Addressing Gun Violence Prevention With A Public Health Lens
Today’s theme for National Public Health Week is violence prevention. We asked our colleague, Natalie Penhale Johnson, to reflect on the work she is doing with the Gun Violence Prevention Training Center for Excellence, a project that is providing technical assistance and training to 10 grantee organizations that are tackling gun violence as a public health issue. Her blog explores why we must treat violence as a public health issue, with a focus on how systemic racism sustains cycles of violence.
Written by Natalie Penhale Johnson
Gun violence is an urgent and ongoing public health crisis in the United States. US residents are 25 times more likely to die from gun homicides than residents of other high-income nations.i Each year, 114,328 people are shot by firearms and 37,603 individuals are killed.ii Youth and young adults are disproportionately impacted by gun violence--homicide is the third leading cause of death among 10-24 year-olds, responsible for more deaths each year than the next seven leading causes of death combined.
Taking a public health approach to gun violence can shed light on the underlying causes of violence and offer hope for effective intervention. A key public health principle is that violence itself is the main driver of violence. Violence meets the criteria of a contagious epidemic disease—it emerges in outbreak-like clusters, spreads and spikes in communities, and is transmitted--through exposure, modeling, and social norms.iii Mirroring other health disparities, gun violence is concentrated in communities most impacted by racism and structural violence. The lack of investment in these communities is evident in the statistics: in 2013, the risk of violent death was 470% higher in Black populations than their white counterparts. Homicide is the leading cause of death among young Black men aged 20-24 years old, and Black children and teens are 14 times more likely to die of gun homicide than white children and teens of the same age.iv Each of these numbers represents individual, family, and community trauma that carries with it a generational impact. Exposure to community violence directly threatens future orientation, the ability of a young person to conceptualize and plan for their futures, which itself can serve as a protective factor for involvement in violence.v Finally, chronic exposure to community violence is associated with later perpetration of violence.vi The enduring legacy of state violence and systemic denial of access to economic, educational, and employment opportunities in communities of color perpetuates the cycle of violence.
A public health approach to gun violence also provides a framework for intervention. By shifting the focus away from viewing incidents of violence as isolated and those involved as bad actors, violence can be approached with the same methodology as other health crises: interrupt transmission, prevent spread, and change group norms and behaviors of those at highest risk.
In 2019, the Massachusetts Department of Public Health invested more than $8 million dollars in a public health approach to gun violence, allocating funds to ten community organizations serving youth and young adults in high-need communities across the state. As part of this initiative, UTEC and Health Resources in Action launched the Gun Violence Prevention Training Center for Excellence (TC4E), which delivers training, technical assistance, and network building to GVP grantees with a focus on violence as a public health issue. Through training grantees in principles and practices such as racial equity, trauma-informed practices, and community mobilization, the TC4E builds capacity of grantees to implement innovative, evidence-based strategies to directly stem the transmission of violent behavior while addressing upstream drivers of community violence.
While the approach of each grantee is community-specific, effective violence prevention organizations share common elements. Grantees balance direct violence intervention and prevention work with providing youth and young adults with comprehensive services and opportunities. Many organizations conduct street-level intervention (Streetwork) to directly prevent, interrupt, and respond to violent incidents as they arise. Streetworkers build relationships with young people at highest risk, recognize and interrupt emerging violence, facilitate gang peacemaking, and recruit young people into organizational programming. If a violent incident does occur, Streetworkers lead community response and reclamation of the space and defuse potential retaliatory violence.
Through workforce development, mental health services, mentorship, and other supports, grantees equip young people with the tools they need to step away from gang or violence involvement. However, the goal for their young people’s lives is not simply the absence of violence, but the expectation of a healthy and happy life. During their time in these programs, young people earn sought-after certifications, enroll in and graduate from college, get bills passed through policy advocacy at the Statehouse, and run successful social enterprises. Unlocking the enormous potential of young people who have faced years of systemic disinvestment benefits us all.
Treating gun violence as a public health epidemic ignites hope for a remedy. The grantee organizations in the GVP cohort provide myriad examples of this hope. Through the TC4E, grantees across the state convene to share successes and lessons learned, leveraging their collective power toward preventing violence and building safe communities.
College Bound (Dorchester): https://uncornered.org/
Madison Park Development Corporation (Roxbury): http://www.madison-park.org/
More Than Words (South End Roxbury, Dorchester, Mattapan): https://mtwyouth.org/
Mothers for Justice and Equality (Dorchester, Roxbury, and Mattapan): https://mothersforjusticeandequality.org/
New North Citizens Council (Springfield): https://www.facebook.com/pg/NewNorthCC/about/
ROCA (Springfield): https://rocainc.org/locations/roca-springfield/
NorthStar Learning Centers, Inc. (New Bedford): https://northstarlc.org/
Old Colony YMCA (Brockton): https://www.oldcolonyymca.org/safecorners
UTEC (Lawrence): https://utecinc.org/
Worcester Youth Center (Worcester): http://www.worcesteryouthcenter.org/
i. Erin Grinshteyn and David Hemenway, “Violent Death Rates in the US Compared to Those of the Other High-Income Countries, 2015,” Preventive Medicine 123, (2019): 20–26. ⤴︎
iii. Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.9, VIOLENCE IS A CONTAGIOUS DISEASE. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207245/
iv. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (WISQARS), “Fatal Injury Reports,” last accessed Feb. 20, 2019, https://www.cdc.gov/injury/wisqars. Calculations include children ages 0–17 and were based on five years of the most recently available data: 2013 to 2017. ⤴︎
v. Culyba AJ, Abebe KZ, Albert SM, et al. Association of Future Orientation With Violence Perpetration Among Male Youths in Low-Resource Neighborhoods. JAMA Pediatr. 2018;172(9):877–879. doi:10.1001/jamapediatrics.2018.1158
vi. Maas C, Herrenkohl TI, Sousa C. Review of research on child maltreatment and violence in youth. Trauma, Violence, and Abuse. 2008;9(1):56–67.