Kaiser Permanente targets gun violence as health equity issue

For decades, gun violence in the US has grabbed headlines and sparked calls for action, as well as political debate. Now, health systems across the country are increasingly turning their attention (and resources) to gun violence prevention as an important public health and health equity issue.

Among them is Kaiser Permanente, a California-based nonprofit health plan and hospital system, which in June 2022 launched a Center for Gun Violence Research and Education.

Kaiser Permanente leaders in January further committed $25 million over five years to the center as part of a partnership with the Health Alliance for Violence Intervention (HAVI) to support research, education programs, and evidence-based community initiatives.

David Grossman, VP of social health and equity at Kaiser Permanente, spoke with Healthcare Brew about the center and how its work on gun violence prevention can help combat health disparities.

This interview has been lightly edited for length and clarity.

When did Kaiser begin focusing on gun violence? And why are these efforts so important?

We actually started getting directly involved in this field starting in 2018, through some investments and research with our research centers at Kaiser Permanente…The message that we’re trying to convey here is that health systems do play an important role…This is front and center for us, and so we need to be front and center for a solution…We see thousands of patients each year for firearm injuries—those are the people who are still alive when they’re brought to us. The fatality rate for [suicide] attempts is around 90%, so many people who die from firearm injury die before they actually reach our facilities.

We also want to recognize that our members have exposure to firearm violence in lots of different ways, both as victims with physical injuries, but also in their communities. Exposure to violence in the community is something else we care very much about since our mission is about caring for our patients, but also the communities that surround them.

Why didn’t health systems really focus on gun violence before?

Our trauma centers have been historically involved in this topic for a long time. Kaiser Permanente South Sacramento Medical Center was one of the very first in the nation to set up a violence intervention program…So, historically there has been interest, but it’s largely come from safety-net hospitals and trauma centers.

Part of why we’re starting to see this resonate now is the very strong recognition that this is an equity issue: that firearms disproportionately affect Black and brown people. The healthcare industry has woken up to the idea that equity is an extremely important issue that needs to be addressed in our society and within healthcare institutions.

What are the goals of this new center?

We’re still working out some of these details with our new partners at the HAVI…Because of our partnership with the HAVI, we will double down on our commitment to focusing on issues that relate to both trauma and equity as it relates to violence. We also are planning to use money to focus on education of the public and framing violence as a public health issue, rather than solely as a criminal justice issue…We really want to be able to augment funding that others are providing to community-based organizations that are relying on fairly promising, if not proven, techniques to interrupt violence the community.

Has this work led to any changes at Kaiser Permanente?

Our mental health teams really are embracing a much more systematic and comprehensive approach toward suicide prevention and treatment of mental illness that incorporates self-harm and recognition of the importance of firearm access as key tenants of those guidelines…Our pediatric group developed a resource toolkit and training module for pediatricians to talk with their patients about our firearm storage and access, as well. That is in the process of being spread…There are a number of examples, and hopefully those aren’t the end. We’d love to see our hospitals get similarly engaged in the community, and that will be something that the HAVI will be helping us with.

Is there any financial reason why hospitals or health systems should be looking at issues like gun violence?

We have not put finance as a reason here. The question is: [Can] you save lives? Can you reduce injuries? Can you reduce emotional trauma? To us, that’s the outcome of interest here…We’re not looking at this with a [return on investment] perspective at all. This is really about solving a problem.