Gun violence expert says tackling underlying inequities key to prevention

Gun violence expert says tackling underlying inequities key to prevention

When the U.S. Congress voted to deep-six gun violence prevention funding in 1996, Wintemute was undeterred. He used more than $1 million of his own money to fund continuing research. His program, which was formed in 1991, investigates everything from criminal gun markets and background check policies to community-level intervention programs and novel methods of assessing threat.

Wintemute’s passion for preventing gun violence didn’t develop in a vacuum. In 1981, he volunteered to serve as an emergency medicine doctor in Cambodia in the aftermath of Pol Pot, the prime minister responsible for killing about a quarter of the population in four years of genocide.

“While there, I learned pretty intensively about the power of violence to shape an entire society. And in five and a half months there, I never met an intact family,” Wintemute says.

He worked in a refugee camp where 40,000 people lived. “There had been such disarray, so much separation, that the family unit was a small group of people pieced together out of the remnants of other families.”

It was clear to Wintemute that the medical issues he was seeing—including people dying from treatable conditions such as tuberculosis, heart failure, and hyperthyroidism—stemmed from the slaughter. “A society had been intentionally destroyed. People with professional education had systematically been killed there. There were no health professionals.”

Those experiences were burned into his memory and propelled him into the field of violence prevention. After earning a master’s degree in public health from what is now known as the Johns Hopkins Bloomberg School of Public Health, he saw the consequences of gun violence first hand while working in various hospital emergency departments.

He tells of an elderly female patient who had shot herself in the chest.

“She and her husband were breaking up. She was despondent over the loss, didn’t want to be a burden to her children and decided just to end things immediately. But that didn’t happen—she survived.”

Thinking about what led to the woman’s near-demise, Wintemute says that many of the causes of gun violence can be addressed.

“Sometimes that’s work at the individual level counseling for people who are depressed. Sometimes it’s systemic change, working to alleviate job insecurity, housing insecurity, working to provide education and making sure that opportunity is inclusive. The absences of those things are important determinants of risk for violence, and we can do something about them.”

A recent study published in the journal The Lancet, for example, examined the link between firearm violence and structural racist policies in an African American community in Boston. “Redlining practices of the 1930s potentially contribute to increased rates of firearm violence through changes to neighborhood environments, namely through preclusion from homeownership, poverty, poor educational attainment, and concentration (i.e. segregation) of Black communities,” the article said. “These downstream mediating factors serve as points for policy interventions to address urban firearm violence.”

Research currently underway in Wintemute’s program details the traumatic impact that gun violence has on communities. In a survey, he explains, “We asked the question, how often during a week do you encounter a sidewalk memorial at a place where somebody has been killed from violence that was not the result of a motor vehicle crash?” Reflecting on the responses, Wintemute says, “I found myself thinking, there are people in California who probably must feel like they’re living in a cemetery. There are just these death markers everywhere they go. They encounter them daily or more than daily, and that cannot but shape one’s own outlook on life, one’s own physical and mental health, etc.”

The next step for that research will be surveying the physical and mental health effects on community members who encounter those sidewalk memorials.

Circling back to prevention, Wintemute cites several programs that have been making inroads. They include what he terms violence-interrupter programs and other street outreach programs including CureViolence; focused deterrence programs such as CeaseFire; alternative lifecourse programs such as Advance Peace; and hospital-based violence intervention programs.

new report by the Annie E. Casey Foundation, for example, shows how public health approaches to gun violence, such as CureViolence programs in Atlanta and Milwaukee, are making a difference. This program, according to the report, has reduced shootings by 60% in communities where it’s been deployed. A major reason for the program’s success, the report says, “has been the purposeful engagement and inclusion of people living in the areas directly affected by violence.” That is, the affected communities are asked for input in identifying solutions. It also includes counseling and healing circles.

But Wintemute rejects the notion that anyone can heal from gun violence.

“There’s no such thing as healing from gun violence, in the sense that the violence has occurred and now healing takes place,” he says. “The violence continues; healing involves both grieving and working toward the goal that the violence will stop.”

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