In 2019, Northwell Health President and CEO Michael Dowling urged other US healthcare leaders—via a full-page ad in the New York Times and phone calls to hospital CEOs—to join him in a new campaign to combat gun violence as a public health issue.
“I got zero response,” he told employees of New York State’s largest health system in March 2023.
Four years after its first public call for action (and several high-profile mass shootings later), Dowling said Northwell—which established a Center for Gun Violence Prevention in 2020 and has held four public forums on the issue since 2019—got a much different response.
“We now have about 50 CEOs,” he said, noting that each exec committed to the effort in a late-February full-page ad published in the Times. Even more have since reached out to join his National Health Care CEO Council on Gun Violence Prevention and Safety.
“There’s a lot of traction here,” Dowling said. “You’ve just got to stay with it. Because it is our obligation. It is our responsibility.”
Northwell’s experience underscores the growing interest among hospital leaders in tackling gun violence as a public health and health equity priority—action that some clinicians like Peter Masiakos, a pediatric trauma surgeon and codirector of the Boston-based Massachusetts General Hospital (MGH) gun violence center, have long promoted.
Hospitals and health systems across the US are increasingly implementing new initiatives that focus on gun violence prevention and community health, often partnering together (as in the case of Northwell) or with groups like the Health Alliance for Violence Intervention (HAVI).
The trend comes as the CDC reported nearly 49,000 gun-related deaths in the US in 2021, and the highest rates of firearm suicide and homicide deaths in three decades.
Gun violence as a public health issue
Fatimah Dreier, executive director of HAVI, said the organization has come a long way since a group of emergency department physicians and trauma surgeons founded it in 2009.
HAVI has worked with hospitals and health systems to develop hospital-based violence intervention programs (HVIPs) in more than 85 cities. And it’s helped secure Medicaid reimbursement in five states—California, Connecticut, Illinois, Maryland, and Oregon—for violence prevention professionals.
Most recently, Kaiser Permanente, a California-based nonprofit health plan and hospital system, announced a $25 million partnership with HAVI to coordinate the work of its new Center for Gun Violence Research and Education. (Kaiser is also part of Northwell’s CEO Council.)
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Dreier said HAVI seeks to help hospitals look differently at their patients and forge better connections with people who are hit the hardest by gun violence so they can provide new forms of care.
Hospitals must identify “clinical champions” to oversee the changes to everything from care delivery protocols to staffing and recruitment of violence prevention professionals—a relatively new position in healthcare, Dreier said. HAVI also trains and certifies violence prevention professionals.
“This is a wholly healthcare-focused intervention,” she said. “This is really about how we transform the lives of people who’ve experienced violence.”
MGH, meanwhile, established its Gun Violence Prevention Center in 2019, committing $1.2 million over three years as part of an effort to build on the work clinicians started in wake of the 2012 Sandy Hook Elementary School shooting.
Masiakos said MGH has trained about 700 residents, medical students, and nurses across five hospitals and three medical schools—including Dell Children’s Medical Center in Texas—on how to screen patient access to firearms.
MGH has also worked with community-based groups like the Louis D. Brown Peace Institute, which helps support friends and family of homicide victims, to better learn about and respond to the issues surrounding gun violence.
“The bullet holes transcend the trauma room,” Masiakos told Healthcare Brew. “The cost to society is great, both financially and also emotionally.”
The costs of gun violence
Gun violence costs the US billions each year. Some estimates put the total economic costs close to $300 billion each year, while others suggest the total societal cost of gun violence is $557 billion annually.
Dreier attributed the varied findings to the poor data-collecting infrastructure for violence statistics in the US.
“The United States has not made significant investment in this as a public health issue,” she said. “Getting to the bottom of costs associated with these homicides is difficult because we’re all tracking them slightly differently. There’s not a central system that sufficiently covers all of what we’re facing. This has been a huge issue.”