are here, to the people who are watching on the webcast, to the people who are joining
online, and say that this a great conversation and it’s one that is going to continue past
today. We’re going to make not only the whole video
available, but pieces of the video available, and unfortunately as these many different
kinds of tragedies keep going, we will be trying in every way possible to introduce
evidence about what works into the policy discussions around the country and here in
Washington. One other thing, during the first session,
I was, I had a prime tweeting seat right here, and I was taking pictures and tweeting. I did the Jeopardy tweet, I did the dog GIF,
I did everything I possibly could to call attention, but I can’t do that while I’m up
here. So I’m counting on people here in the room
to tweet using hashtag gun policies that work and people who are watching online to join
the conversation at hashtag gun policies that work. So, we are now going to talk about a whole
different set of policies with strong evidence for them that reduce gun violence. She’s also an affiliated research analyst
with the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public
Health, Dr. Buggs. And it’s my pleasure to introduce Dr. Shani
Buggs for the next presentation. She is a post-doctoral fellow in violence
prevention research at the University of California at Davis. Thank you, Josh, and good morning everyone. The Group Violence Intervention and Cure Violence
models are two of the most well-known strategies for reducing gun violence among individuals
most at risk for violence. Both approaches are rooted in the concentration
of violence theory, which suggests that a substantial proportion of violence in any
given community is driven by a small number of people. Research in cities across the country, including
Newark, New Orleans, Seattle, Oakland, and Chicago, has found that the majority of gun
violence is committed by a single-digit percentage of those cities’ populations. Research has also found that there is great
overlap between those who commit violence and those who become victims of it, due to
similar geography, social and peer networks, and risk behaviors. So, by concentrating on those individuals
who are greatest risk for violence, victimization, or perpetration, communities can see potentially
substantial reductions in gun violence. This conceptual model, highlighting the similarities
between the Group Violence Intervention and Cure Violence was adapted by one created by
Dr. Caterina Roman at Temple University. It shows that both strategies aim to identify
those at greatest risk for violence, to interrupt conflicts before they escalate or continue
a cycle of retaliation, and to engage community organizations and members in the strategies. Through these actions, the objective of steering
individuals and groups away from violent situations can be achieved, which then leads to declines
in gun violence and a shift in the acceptability of violence as a means to reduce, excuse me,
as a means to handle disputes and conflicts. However, these interventions accomplish these
outcomes through two very different processes. The Group Violence Intervention, or GVI for
short, was developed in the 1990s by criminologist David Kennedy, and it has since been referred
to as focused deterrence, pulling levers, the Group Violence Reduction strategy, or
Ceasefire. The model relies on the threat of law enforcement
intervention for those who do not heed warnings of severe consequences if gun violence continues. The strategy entails the formation of a cross-agency
enforcement team, including local, police, city, state, and federal prosecutors, federal
law enforcement agencies, and parole and probation departments. It utilizes data and intel from frontline
police officers and detectives, to identify key individuals within groups involved in
violent activity. The enforcement team then develops a strategy
to influence the behaviors of those individuals and groups by using all possible legal sanctions
against them. Once the strategy has been determined, a call-in,
or personal notification meeting, is held to directly communicate that the gun violence
must stop, and that there will be severe sanctions and enforcement actions if it does not. The message from law enforcement is accompanied
by messages from community members who have been negatively impacted by gun violence,
and who implore the individuals to cease the harmful activity. And the model includes a concrete offer of
services from local agencies and community-based organizations to support behavior and lifestyle
changes. If a shooting does occur, following a call-in
or notification meeting, and the police determine that it involved a member of one of the groups
represented in the meeting, then the enforcement team delivers on its promise of harsh consequences
to the entire group. Since its formal development, the focused
deterrence model has been applied to various types of crime concerns, including illicit
drug selling, and has been evaluated over two dozen times. In 2018, a systematic review of focused deterrence
interventions found that nearly 80 percent of the evaluations showed that the interventions
significantly reduced crime, and that the greatest impact was found when the approach
focused specifically on curbing violence. For example, in Lowell, Massachusetts, the
intervention was associated with a 44 percent reduction in gun assaults, with no evidence
that the violence was displaced to other areas. In New Orleans, the intervention was associated
with a 17 percent reduction in total firearm homicides, and an over 30 percent reduction
in homicides among those whose groups were represented in the call-in meetings. And Indianapolis saw a 40 percent reduction
in homicides following the intervention’s implementation. However, there are several points to note
regarding the GVI. First, the model has evolved over the past
20-plus years since it was first introduced, and different jurisdictions have interpreted
the significance and application of the components of the strategy differently. We also know that, although many replications
of the model have been independently evaluated, other cities that have not undergone evaluation
have opted to implemented some or all of the strategy. So, we don’t know the full scope of the mode’s
effectiveness. The evaluations that have been done have only
examined the intervention’s impact for around one to two years, so the model’s ability to
reduce violence over longer time periods is unclear. Additionally, several evaluation studies have
found that threats to model fidelity can occur at several stages of implementation, which
can undermine the success of the intervention in a given community. And importantly, because the GVI is most impactful
when its focus is on the specific behavior of gun violence perpetration, rather than
criminal behavior or group identity more broadly, it requires a fundamental shift in policing
strategy and an engagement with communities that are often already distrustful of law
enforcement. The Cure Violence model is premised on a much
different approach to violence deterrence. Originally known as Ceasefire Chicago, where
it was first applied, the model is based on evidence that violence behavior, like infectious
diseases, exhibits properties of contagion, including clustering, transmission, and spread
effects. The model entails three specific components:
interrupting violence transmission by mediating conflicts and eliminating the likelihood of
retaliation, identifying those at greatest risk for violence involvement in reducing
their risk through behavior change and linkage to needed services, and changing community
norms around violence through community mobilization and anti-violence messaging. The intervention employs street outreach workers
to develop relationships with the individuals at high risk for violence. The outreach workers often themselves have
had criminal or violent histories and are well-known in the communities in which they
work. They have also undergone personal transformations
and desire to steer the individuals with whom they work away from violence. Being previously engaged in or familiar with
the very behaviors and activities they hope to change increases the likelihood that the
outreach workers will be seen by their intended clients as credible messengers and potentially
trustworthy resources. Thee staff, then, serve as role models who
can exhibit prosocial behavior while helping to link individuals and their families to
critical supports and services. Through those relationships and supports,
program participants and those around them will ideally choose positive paths of development
and conflict resolution. The model also employs special outreach workers
who operate primarily as violence interrupters, working to identify, mediate, and deescalate
potentially dangerous conflicts that could lead to shootings. The violence interrupters play an essential
part in teaching nonviolent dispute resolution and minimizing the spread of violence by interrupting
retaliation following a violent incident. Because of the need to build genuine and trusted
relationships with those at greatest risk for violence, in order to mediate conflicts
and effectively help provide support, it is critically important that the outreach workers
and violence interrupters maintain a clear distinction from law enforcement. Though the employment of street outreach workers
to connect with and help redirect individuals involved in violent activity has existed for
decades, the Cure Violence model was developed and codified in the 1990s by epidemiologist
Gary Slutkin. The model has since been replicated in dozens
of cities in the U.S. and around the world with numerous independent evaluations. Those evaluations have yielded mixed program
results. For instance, in Chicago, the program was
associated with reductions in non-fatal shootings in some, but not all, of the communities where
it was implemented. And program effects on group involved homicides
and retaliatory shootings varied across sites. In Philadelphia, the program was associated
with a 30 percent reduction in non-fatal shootings two years after it was implemented, while
in Baltimore, the program was associated with reductions in homicides or non-fatal shootings
but not both in three of the four communities where it was implemented. And more recent evaluations show that its
effects have attenuated over time. Several evaluations have also examined Cure
Violence’s influence on attitude changes about the acceptance of violence to handle conflicts. They found that the program was associated
with significant improvements in attitudes towards violence, and with increased confidence
in relying on police to intervene when violence occurs. However, like the GVI, several Cure Violence
replication sites have encountered major implementation challenges, from hiring the right outreach
workers to adequately supporting those who work in the program, to providing program
clients with sufficient and appropriate service linkages. And there have been some concerns about the
program’s ability to sustain reductions in gun violence over time, due in part to the
evolution of the nature of gun violence over time, and who may be seen in a community as
credible messengers with influence to intervene in conflicts. In interviews with street outreach workers
and violence interruption workers, researchers have found that some types of grievances,
such as those involving retaliation for the murder of a family member or friend, are more
difficult to mediate than others. There can also be problematic tensions between
program workers and law enforcement, who can sometimes view the alternative strategy as
counterproductive to their own violence reduction efforts. We have learned important lessons from the
implementation and evaluations of the GVI and Cure Violence models. Some cities have used those lessons, along
with requests from communities most impacted by gun violence, to reimagine public safety
and combine the approaches, while also incorporating essential elements such as case management,
mentorship, and healing through cognitive behavioral therapy. New York, Oakland, and Los Angeles have each
achieved impressive city-wide reductions in gun violence, by focusing less on any particular
model and authentically engaging with communities, allowing for collaborative, strategic planning
and meaningful feedback loops. They seek to meet individuals where they are
on their change readiness and personal goals, and they provide wraparound services to address
program participants’ needs. They have integrated elements of life coaching,
restorative justice, and community empowerment into program offerings. They prioritize approaches that encourage
positive police-community engagement. And most importantly, they have allocated
substantial and sustained resources for gun violence prevention programs, their participants,
and the staff doing the work. Knowing what we know, policy makers at every
level of government, mayors, city managers, city council members, state governors and
legislators, congresspeople and federal agency heads, should recognize that public safety
starts before, and extends far beyond, police and emergency services. Local officials should authentically engage
residents in the development of public safety plans for their communities, so that the residents
can help drive the changes they want to see. Local and state lawmakers should invest in
strategies that concentrate on those at greatest risk for violence, that employ community members
in both messaging and action, that provide bona fide support to individuals and families
by connecting them to the services they need to aide lifestyle change, and that foster
trust building and reconciliation between police and communities. And finally, Congress should allocate long-term
funding and devote resources to spur innovation in gun violence reduction approaches, especially
those that are community-driven and community-approved, and to effectively evaluate promising interventions
for their impact and scalability. Thank you. Thank you so much for that great presentation. I’m next going to ask Dr. Carnell Cooper,
who is the Chief Medical Officer at Northeast Methodist Hospital, to come and talk about
hospital-based interventions. So we’re going to move from the community
to the hospital. Dr. Cooper. Thank you, DR. Sharfstein. As I show this first slide only to let you
know that the National Network of Hospital-based Violence Intervention Programs has changed
its title, and we’re now the Health Alliance of Violence Intervention. This is the organization that really tries
to promote the proliferation of hospital-based violence intervention programs. I am a trauma surgeon, and 30 to 60 percent
of all our patients who are seen at our nation’s trauma centers for violent injuries, will
return to that trauma center with another violent injury. Now, if that were, if there, if it was a medication
or procedure that filled that amount of time, we wouldn’t have it, but that’s the data at
our nation’s trauma centers. When those patient’s return, we know that
they have a higher likelihood of dying. Data from the Lincoln Center in the Bronx
in New York in 2012, show that, that, that patients who presented to their EDH for penetrating
trauma injuries, who came back for a second or third time, were 10 times more likely to
die than the person who presented the first time. Therefore, at our trauma centers, when we
see our patients, we have an opportunity, perhaps, perhaps even an obligation, to offer
something other than patching them up and sending them out again. And that’s where hospital-based violence intervention
have an, come into reach. That’s the space that they come in. We see that patient when they arrive at the
hospital, after they’ve been stabilized, from multiple operations and surgery, while they’re
sitting in bed with that incision on their belly, with multiple tubes and multiple orifices,
families at the bedside, crying and wondering if they’re going to survive. And for the first time, that patient’s life
may have slowed down enough to begin to look at what is, what’s going on in their life. A teachable moment. And that’s the time when we see the patient
at their bedside and begin to address the issues that put that patient at risk for being
a victim of violence. So, what are those risk factors? Well, they’re being, they’re living in a dangerous
neighborhood, a violent neighborhood, they are, they are being poor, being in poverty,
they are having less than a high school education, being involved in I call them substance abuse,
being a single-parent family, having a history of being abuse, having been a part of the
criminal justice systems. That’s just some of the factors that put them
at risk. And the idea behind hospital-based violence
intervention programs is to meet that patient at the bedside and begin to address that issue. At the right, at the top of the screen, there,
you can see the hospital VIP team. That, that is part of the folks who will being,
address those issues. The most important member of our team is the
prevention specialist. That’s the individual that often grow, has
grown up in the same neighborhood that that patient is, is a peer, who meets them at the
bedside and begins that conversation. Begins to build a relationship. And then once that patient’s out of the hospital,
he’s going to help that patient get, fill out a job application, which we think may
be simple, but for some of our clients who have never had a job, it was challenging. For that client that has never finished high
school, filling out a job application is not something that he or she is going to admit
to, but it can be challenging. So that prevention specialist helps fill out
a job application, make sure they’re properly dressed and go to that job interview, accompanies
them to that job interview, helps them fill out that GED application, helps them get into
the GED programs. In other words, it’s meeting them, meeting
that patient or that client where they are and moving them forward. And that prevention specialist is the most
important part of that team. Although you can see the team is fairly, fairly,
fairly robust. So what is the data, says that this approach
works? Well, you can see on the screen here, there,
there are three studies. All of them randomized perspective studies
from, one from my team at the Shock Trauma Center in Baltimore, the other from Dr. Zahn
(phonetic) in Chicago, all showing robust differences in recidivism, meaning returning
to the hospital for another violence injuries compared to the control group. Randomized perspective studies. Dr. Aboutanos’ group from VCU, not quite robust,
but, but his study is small numbers and didn’t have quite as much support as the other two
studies. And you can see, in the mentor studies and
the case manager studies, for pediatrics, again, significant improvement in those patients
who got the intervention. And this is just a, a number of studies that
have, again, been done, including ones I showed you, that have been done in the past 10 years,
all showing that this is a, a, a policy. This is a program that works, that reduces
violence, that, that actually used to, that saves, saves lives. When we started, when we did our, our study
at Shock Trauma Center, we had, we debated whether to do a case control versus a randomized
perspective study. The case, the social worker in our team that
we sat there with, months, involved it in, said, I want to do a case control study, and
she said, it’s because if we don’t do a case control study, someone who could live will
die, who won’t die if you do a randomized perspective study. And there was this other person in there who
said, I understand that and respect that, but the gold standard for this work is randomized
perspective studies, and if I’m going to convince these crabby, cynical surgeons that these
kind of programs work, that’s where we’re going to have to go. And I, of course, was that person on the other
end of that trail. So, in our study, there were a hundred patients. Two patients died during that study, both
of them in the non-intervention group. I still see that, that social worker. She still smiles and reminds me of that decision. So, opportunities, there is, there are, there
are, we are now partnering with both American College of Surgeons and American College of
Emergency Medicines to try to get more hospital-based programs within our institutions. The data shows that it works. How can we build more? How can we make sure they follow the model
I described to you, again, that results in lives being, lives being, being saved. The other, is, is for having more of a conversation
about violence from a public health perspective, instead of it being from, from law enforcement’s
perspective. In neighborhoods that I grew up in, violence
was just a part of it. There was, there, there was the, alcohol,
there were poverty, there was domestic violence, there were fights. It was a part of the (inaudible). There were buildings that were vacant, there
were rodents that Dr. Branas is going to tell you about next. It was just a part of the, of, of that neighborhood. If we’re going to address violence, then we
got to address all of those things, those risk factors that put people at risk, from,
from those kinds of neighborhoods. If you grew up in a neighborhood where domestic
violence and gunshot wounds are part of who you are, then that is, that is the way you
develop. That was a part of my neighborhood. That was the way it was, a daily, weekend
routine. If we’re going to address the issue, we must,
again, address those, those public those. Now, I mentioned earlier the, the health issues
that, that begin to, that, resolve frontline workers, the prevention specialists. Two years ago, we went to a national claim
commission for uniform codes and asked that our prevention specialist be awarded a code
to be able to be billed for by Medicaid and other third-party payors, because the work
that they do warrants it. It’s the same thing that we do with some community
workers, workers, it’s the same thing we do for peer reviews for opioid abuse and for
some mental health issues. So, we were able, after a, being, being rejected
the first time, went back again, and now our prevention specialists are on the uniform
claim code, section on taxonomy code. The next step in the process is how do we
now get Medicaid authorized peers to recognized the work that they do and begin to reimburse
them for, for that. And that’s, again, why we continue to push
for the data that shows the work that they do is, is (inaudible). So, we’ve had, there’s some opportunities,
and, and we’ve had some successes. I want to, to highlight, there, in New Jersey,
this past year, there was bill, bills outlined there. The first bill was, we’re able to ask to,
get the commissioner to work with hospital-based violence intervention program to try to increase
the numbers. The second bill outlined there says that it
requires that all level one and level two trauma centers have a hospital-based violence
intervention program. And finally, the third bill, that, from New
Jersey, requires that the VOCA, violence, the Victim of Crime Act, provide funding for
those hospital-based violence intervention programs. And finally, the last bill to outline is on,
is on Governor Newsom’s desk in California. It’s geared towards being able to reimburse
the prevention specialists for the work that they are, are doing. So those are the things, those are, those
are some of the successes. If the interviewer from California, you know,
can get the word to Governor Newsom, I would very much appreciate it. And finally, the recommendations. Not, not surprisingly, and I think our data
supports it, is we recommend that, that trauma centers around our nation who see violent
injuries, and on my slide says a hundred, I don’t know what the exact number is, and
that’s up for debate, but trauma centers who see a significant number of violent injury
patients, should have a hospital-based program. It offers that patient a reason, to get, will
help them not come back again. Keeping in mind, as I said earlier, if they
come back again to our nation’s trauma center, their likelihood of dying is higher. So we have an opportunity and obligation,
from my perspective, to offset them. It also provides for the staff, those surgeons
there. So, we need to find ways of supporting this
program. The Victims of Crime Act is one of those agencies
that, that we have been able to That program offers them a support, offers them something
different, that we can do, that we can keep them from coming back. And finally, funding. Hospitals, obviously, as we all know, are
on a very slim margin, and they’re looking for things that are, for that, are going to
affect their ROI. They don’t see this, necessarily, affect their
ROI. It does impact readmissions, as we show in
our data, but otherwise, ROI is not like myself and nurses who are seeing those patients come
in, to say, we have something else to offer. We have something that, that will keep that
patient from coming back in. So they aren’t feeling like, gee whiz, we
shouldn’t pass, why are we doing this? They’re going to come back anyway and work
with to support programs across, across the, across the country, and that is an opportunity
and recommendations that we, that more of that money be, from the, from the VOCA funds,
and other, in the DOJ, and other federal organizations being able to support this, this, this process. And finally, getting back to that prevention
specialist, who, again, is most important part of our team. Over the past year, the health care, the,
the, for, for, for violence intervention, has developed a 35-hour prevention specialist
program. We want to make sure, once we got the taxonomy
code in place, we want to make sure that we had a uniform way of making sure that those
specialists all receive the same level of training. So, the care that they’re offering our patients
is uniform, the same that you would expect from a social worker or from a surgeon or
physician, et cetera. We want to make sure they all had a certain
level of training. So, over the past two years, actually, we
(inaudible) this difficult, this difficult training, essentially 35 hours, as I said
earlier, that will allow them to come away with a baseline of training experience that’s
necessary to offer support that’s necessary to move these patients, these, these patients
forward. Thank you very much. Thank you very much, DR. Cooper. Our next speaker is going to speak about reducing
blight in urban areas as a strategy to reduce gun violence. He is Dr. Charles Branas, the Gelman Endowed
Professor in Chair in the Department of Epidemiology at the Columbia University Mailman School
of Public Health and the Columbia Center for Injury Science and Prevention. Good morning. It’s good to see everyone here. It’s a pleasure to be here to come speak with
you. So, over a decade ago, some of our research
teams frankly became a little frustrated by the progress we were having in different cities
in terms of reducing violence and gun violence in particular. And we did something that is far too unusual
for researchers. We went out to the communities and we asked
the communities that were most effective, what is it that you think is generating the
violence and the gun violence in your neighborhoods? And we got a number of different answers ranging
from family structures, youth who are committing these violent acts, but the one thing that
came up over and over again across all different types of neighborhoods and different people
was this recurring theme of the abandonment and the vacancy and the physical dilapidation
of their neighborhoods, and that they knew, because they were witnessing it on a day to
day, that this physical dilapidation, and for lack of a better word, blight, in those
city neighborhoods, was generating the violence. Now, it’s been perhaps 60 or 70 years that
we’ve been in this terrible spiral in our cities. And I’m not just talking about our major cities. I’m talking about our mid-size and our small
cities, as well, in the United States. In this spiral of disinvestment, and by disinvestment,
I mean that people have pulled investments from cities, but much of it has been a systematic
disinvestment with terrible policies such as redlining, systematic, pushing people out
and into neighborhoods or not permitting people to be in certain neighborhoods. That sort of disinvestment in resources and
the capacity to have housing in certain neighborhoods has led to this spiral of crime being committed
in those neighborhoods, which has led to people leaving the neighborhoods who can, yes. And then, that whole spiral continues. That abandonment leads to greater disinvestment,
which leads to crime, and these cities have spiraled down in the past 50 or 60 years. Some cities have lost nearly half their populations
from the 1950s, cities like Detroit and Philadelphia, who, which are replete with properties just
like this. Abandoned buildings and abandoned vacant land
in these cities has grown to epic proportions. So, one of the things to consider is what,
what can we do about this? We have these and what the neighbors told
us in the, in these neighborhoods, over and over again, was these are the things. They know that the shootings are happening. They know that the city is probably not responding
as well as they think to these shootings, but this, these are the things that they see
on a day to day when they go walk to work, go to the bus, right? Go to the subway, send their kids to school. This is the surroundings that Dr. Cooper was
just talking about, that people see on a daily basis. And this begins to erode your health and probably
your safety. And I want to talk about that a little bit
more now. So, this, for those of you who have not visited
Europe, this is a map of Switzerland, yes? With work that we’ve done and earlier work
from the Brookings Institution, if you take this map of Switzerland, and you add up all
those abandoned spaces in cities around the nation, the space and the square footage and
the square mileage of those, of those abandoned spaces adds up to an area the size of Switzerland
in the United States. This is a massive challenge. Yes? But I’m going to, I’m going to argue to you
right now that this is also, it is a major challenge, but as we thought maybe 10, 15
years ago, and others are beginning to see, this is also a great opportunity to do something
and to have an impact and to make changes on our cities, and perhaps on the gun violence
in our cities. Now, public health, since we’re in a, public
health, this is sponsored by the American Public Health Association, public health and
epidemiologists are fond of talking about their desire to, to focus on three things:
people, pathogens, meaning diseases themselves, and places. Now, if you talk to, for instance, if you
think about people who are trying to prevent malaria, they are going to focus on well,
putting, giving people bed nets, for instance. Not let the mosquitoes in, right? Giving people different sort of anti-malarial
drugs to prevent the disease from circulating in their bodies, but it is a classic approach
in malaria prevention to also focus on the standing water in the spaces and places that
are generating the malaria, the mosquitoes and the malaria, in the first place, and to
fill them in. Yes? This is no different, frankly. It is a analogous situation with our firearms. Yes? And firearm injury, and the people who are
affected and the places. Now, we focus and we’ve talked a great deal
today about the people and the firearms. We devoted an entire panel to the firearms,
and to, to the credit of this group, we want to find multiple ways, not simply focusing
on the firearms, but bringing in other approaches, and unfortunately, we have not focused as
much on the places and the surroundings that may be generating and cultivating this firearm
violence in the first place. So, very importantly, I want to tell you about
a number of the things that our group has done, but also that other groups in cities
around the nation have done. Cities like Philadelphia, Newark, Cleveland,
Chicago, Detroit, New Orleans, these are cities where a number of different studies of have
been, both observational studies, meaning that the folks in the city and the, their
university partners studied what the city implemented in terms of place-based solutions
to gun violence, but also there have been now a number of randomized controlled trials,
that is true experiments of these different sorts of treatments to these abandoned and
vacant places and spaces. Buildings and land in cities. And you get a sense here, I wanted to just
show this to you briefly. These experiments run by picking, randomly
choosing spaces in cities, perhaps a small percentage of them, because we can’t afford
to do them all in the context of the study, where a city might have perhaps 50, 60 thousand
such spaces in, in an inventory of buildings and land in the city and lot. The yellow in the, on the left side of that
slide, is, the red is the chosen lot, the yellow are all the other abandon lots in that
particular space. So you get a sense of some blocks and some
streets, people are living with, perhaps, half the, half the buildings or half the spaces
in their neighborhood are this way, are like the pictures I just showed you. Again, very difficult to step out and see
that on a day to day basis. So, what did these randomized control trials
tell us? Well, I’m going to tell you about the findings
for some of the greening, that is the vacant lot greening studies that we’ve done, and
some of the abandoned building studies that we’ve done, where you take spaces that look
like the spaces on your left, and you move to the right through very simple and inexpensive
processes, yes? And these are processes, by the way, that
originated, the process, the recipe for this, the cookbook for this, originated with single
neighborhoods and single cities, where some motivated residents said, we’re just going
to do this. We’re going to try it on a couple of these. And many cities have now scaled this up because
it’s very inexpensive and quite scalable, and what they’re finding, if you go from left
to right here, is across a variety of studies, whether it be greening, fixing the buildings,
we have a great new lighting experiment that’s just come out in New York City, or planting
trees. Some of the earliest work was planting trees
in the city of Chicago. These studies have generated and have shown
across them, anywhere from 5 to 56 percent less gun violence. But not just gun violence when you treat these
sorts of things, also vandalism and other sorts of crimes are affected by this. And very importantly, we have teamed up with
a number of different economists to look at what a city would get back. What do taxpayers, what does the society and
the communities in that city get back? So, for every dollar invested in these programs,
because they are so inexpensive to green lots and to treat abandoned buildings, to remediate
abandoned buildings, and because gun violence is so expensive, okay? The trade-off here is for every dollar in,
there are hundreds of dollars returned to the taxpayers and to the neighborhoods of
that city. So, the return on investment here is quite
high, quite effective, and quite high, and we think of this as a, as a form of what we’re
calling win win science. So, this is the opportunity for scientists
to actually not just generate knowledge and new, new thinking about what can be done about
something like gun violence, a prime public health crisis, but it also brings resources
to those neighborhoods. The, the studies that have already been done
have changed thousands of different buildings and vacant lots in cities across the nation
just by doing the research itself in an effort to study it. So, things like gun violence go down, yes? You can see that on, on the left, but also
things like nuisance crimes and vandalism, public drunkenness, these sorts of things
also go down quite a bit. But then people go outside more, is one of
the things we find as part of this, and not only does the violence that is report to police
and, and reported and recorded by police go down, but neighbors feel safer. They’re also self-reporting that the crime
went down and the gun violence went down in their neighborhoods. So, briefly, how does it work? Well, the primary way that this works is because
these spaces, the abandoned buildings and the abandoned lots, and right next to the
spaces, perhaps, abandoned cars that are put purposely near those spaces, are opportunities
for the storage of illegal firearms. So, the police will call these frankly storage
lockers for illegal guns. If you remove the storage lockers, you’re
having an impact on the means of the violence itself, which is one way we think it happens. The other way we think that the reduction
occurs, is because, you know, neighbors have been living with these, as I said, for decades,
these sorts of spaces. Once you clean and green or get a building
fixed up, neighbors do not want it to return to the way it was, so they will go out of
their way to informally police that space on a day to day basis. They do not want someone perhaps selling drugs
in front of that space, or, or doing anything with a firearm in front of that space, so
they will move that person off the space and ask them not to do it, and in the end, this
does not move crime around the corner, it actually reduces the commission of these acts. And then the last way is, because neighbors
are coming outside more, they’re able to connect with one another and share information to
a greater degree. So the recommendations that I have at the
end of this, coming out of it, is that we really do need to infuse and include these
sorts of population-wide and place-based interventions which, as I was showing with the malaria example,
these are — these interventions, if we use them for gun violence, we would be standing
on the shoulders of many other public health interventions that preceded these whether
it be for infectious diseases like malaria. It could be the purification of drinking water
or chlorination of our water systems. It could be removing lead poisoning from buildings. This is built on the backs of that kind of
work but focused on the reduction of gun violence. So we’re in good company. And then gun violence interventions to change
these blighted and abandoned spaces are, A, I have to say they’re well-studied at the
highest level of science, so we do have not just observational studies but we have a series
of citywide experiments that have been done to demonstrate that these work. So they are effective. They are inexpensive, very important to understand. These are not — this is not building the
High Line in New York City, yeah. So these are inexpensive, singular introductions
and placements in neighborhoods that are distributed. One reporter called these building the park
of a thousand pieces in a city. They are distributed and they are designed
not to have people move out of their neighborhoods, but to give people opportunities for parks
and not dilapidated spaces right next to their homes. They don’t need to go anywhere and they get
to stay in their neighborhood. They are, again, because they are inexpensive,
they’re scalable citywide for a very relatively low amount of money compared to other — and
finally they’re apolitical. This is not taking firearms out of the hands
of any legal owners. This is just opportunities to impact the illegal
storage and movement and usage — misusage of illegal firearms in cities. And then, finally, I’ll pitch to say that
I would like to see city and state legislators but also federal policymakers to begin to
invest in — as a first step for a city to do this sort of thing, a city must have an
anti-blight ordinance. You’d be surprised how many cities do not
or have a sort of impotent anti-blight ordinance. And so we need that legislation to be in place
for many cities, but then we also need to, again, direct the resources to this kind of
reduction in dilapidated and abandoned spaces across cities in the U.S. And the return on the investment could be
quite high to do this. And I think that’s it. Thank you very much for your time. Thank you very much, Dr. Branas. Our last speaker is going to talk about gun
violence research. She is Dr. Linda DeGutis, the executive director
of the Defense Health Horizons and an adjunct professor at the Rollins School of Public
Health at Emory University. Good morning. Thanks. So I’m going to talk about the, some of the
issues that have occurred with federal research funding and some of the issues that have occurred
with research agendas. We’ve heard a lot of reports and research
this morning and, obviously, a number of things that are successful, but we really don’t see
as much research on gun violence as we do on other diseases that are causing public
health, you know, our major public health problems. So basically, the federal funding for research
has been at a, pretty much a standstill since the Dickey Amendment passed in 1996. That amendment actually didn’t say that research
could not be funded. All it said was that federal money couldn’t
be used for advocacy for gun control, is what it — basically what it said. So it didn’t say you couldn’t do the research. However, the conversations that went on around
it basically threatened the CDC in saying, oh, well, if you do fund the research on gun
violence, we’re going to start to think about shutting you down or shut down the Injury
Center which had been formed not all that long before. So that amendment, then, a few years ago was
added to the NIH appropriations bill. And we still see restrictions on the federal
funding. But basically funding from 2004 to 2014 for
gun violence research was only $20 million. And in the context of the federal budget and
what gets spent on other things, it’s basically decimal dust, is way policymakers would put
it. But it doesn’t mean much. It’s like the pennies that are in your pocket,
you know. So after Sandy Hook, after the Sandy Hook
killings occurred, President Obama issued an executive order that told CDC to resume
the research on violence resume, the funding on gun violence research. It told Congress to appropriate $10 million,
another few cents, basically, to fund gun violence research. And then it told CDC to develop a public health
research agenda and asked federal agencies to study the causes of gun violence, to identify
what interventions could be effective and then to develop strategies. However, there was not any funding associated
with this and so there were a number of things that did not happen. What did happen was that, at the CDC, we worked
to develop a research agenda but that was not without some fighting. At the time, I was the director of the Injury
Center and said that we could not internally develop that agenda because it would be seen
as biased. And so we had to fight to have it go over
to the Institute of Medicine and have them do it. They did develop the research agenda and published
it in June of 2013. And that was basically, you know, that’s basically
about all that happened out of that list of things in the executive orders. There was no resumption of funding of gun
violence research by the CDC. The message that was given was that there
was no funding for it. There was no thought to using funding that
was there for violence research. That was not something that was allowed. And this was, this came from a higher level. It was all political. People were afraid to do something. They were afraid to say, okay, we’re going
to start funding the research because there was still that fear that we were going to
lose money, CDC would lose money. So, to me, that was kind of being chicken. We’d seen so many events, we’d seen so many
things going on. We knew how many deaths there are. But the research was not funded. So on the left-hand side of this slide, you
can see research funding for various diseases. And that little, little, tiny bit at the bottom,
the fourth one up is where the money goes towards gun violence research. So the proportion of money that goes towards
research on gun violence, one of the leading killers, especially, of young people is very
minimal. And it just is not sufficient or comparable
to what gets funded for other diseases. So basically, you know, we have a long way
to go, but what we do know is that research funding for other leading causes of death
and illness and disability have really made a major dent in those illnesses and those
causes and those injuries. And one of the examples is motor vehicle crashes. We know that there was, you know, especially,
back in the late 80s early 90s there were a lot more deaths in motor vehicle crashes
than there are now. The reason is that we did a lot of things
in order to prevent them. We didn’t take away cars because they were
killing people, okay. Everybody still can get in a car and drive. But we did other things. We found out what might work as far as vehicle
redesign. We found out what kinds of things might work
as far as vehicle redesign for preventing some pedestrian injuries, the interiors of
vehicles. Some people may remember that a lot of the
knobs were pointed or something, and if somebody hit something during a crash, you could have
a fairly serious injury. And I remember and Carnell probably does to,
don’t you — seeing people with, you know, like things embedded in various parts of their
body in the emergency department because the vehicles had these very dangerous kind of
things on the inside. Those don’t exist anymore in the manufacture
of vehicles. We made the roads safer. We did other things on roads. We found out that maybe putting a big sand
barrel in front of a bridge abutment really absorbed the energy if a car crashed into
it as opposed to the car crashing into the solid concrete barrier. So there’s a lot of things that we did, and
we did improve things. We have changed driver’s licensing now so
that there’s graduated licensure laws in most states so that people have to — young people
have to have experience riding with someone, driving with someone, who is an adult who’s
a licensed driver for a period of time before they can get a license. So those have all been effective. So we know that those kinds of things can
work. One of the other things we know is that the
lack of research really limits progress. It doesn’t allow us to understand what works. What it does is it sets things up so that
people say, well, I think this would work, so let’s just do this. Oh, I think this would work. Let’s do this. And we invest a lot of time and money in things
that don’t work. They end up not working because we don’t have
any research to tell us what will work. We just have emotion and we have people’s
ideas. And it doesn’t work, necessarily. I mean, the ideas maybe need to be tested. But, you know, just think about some of the
things that have come out now, you know, on policy and things like, oh, in some states
giving teachers — arming teachers. Is that an effective policy or is it more
likely be detrimental? What about active shooter drills? We’re finding out now that those may be more
detrimental to the kids in the long term than they are as far as actually helping kids survive
something that happens. What about bullet proof backpacks? You know, somebody’s — it’s a great marketing
strategy that somebody has, playing on parents fears. But, you know, what — how effective are these? We have no evidence that they really would
work and a child would have to be wearing the backpack when a shooter came in. And then we even don’t know if it would work
depending on, you know, the angle the shooter was coming from. So we don’t have a lot of things that we know
work. Federal funding’s definitely influenced by
politics. And as DR. Webster mentioned earlier, the groups
that can come in and lobby on a single issue and advocate for things on a single issue. So we need to have other funding. Private funding can fill some of those gaps,
can help retain some independence in the research questions that are asked and allow people
to ask a number of research questions. And then, basically, I think the other piece
of it is having funding that is going to academic centers where people can decide what questions
they want to ask. You know, they have the independence. You’re a researcher at a university, you don’t
— the university is until you what questions you can ask as far as your research goes. If you’re in a federal agency, the federal
agency may tell you what questions you can ask as far as your research goes. You know, having been — I mean, when I got
to the CDC, somebody told me, don’t even say the word G-U-N, okay, because it’s just not
a good idea — because we might get in trouble. So, you know, that doesn’t happen in academia. You know, you can research whatever you want. So I think those are the kinds of things that
we need to think about as far as where the research gets done too, that it needs to be
done by people who are more independent in their research, can ask the tough questions
and can test things out and do the research. So we have some opportunities. We have opportunities for basically to move,
as far as researchers go, from just publishing the data to translating the data to the public
so it can effect change or working with people who can translate that data so that the change
can be effected. I mean, it may be that people who are doing
the research don’t have the time or opportunity to do that, but there are people out there
who can. They sometimes need some interpretation of
the data or translation of it, but there are plenty of people who might advocate. We can make science integral to identifying,
you know, these effective policies and really push for that and let policymakers know, on
all levels, that this is what’s really important. We should consider using more kinds of things
that really provide collaboration and require collaboration. You know, we’ve heard about the need for a
lot of disciplines to be involved in this, not just, you know, not just one group but
it’s, you know, it’s the hospitals; it’s the community; it’s social work, sociology. It’s law enforcement. There’s so many different groups that need
to be involved, and we really need to focus on having that kind of collaboration and involvement. So that’s another thing we have an opportunity
for. Training opportunities are other things. If we don’t train people to do this research,
we’re not going to have any researchers to do it later. We really need the training opportunities,
and we need the funding for them. I mean, it’s not — those aren’t there either
the training funding isn’t there the way it is for other kinds of health issues, so we
really need that as well. And certainly practice needs to inform the
research, as it has for a number of these studies that people have already been working
on. But we really need the practice to continue
to inform the research and we need the multidisciplinary collaboration. So some recommendations: Congress should fund
gun violence research at a level that is similar to that for other public health epidemics,
such as the opioid overdose crisis, HIV, infectious disease. You know, how much money went to Ebola and
how many cases of Ebola occurred in the United States, okay. I mean, so we should be funding, spending
a lot more money on gun violence. Congress should fund improvements in the databases
and ensure that researchers have access to those databases so that they can look at some
of the impact of these policies and some of the strategies that are used. It also would be important to have acre group
of experts again look at priority research topics, perhaps revisit what was done at the
Institute of Medicine and either updated or expanded, but have a more independent organization
like that be able to convene the group so that the bias accusation is not there and
it didn’t come out before either. Congress should also fund training and mentorship
for people who are learning how to do this research. States can fund research and translation of
research as well as the programs that are related to that research. And we have a couple of states that already
have been doing that. The private sector, certainly, can provide
funding for any kinds of initiatives or research that are sort of related to the private sector’s
mission and the intent to keep their — keep people healthy. And everyone should really focus on funding
the research so that we know what works, not what we think will work. And really, what they should do, in summary,
is, you know, do what will really improve the health of the public and for legislators
not what will get you — what you think will get you re-elected or elected. So that’s where we should go. Okay, thank you. Fantastic. Well, those were four fantastic presentations. I want to thank you all for traveling here
and helping us with this. And we now have the opportunity for some questions
and answers. And I wanted to start with one. You know, the previous panel talked about
policies that sort of get put into effect and then implemented through legislation. You all are, the three of you who talked about
different kinds of policies are really, in a way, talking about institutional priorities. And it’s beyond just what legislation could
do, but what particular institutions could do. And as you’re thinking about making the case
for those institutions, I want to ask a question about the strength of the evidence. So, for example, DR. Buggs, you talked about evidence for community-based
violence interventions. And I’m going to ask you, in a second, to
talk about how that evidence compares the evidence of law enforcement interventions. You know, Dr. Cooper, you talked about projects
in the hospital. And I’d like you to think about — and I’ll
come back to you — how — what hospitals could do to prevent recidivism compared to
other things that hospitals do all the time. And then, Dr. Brown, as you talked about the
value of cleaning up and improving very rundown areas in urban areas, and, you know, cities
have to make priorities decisions all the time about where to put resources. And I wonder if there’s a good point of comparison,
as you think about talking to city policymakers to invest in these kinds of strategies, how
does the evidence like where the other — you know, what kind of evidence are they looking
at for the other ways that they might spend money, how does that compare. So we’ll start with you. So we know that there are law enforcement
strategies that can work to help reduce gun violence. And the strategies that have been most effective
are those that, again, focus very specifically on the issue of gun violence. They are very precise and focused on individuals
most at risk for violence and the problematic places — problematic street corners or bars,
those kinds of places where violence recurs. But what we’ve found is that the community
based strategies, in terms of investment, cost far less than law enforcement strategies. And importantly, you know, where law enforcement
engages with communities that are most impacted by gun violence, those communities have — often
have great distrust of law enforcement, and there is a breakdown in communication and
in relationship between the community and the police. And so we know that law enforcement can make
a difference in terms of gun violence reduction, but it is really important to engage the community
in the kinds of changes that they want to see. As Dr. Branas talked about, you know, going
out to the community and asking the community what they want to see can direct us to the
actual problems that are helping to create the gun violence rather than assuming that
we know what the problems are. So for a city that’s looking at some very
targeted law enforcement strategies as well as community-based anti-violence initiatives,
would you say that the impact of those is generally comparable? Or would you say that one is clearly, you
know, better than the other? In other words, should this be part of a city’s
discussion if they’re thinking about gun violence as — even as they’re discussing law enforcement? So I’ll re-echo the point that’s been made,
that there is not one policy, there’s not one strategy that’s going to be most effective. A comprehensive strategy really is what is
what will make the difference. And we did study in Baltimore of various interventions,
including law enforcement strategies, to reduce gun violence. And the one intervention that mirrored reductions
in gun violence was by a special enforcement team in Baltimore that was focused specifically
on gun violence. Now the challenge is that we also saw that
that special enforcement team has been associated with civil rights abuses and discourtesy complaints
and actual physical violence. So you have to, you know, weigh the costs
and benefits of having law enforcement without checks and balances over those teams, and
they need to be focused very specifically on the gun violence activity. And so again, community-based strategies can
work, but it is very important also — I talked about implementation challenges for some of
the community-based strategies. You know you need to engage the community
and you need to consider where there’s accountability, where their feedback loops in any of these
strategies so that there can be checks and continually improvements made on the strategies. Yes. And how did those � Yes, so we looked at the � Baltimore’s version
of The Cure Violence model. And again, it was found to have effects, reductions
in gun violence in certain neighborhoods, but some of those effects did attenuate over
time. And so we have seen that it can work. And that Baltimore study also evaluated some
community-based? The community-based strategies do work and
can be equally effective or even more effective than law enforcement strategies. We saw that some of the law enforcement strategies
that were employed did not work at all. Some were associated with increases in gun
violence rather than decreases. And so again, it’s important to consider a
comprehensive strategy and to really engage the community in the process so that we — they
are a part of the solution and we can have the kinds of accountabilities and checks that
we need to make sure that any of these strategies are actually effective and making a difference,
a positive difference, in the communities. Great. Thank you. DR. Cooper, so how did the evidence for violence
interventions in the hospital compare to other kinds of things that hospitals might be investing
in because, you know, new surgical procedures, new surgical devices, all those different
things — how does this compare? Right. Well, to be clear, the our nation’s trauma
centers do a excellent job of caring for our patients who present with violent injuries. And we save lives every day and there — we
are constantly investing in new products and new techniques to save to save those lives. So we do a good job overall. However, we are missing opportunities. I can tell you one of the toughest jobs I
have or one of the toughest things I do, as a trauma surgeon, is, after spending four
or five, whatever number of hours in working on someone and then failing and having to
come out and talk to that family. It is the toughest job. You walk into the room and it seems like — there
may be only three people there — it seems like sometime. You try to identify the most important member
of the family and you focus on them, and you can’t say your loved one has sort of passed
on. You can’t say — you’ve got to say you’re
your daughter is dead or your son is dead. And then the scream that comes from that sometimes,
it’s like, it reverberates through you. And all you can do is sit there and hold their
hand or put their arm around them until they stop screaming. It is the toughest job that I do. Clearly, there are patients — well, back
— there are — the data shows, again, when those patients come back with violent injuries
they are more likely to die — for whatever reasons. It’s unclear why. Some people say it’s because the immune system’s
depressed. It’s more than likely because they have — it’s
more difficult to operate on someone a second or third time in their belly when they’ve
had multiple operations. It’s just more challenging. And so their likelihood of that — likely
that surgery is successful is more likely, more than likely. But that’s — we do really don’t know why
our — their death rate’s higher, but it is higher. And that’s why hospital-based violence groups
are helpful because there are — they — when they — because that higher percentage of
folks who die when they come back. It’s an opportunity to intervene in a way
that hospitals, again, have already failed. And I can’t assess how much what it does for
the staff as well, because if you a surgeon or nurse and you sit in that ED, in that trauma
and they’re constantly coming in, you get a little bit down after the third or fourth
person comes in and dies. And having something else you can say that
— you can say that — especially if someone you’ve seen before. You know, we — I saw him a year ago. He comes, he’s dead now. What could we have done different? And I think it’s very important for the hospital
staff to have — to be able to say, he’s here. We saved him. We have an opportunity — we have something
we can do now that can make sure that person doesn’t come back again. So it gives the staff more hope rather saying,
you know, why are we doing this? He’s just going to come back in 10, in 12
months. Why are we wasting all these resources? I mean, I know it sounds a little callous,
and I would like to say that that never happens. We’re humans. When you’re seeing that — I mean, when you
know those folks — they’re just basically going to come back again and you’re spending,
going through resources like mad, those sort of things creep into folks’ mind, I think. I want to encourage people who are watching
to join the conversation at the hash tag gun policies that work. Then I want to go back to that Cooper for
a quick follow up. So if this weren’t gun violence, but you had
an intervention that could have a similar impact, as your gun violence intervention
program on a serious illness — say it was on car crash victims or, you know, and you
could do something to have the same impact that hospitals could have if they implemented
these policies, do you think people would say there’s not enough evidence? Or do you think if — let’s say there were
a machine you could do and bill for. You know, what would be the reaction? How does this compare to other things that,
you know, hospitals might do? Well, I think that if it was something more
concrete, I think that hospitals would react in a more of a more — I saw and we’re going,
yeah, that works. We’re going to institute that. It’s the fact that you have to — that there
are — you have to have — the data is so dependent upon having a interaction with individuals
and impacting them in a way — on social issues hospitals aren’t really equipped to deal with
the social issues that bring these patients to the hospital. And that’s why having the hospital-based violence
group, which is really a group that’s able to not necessarily — well, they’re embedded
into the hospital now, but more often they are — they bring expertise outside the hospital. So I think that being able — part of the
issue is being able to show them the data that says that it’s not new anticoagulant,
it’s not a new tube you put in, et cetera. But being able to say that we have the data
that says addressing the social issues, that — such as work — getting folks in jobs,
substance abuse, et cetera — that hospitals aren’t used to doing — Right. Might be better than the new anticoagulant. Might be better than the new anticoagulant. But we — one of ourselves — we have to continue
to provide the data that does that and — oh, and more data does that so we can convince
the — it’s not the trauma surgeon but it’s also convince the chief executive officer
and the chief operating officer, all those folks who have the money, let’s invest in
that. As well as the insurers, as you pointed out. As well the insurers. Right. That’s — Great. Thanks. Dr. Branas, so a question for you. How do these conversations generally go in
cities? Is it a little easier sell now that you have
randomized data? Or– It is. Or — and what are the competing priorities,
and what’s the evidence for those? Well, I just want to first say thank you so
much and that gun violence is definitely in your lane of what you are supposed to be doing,
not just in the hospital, within the community. So we’re so pleased that the hospitals are
investing in this sort of thing — and have been for quite some time, but unfortunately,
have not been recognized for that kind of community’s work. So cities are always doing tradeoffs and,
to Dr. Buggs’ comment that, you know, for most cities one of the biggest line items
in their budget is law enforcement. So most cities are investing a heavy amount
of their funds into their law enforcement practices. And by the way, law enforcement works. We know from cities and some great experiments,
in fact, cities like Kansas City, that law enforcement has the capacity to reduce gun
violence and things like focused deterrence which Dr. Buggs was presenting or this attempt
to blend traditional law enforcement with more community-based programs. So that’s nice, and that helps to bring law
enforcement into the community and to build community relationships. That being said, there are two issues — one
which you raised, which is that law enforcement and policing isn’t always welcome in many
of these communities. You know, when I said that we asked the committee
members what to do about the violence in their neighborhoods, very few of those people said
more police, to be quite honest with you. So that’s one thing. It’s not that policing doesn’t work, but the
community relationships with our local law enforcement agencies is challenged. Now the other thing that I will say, and one
of the reasons that we as scientists began to pursue place-based interventions, is whether
it’s policing or interrupters, these person-based strategies where people have to be there,
perhaps having a great impact in reducing gun violence but that impact only lasts while
they are there. So if you look at — for instance, if you
watch The Interrupters, as a documentary, about the interrupt the Cure Violence program
in the city Chicago it’s doing quite, quite well until the money runs out and the interrupters
can no longer be president in those communities, and the violence returns to those communities. So we really were thinking about these place-based
strategies in a way to convince the municipalities and the policymakers and municipalities is
that perhaps there’s a bit more sustainability on these if they’re married with other community-based
programs that bring police or interrupters or other community based practitioners into
the field. Great. Thank you. DR. DeGutis, do you see a more — more of an openness
to funding research in this area now that this conversation has gained momentum nationally? : I think that, you know, we hear more about
a desire to do some funding but we’re still not seeing any action on it. Okay. I think where we’re seeing the action has
been on the state level for a few states and then from the private sector from some foundations
like Bloomberg, who actually are funding some of the research and, you know, there’s one
or two other places that foundations are funding research but — Well, certainly, our hope, as people watch
this and really become familiar with just the evidence that’s there really being compelling
and showing the value. Let’s go to maybe some of the questions that
have come in online Yes, we have had a couple of questions and
I’ll just provide you with two. First is if any of the panelists could talk
a little bit more about gun violence prevention in schools? And then also, directly to Dr. Cooper, does
your program work with community partners in public health departments? Well, I’ll start. So when we started our program, of course,
it was this hospital-based, trying to work folks with who came there. But then we — it was obviously — clearly
a question is how can you work with patients before they get to you in a trauma center. So we — am I on? Yeah. Oh, sorry. I’ll just talk a little louder. So what we did, then, was we actually partnered
with schools and began to go out and talk to them about things that put the risk of
violence. We actually invited — we partnered with things
like the Powers Program, folks athletically and had them bring groups to our hospital
where we would talk about risk-based behavior. And we would — thank you. And would give — we’ve given examples of
behavior that resulted in an injury to patients and asked them, what would you do? You know, my classic example is a kid came
to me in Baltimore, was playing basketball in Baltimore and he saw some other kids show
up. He knew they had a beef with the other kids
he was playing basketball with. And he said, well, you know, I knew they were
going to — something was going to happen, but I’m having fun, I’m playing ball. You know, I’m not winning. I stay on. And then of course, what happened was he got
shot and came to me. So we had — we gave examples like that and
asked them what should that kid have done differently. So we’ve gone to schools and tried to do those
kinds of things and partnered with — partnering with schools. And the second question was? Is your program working with community partners
in health departments as well? Absolutely. I think that we welcome any partner who can
help with education, can help with funding, can help with getting access to our — to
the communities that can result in our patient — lives being saved. For a quick example, for the Health hospital-based
programs, this is our 10th year now. All of the processes and intake forms, et
cetera, we share. There’s no copyright on any of it. We share it with any place that wants to develop
a hospital-based program. We will go out to — we’ve helped many cities,
sometimes on our own dime, to help them be educated and walk through the process of building
programs. Again, simply because we feel very strongly
and our growing data shows that it saves lives. Anyone else want to add to that? Dr. Buggs? On the topic of gun violence in schools, there
have been replications of the Cure Violence model. Some violence interrupters and outreach workers
are reaching into the schools and helping to mediate conflicts within the schools, but
also providing mentorship and support for the young people who are at greatest risk
for violence. But one thing that we also see is that young
people frequently, you know, when young people have have guns on them in school, they’ve
been arming themselves because of their commute to school. They are they are through — my mic is out
too. Thank you. They are passing through dangerous neighborhoods
to get to schools. And so it is really important to think about
the environment, as Dr. Branas talked about, that young people are having to traverse to
get to and from school. In addition to just providing them support,
the question was raised earlier about ACES, adverse childhood experiences, for force mass
shooters. But you know, as was pointed out by the previous
panel, that is that is a common feature. Dr. Cooper mentioned it as well. These individuals who are at greatest risk
for violence have had extensive trauma in their backgrounds and really do need support
and mentorship and connection to services. And so some programs are reaching into the
schools to help identify and support those permanently. And as many know, we’re an integrated health
system. And I have two questions I promise not to
be long-winded, but everything you’re saying resonates with where I come from. And I work in the department that does a lot
of the community investments and grants for commit community benefit. So it’s not only investments for our members
in the community, but the communities and where we operate. And one of the areas that we focused on most
recently, based on an environmental scan, is West Baltimore in the 21223 zip code. And we created a police-based initiative called
Future Baltimore. And through — it took about a three three
year process, but we joined with young people. Great. Question. MS. MOYER: Good morning. Good morning. Thank you today for all the panelists and
all of the great information being shared. My name is Amy Moyer, and I work for Kaiser
Secours and some other non-profit organizations. But to date, we’ve done 1,200 screenings for
behavioral health services. This is all with community feedback, is what
they wanted. A hundred certified nursing assistants graduated
from programs that we created. We have 11 micro businesses graduated from
an incubator program, and they’ve already received $100,000 in loans. Seventy-five families per week receive fresh
produce and $6 million in capital was raised for a Community Resource Center which the
community said they wanted. And we provided $2 million — our initial
investment was $2 million. I’m saying all this to say that it took a
lot of energy and buy-in from other non-profits or other private institutions. And so I guess I would say, is providing the
business case, even the research is there, what would you say would be the top things
that organizations like ours and others could do to get involved in something like this
as either corporate social responsibility or not as only a means to prevent violence,
looking at the root causes, social determinants of health? But how can people get involved with this
knowing — because we operate from the standpoint of social determinants of health. And so that’s the first question. The second one is about hospital interventions,
but I’ll let you answer that. Why don’t you go ahead and quickly ask the
second one? MS. MOYER: Okay. So the second — the second one is, last year
we also contributed $2 million to gun violence research. And when you mentioned the hospital interventions,
some of the things that our physicians and clinicians thought were important to do research
on was, one, evaluating a Web based education tool for safe firearm storage and patients
at risk for suicide, and then understanding risk factors of firearm-related injuries and
death in adult and pediatric populations and then integration of firearms, suicide prevention
tools and health care settings. So that’s the patient-reported access to firearms
and decision aid for storing the firearms. Would you say those are three areas that could
be incorporated with the hospital- based interventions that Dr. Cooper spoke about? Well, thank you for your for your question. And I should also say that Kaiser has been
a very good supporter of the Health Alliance I’ve also mentioned. At our Annual Meeting, our 10th annual meeting,
this past September, you were a supporter, and we’re very thankful for that. We try very hard to make sure that we educate
our clients and any patient that comes to the hospital with injuries on the kinds of
things that we talk about. I mean, we have those, with our clients, we
have those very tough questions about are you still carrying a weapon? Is there a weapon inside your home? We try to make sure that we hold our clients
accountable. We’re investing in them. They’re part of our program. So we do have those tough questions with our
clients themselves. We’ve not gotten more broadly in having those
questions in the general population of our hospital. But those are things that are, again, at least
being discussed as we try to broaden the — our success efforts. Great. Thank you. Any anyone else interested in responding? And we should use these mics, if you can do. I can — I’ll be happy to use that. I’m happy to try to answer your first question. So first, wonderful work that’s being done
in West Baltimore. Congratulations. I’d love to see it. And it speaks to this notion, and DR. Cooper will know this, of course, is that
health care is really not simply about what happens in the walls of the clinic, whether
that be the walls or the hospital the walls of some satellite outpatient clinic. The providers need to understand the context
from within which their patients emerge because if you keep issuing the same treatment to
them when they show up at your clinic, they’re going to return to a chaotic and a difficult
environment that’s not going to permit that treatment to work. So that’s the first reason that you need to
be thinking — well, I’m not necessarily — the health systems need to be thinking about beyond
just the walls of their clinic. Now the other thing I’ll say is that, I’m
going to applaud you, but say that there’s not enough of this going on and emerging from
health health care systems around the nation. The other great example that I have in mind
is Nationwide Children’s Hospital in Columbus, Ohio that has just built hundreds of homes
— built and rebuilt hundreds of homes in their surrounding area in Columbus. And they’re reaping the benefits of that in
terms of the cost-savings because folks who’ve been showing up over and over again to that
hospital might not be coming back over and over again for various issues, including acts
of violence and violent injury. So there are a lot of benefits here, and I’m
so glad to see that your health system and others are really investing in this, not simply
offering it lip service, but going into the communities to do actual programs and to perform
actions in those communities to to try to address this. And I would just say I think it raises the
question also for businesses where their line of business is relevant to gun violence. And we’ve seen some businesses stop selling
certain types of guns. You know think, about that. For a healthcare business, it’s also about
opening clinics, you know. And West Baltimore is a real desert when it
comes to primary care. And I think there’s been an interesting long
time in more primary care in West Baltimore which could combined with some of the great
investments that Kaiser’s making on the social determinants side. MS. MOYER: Thank you. Great. Josh? MR. HOROWITZ: Josh Horowitz. Yes. MR. HOROWITZ: The Educational Fund to Stop Gun
Violence. What I think about some systemic issues that
might link this incredible important discussion about urban gun violence with rural suicide
issues? So we’re seeing a complete, you know, some
of these things we’re hearing about this disinvestment, like you, Dr. Sharfstein, brought up the lack
of mental health services in some of these communities. We’re seeing that actually mirrored, I think,
in rural America as well where you see some of these, some cities with really, you know,
empty storefronts blighted buildings, blighted parks no access to services. Do you think some of the strategies that we’re
talking about here in this panel could be applied for, for instance, in rural America
to deal with some of the suicide crisis that were going on? And maybe, Dr. Branas, you can start with
that because I’m — I was really taken with your discussion of sort of putting parks in
and putting and getting rid of blight. And that’s something you — the more you spend
time in rural America now, you’re seeing that being mirrored in small towns all across the
country. So I just wondered if there were some commonalities
we can sort of bring together here. DR. BRANAS: Yeah. And it’s one of the reasons I said that big
cities, midsize cities but also small cities which were disproportionately affected by
the Great Recession, frankly. So rural and semi-rural America is very challenged
by this, as you’re saying. But then I’m going to put my hands up and
say that we haven’t devoted the research energy that we should in terms — particularly in
terms of place-based interventions for these, the challenges of rural America, particularly
for suicide and gun suicide that we have you know the $300 million that went to the opioid
crisis much of it was focusing on, on the rural crisis. We haven’t even scratched the surface for
what’s right, coming up right under that which is suicide and gun suicide, particularly in
rural communities where the risk is even higher than in our cities. The one thing I will say that we’ve been thinking
about is this — I don’t know if any of you have followed, but the UK has created a Minister
of Loneliness. So in the UK they really are addressing loneliness
as a health concern, a major health concern that’s driving a number of different things. And I think there are opportunities to begin
to think about that and perhaps some strategies that emerged from folks who were thinking
about addressing these issues of loneliness, particularly isolation that occurs in rural
areas, and applying them here and seeing if they have some kind of an effect on particular
rural and semi-rural gun suicide. Thank you. All right. Next been sharing both on this panel and the
previous one. My name is Ruhee Bengali. I’m going to keep my question short. I was just wondering if any of you could speak
a little bit about policies and practices that address police violence, specifically,
so much of which is gun violence and that doesn’t quite get the attention within the
gun violence space as it should and really undercuts, at least in my view, as so many
of these programs that you’ve shared about because it really is sort of what is driving
the mistrust Hi. Good morning. Thank you so much for all of the information
that we’ve of police in those communities. There has not been enough research on police
violence, that is you’re absolutely right. It is a critical piece of the puzzle. When you talk to community members about what
they need in the communities most impacted by gun violence and about what they need to
feel safe. Dr. Branas said, there is not a call for for
more police. Often there is a call for no police because
of the history, because of the many stories of concerns about police violence. And police-involved shootings receive, you
know, similar to mass shootings, they receive the most public attention. But there are also concerns about harassment
and humiliation and disparagement. And so there needs to be more research on
that. And I believe that the strategies — it’s
quite possible that many of the strategies that have been discussed could also help address
police violence. And there needs to be real, you know, honest
conversations around how the police engage with communities, and is it the kind of engagement
that that the communities want. And too often communities are not part of
the conversation. It is a top down assumption about what how
communities should be policed. And it is not working. We continue to see high rates of gun violence
in communities where there are high police presences. And so the strategies that have been used
are not working. The investments in public safety focusing
only on law enforcement is not — is not gaining the lives that we want to save. And so you’re absolutely right, but there
needs to be a lot more research on police violence and its relationship to violence
in the communities. Thank you. Maybe we’re close to the last couple of questions
here. Go ahead. We’re both fielding some from our livestream
audience. Dr. Brandas, some people would like to know
� you talked a little bit about anti-blight ordinances, and you said there are good ones
and there are impotent ones. And they wanted to know, did you have kind
of maybe a short list of what a good anti-blight ordinance contained? I think — so there are good ones, impotent
ones and completely absent one and so. So let’s start somewhere and put some in place
and ones that don’t function as well don’t give the city the capacity to make changes. It mirers the opportunity even after perhaps
an owner of a blighted property has not cannot be identified or has passed away or has not
been an owner of that property for decades. Cities, many cities in the absence of an ordinance
or an ordinance that doesn’t function strongly enough it will take the city much too much
time to be able to act. You know, as researchers, when we do or if
our research and go into communities and change these properties, the community doesn’t think
we’re coming from a university. They think that we’re coming from city government
oftentimes. And they — a common response is we called
you 30 years ago — no joke — we called you 20 or 30 years ago to do this and we gave
up after a while. So I think that some communities do have these
mechanisms, some cities do have these mechanisms but they’re just mired in red tape and they’re
not streamlined enough to be able to get in there and make the change on behalf of the
neighbors. And the question was, even when funding has
been allocated it’s often not released properly or it doesn’t go to the programs that truly
support the policy. How do we overcome funding? Great. So we have another question from Twitter,
and it’s about those hurdles? That’s a good question. I think there’s a number of things. I think it depends on where the funding is
going to, so where the money is appropriated to as far as funding goes. When you talk from a federal level of funding
there are, you know, some agencies are more likely to maybe follow their own priority
research agenda than maybe in a more general research agenda. So it really depends on that. I think the — it depends on where the research
is going to get done and what they’ve made decisions about as far as where that money
is going for the research — are they keeping it internally or are they giving it to independent
researchers. And I think those are some critical issues
because you do have places where the research is done in-house. And when you talk about things that are governmental
and it’s done in-house there’s more politicization of that kind of research than there might
be — than it would be in an academic environment or in research that is funded perhaps by a
private entity or you know by foundation. So a lot of it has to do with how the money
is appropriated to the distributor of the funds, I guess, is the best way to say it. Great. Thank you. Please join me in thanking this great panel.10
Thank you. Maybe I’ll ask Dr. Benjamin, if he wanted
just to come up, I’ll ask you to give the couple — any closing thoughts you might have. But while you’re coming up I will just say
how pleased I am with how today went and the fantastic discussion we just had and just
share three of my own thoughts. First, I think what we heard today is we did
not hear people who were trying to change the standards of evidence. They’re actually trying to get people to pay
attention. We’re all trying to get people to pay attention
to the evidence that exists because the evidence that exists for policies that work is quite
strong and compares very well to, in many cases, exceeds the evidence that supports
other kinds of interventions for similar challenges or even violence itself. Number two is while it’s important to have
more research there is a lot of evidence, and you don’t need perfect knowledge of everything
in order to take action. And so we really heard very clear recommendations,
based on the research that exists, even though it’s very important to continue to push the
envelope in terms of understanding what works. And then, number three, I think there is every
reason to believe what we heard was that this has been an area of very little money and
very little research really. And even with that, we have real knowledge
about what can save many lives. There is every reason to believe that with
further investment, we can answer and improve some of the challenges that we know are still
there — challenges like how to best enforce some of the different legislation around guns;
challenges like how to get hospitals to effectively implement some policies that can reduce recidivism
and injury; challenges like improving policing practices and community trust and how to maintain
fidelity of models of community based intervention so that more communities can benefit over
time. All of these things are possible and today,
I hope, was an opportunity for people to really not just get a vision of what can be accomplished
with what we know today but just the fact that we can be, as a nation, on a trajectory
for substantial improvement. Dr. Benjamin? You know, we’re at a really extraordinary
moment in our in our nation I think. And you know every time we have a tragedy
that gets the attention of the media we always hear that familiar phrase of giving people
hopes and support and people should have hope and support. But, you know, this was an opportunity for
us to actually do something about that. Thinking a problem away does not make it go
away. Bad news does not get better with time. It never has and it never will. We put people in policymaking positions for
them to help us as a collective to move things forward. What stimulated this particular forum was
the last mass shooting that we had. But again, I’ll just remind you that each
and every day we have a tragedy that occurs in many tragedies that occur in our community. We also often get asked why the public health
community is so concerned about that and whether or not this is our lane. But I want to be real clear about this. If it hurts people or kills people, it’s ours. Now it’s not ours alone, but we do have an
opportunity to gather with people in other disciplines in health, in the criminal justice
world, the public safety world and policymakers to make a difference. What we hoped to do today was give you a series
of our thoughts about policies that work to reduce gun violence. Well, we’re hoping that, as our nation has
this very intense debate over the next several days two weeks over how best to make our communities
safer and reduce the carnage that occurs from firearms in the context of legal authorities
and the second amendment, we’ve given you some ideas of what will work and how we can
move this nation forward. With that, I thank you. And please give all of our speakers a great
round of applause. And we’ll look forward to working with anyone
that wants to make a difference. Thank you very much. Thank you.

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