CareTalk Podcast – Keeping Kids Safe From Guns

Gun violence is a health crisis in the USA. Annie Andrews, MD joins the show to discuss why gun control is so crucial to the safety and wellbeing of our youth.

David Williams:

Welcome to CareTalk, America’s home for incisive debate about healthcare, business and policy. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David, who do we have to talk to today?

David Williams:

We have Dr. Annie Andrews. She’s an expert in gun violence prevention and a volunteer with Moms Demand Action.

John Driscoll:

Well, welcome Dr. Annie.

Annie Andrews:

Thank you for having me.

John Driscoll:

Tell us a little bit about where we are in terms of gun violence and particularly around kids. I mean it just feels like this issue is treated much more like a political issue as opposed to a healthcare issue. And I think every American understands we want to protect our kids and our families. And can you give us a sense of the state of play around just protecting our kids and how we’re doing?

Annie Andrews:

Sure. Well, I have to agree with you, this topic is approached politically so often, but I wish it was approached from a medical lens more than it is. And I think we’re making progress, but the news is not good when you’re talking about gun violence and kids. In fact, in 2019, according to the most recent CDC data, gun violence became the leading cause of death for kids in our country. It has been the leading cause of death for black youth in our country for decades, but in 2019, it became the leading cause of death for all kids in the United States.

John Driscoll:

What’s driving that, Annie?

Annie Andrews:

Well, I think it’s a combination of things and I think what we haven’t done is taken a multifaceted, comprehensive public health approach to gun violence in this country. And when you look at the graphs that compare the mortality rate of firearm injuries in children to the mortality rate of motor vehicle crashes in children, you can really see that in black and white. And motor vehicle crashes have plummeted because we have taken a comprehensive approach to decreasing those injuries among children. And that includes legislative solutions, that includes industry safety standards, that includes education. And those are things we can all support because who wants kids to die in car crashes? But why is firearm injuries any different? And unfortunately, we just have not seen an acceptance of this issue as a public health crisis and we have not taken a comprehensive approach to addressing this crisis.

David Williams:

We talked about having a comprehensive approach with all these different facets to it. And one of those is about when someone goes to the pediatrician, having kids myself, at a certain age, they’ll say, “Hey, the kid is at the age where they might reach up to the stove so make sure you don’t have something that’s coming off of it,” the car seats when they’re little, even coming home from the hospital and so on. And pediatricians are trained to talk about it, they talk about it at different times. Now, I saw on your Health Affairs post that the percentage of pediatricians that are willing to discuss firearms has actually dropped, it hasn’t gone up or stayed the same, it’s dropped. And is that just an expression of the whole political element to it or how do we understand that?

Annie Andrews:

So I think it’s a couple things. One, I think we don’t learn about this in medical school. There are a few exceptions to that, and we are working hard, a lot of people across the country working hard to make this a part of undergraduate medical education, as well as residency training programs. Because if we aren’t teaching our physicians how to do it, how are they ever going to feel comfortable doing it? And I do think that the political aspect of the firearm conversation does weigh into this. And I have talked to plenty of my colleagues and partners about this issue, that we fear that it will trigger a political debate in the exam room. And of course we want to avoid that, but we just need to go back to the basics that we talk, like you were saying, to parents about car safety, we talk about locking up prescription medications, locking up cleaning supplies under the kitchen sink. We should be talking about locking up firearms as well.

John Driscoll:

How do you take a conversation about politics and turn it into one about public health?

Annie Andrews:

I think that’s a great question. And I think what has worked for the work that I have done at my own institution is, number one, focus on the kids, because I think that you can get some more sympathetic ears if you’re talking about children. And I think the other thing is to talk about it from a safety standpoint. So I’m not talking about whether or not you should own a gun, I’m talking about how you should secure the gun in your own home if you choose to own a gun. And I think we just have to pivot away from any attempt to make this a political conversation in the exam room and just boil it back down to we’re talking about kids and safety.

John Driscoll:

Yeah, I mean when you’ve got four out of 10 households in America with guns, I think is the number that I recall, and three quarters of the people who have those guns are not going to give them up, it’s 80% of them believe it’s essential to their version of freedom. And particularly given the public health debates we’ve had over basic stuff over the last year and a half, I don’t think we’re going to make progress on that around guns given the strength of feelings there. But it does feel like with kids we’ve got a different vector of opportunity from a public health perspective, because I’ve got to think that the vast majority of Americans, even those who have guns, want them to be held in a safe fashion. What does that actually mean?

Annie Andrews:

Well, so that has been my experience. I practice in the Southeast and I talk to parents about this all the time. And we want parents to keep their guns locked, unloaded, and separate from ammunition. And that really is the definition of secure storage. And like you said, we can all agree we want kids to be safe, so if you introduce the conversation in, “I want to protect your child and I know that the evidence supports that children are safer in homes with firearms that are locked, unloaded, and separate from ammunition,” you can keep the conversation focused on the child’s safety.

And the other thing I will say is that I think as healthcare providers, we are witness to some really awful tragedies all the time. We see sort of the effects of failed policies in our hospitals and our clinics all the time. And I think that for some reason, we feel like we need to kind of keep what we see to ourselves. And certainly we have to respect HIPAA and patient privacy, but there’s no reason we shouldn’t be telling the public what it’s like to care for a child who has found their dad’s gun and accidentally shot themselves in the face, and what it’s like to talk to those parents every day. Or what it’s like to talk to the teenager who was shot in the spine and will never walk again and you’re trying to motivate him to go to rehab but you also have to give him the expectation that he probably won’t walk again.

These are things that me and my colleagues and all of us are seeing day to day, and we need to talk about that so that the public, who we think will be sympathetic to these stories of children getting shot, that they can understand where we’re coming from. And it’s not from a political place. I’m not interested in the politics around guns, I’m interested in keeping kids safe from gun violence.

David Williams:

So if you look at the age span that a pediatrician is typically caring for, anywhere from zero to at least 18, maybe 21, how do the messages differ across? I mean the safe storage is the same at different ages, although at a certain point you say it’s not enough to put the key just on the top of your cabinet or whatever, but beyond the storage element of it, what are the messages that are different across the different age spans?

Annie Andrews:

Yes. Well, you guys have certainly done your homework about secure storage. I’m happy to hear that. So I think it’s important, I think we often immediately think about the preschool and toddler age children when we talk about unintentional shootings, but when we take a step back and think about firearm injuries and kids as a whole, we know that the majority of those injuries are actually assaults or homicides, a third are suicides, and about five percent are those unintentional injuries.

I have found it easiest to start the conversation about those young kids. You don’t want them to access an unsecured firearm and that children as young as the age of two are strong enough to pull a trigger. Those conversations, I think everybody can kind of understand where I’m coming from, but you’re right, that as children get older, we start to see a much larger proportion of the firearm deaths related to suicide. And that conversation needs to be different because adolescents have a different ability to access firearms in the home. If they know the code to the safe, or if they know where dad keeps the key, or if they know that on Sunday afternoon, dad is cleaning his guns and the case is going to be open. So you have to think more critically about how you’re securing guns in your home when you start to have those adolescents and even preteens. We start to see suicide pop up in those nine to 10-year-olds. And so it’s an important conversation to have across the pediatric age span.

John Driscoll:

And don’t we have sort of a growing problem with suicide, particularly during COVID with kids? I believe the numbers have sort of popped. They were going in the wrong direction already and I think they’ve gotten even worse in the last year.

Annie Andrews:

Yes, you’re absolutely right. We’ve sort of seen a convergence of multiple crises that are affecting our youth. And I think anyone who takes care of children can tell you that COVID has had an incredibly detrimental impact on the mental health of children of all ages because of isolation and being away from their friends and the stress of living in the time of a pandemic. And we were seeing mental health crisis already before COVID, and then you compound that with the public health crisis that is firearm violence. And yes, I am deeply worried about the youth of our country as these two things continue to intersect.

And so we have to go back to what we can do to prevent it, and it’s access to mental health care for youth. It’s identifying risk factors in youth who need support from mental health services. It’s better funding for mental health services across the country. And then it’s those basic steps of keeping lethal means away from at-risk youth. And so that goes back to locking up your firearms and locking up prescription medications.

John Driscoll:

Annie, if you think about the conversations day to day you’re having with a parent in the South, you’re likely to be running into a lot of gun owners. People who have guns typically don’t just have one, they’ve got a few. Gun ownership continues to grow, but actually gun purchase among gun owners is going up. How do you have that conversation in a non-kind of charged way?

Annie Andrews:

Well, I think you’re right. And I’ve talked to a lot of, living in the South, a lot of people who think of hunting as a really important of their family tradition, and they’re taught about hunting and firearm safety at a young age, and similarly people who have served in the military who take this very, very seriously. And so I think we have to be smart about who the messenger is and have a big tent and bring gun owners and military people, police officers into this movement to help us educate in the most effective way possible.

And I do think that we all need to do our due diligence in educating ourselves about firearms so that the family I’m talking to understands that I have put in the work to understand how gun locks work and how safes work and what the different kinds of firearms are so that they can see me as a trusted messenger. I mean it took me a long time to learn about pneumonia so that when I talk to a family, they can see that I know what I’m talking about, and we need to do the same thing about firearms, and we need to find ways to educate ourselves so we can have effective conversations with families.

David Williams:

Now, there’s a lot of news that this is a challenging topic and a lot of bad news. It sounds like there’s some progress in some places. What can you say about progress either on the sort of legislative or awareness side or what you’re seeing even among the physicians that are coming into practice now?

Annie Andrews:

Yeah, so I do think that we get caught up in the wins and the losses, but I think overall the culture of our country is moving in the right direction when it comes to protecting kids from firearms. I think that this has become a more normalized conversation between parents about secure firearm storage in the home. I think there are more physicians who are vocally advocating for common-sense gun laws. And I think that change will take time, but I am optimistic that we are moving in the right direction. And while I don’t think it should be the solution, we have seen a lot of incredibly effective youth advocates out there talking about how they don’t want to grow up in schools worried about a school shooting. They don’t want to go to the movie theater and think about this. And I think it is a little bit of a sad reflection on our society that sometimes we look to the youth to help us lead these movements, but thankfully there are some really stepping up and I think the adults need to pay attention and get on board.

John Driscoll:

Do you think doctors are afraid to have these conversations, Annie? I mean that there’s been a reluctance to jump in?

Annie Andrews:

I mean, yes, I do think that doctors are hesitant and I think it goes back to us not getting the training in medical school to address this. And I think that will help solve that problem, if we start incorporating this into medical school or residency training.

David Williams:

John, I hesitate to ask this, because you’re going to give me a hard time for reading it somewhere, but we know that the federal government hasn’t really funded gun research and we hear that’s important and maybe that’s going to come up and maybe there’s some private sources of funding as well.

John Driscoll:

Oh but it has, David, did you do your research this time? It actually has.

David Williams:

I’m not caught up in my reading, John, but Annie, are there areas of gun research that would be helpful? I mean what does that mean that we need research? Would that help with some of these questions that we’re asking here?

Annie Andrews:

Yes, I think that’s one of the really unfortunate things that’s happened over the past decades in our country is that physicians haven’t had a lot of access to funds to study this problem. And that probably drove some physicians to not choosing this as a career path, right? Because if there aren’t grants available, why are you going to pick this as your research topic? Fortunately, that is changing, but not nearly as rapidly as we need it to. There are those graphs that show the burden of disease versus the level of federal funding and we are way out of whack when it comes to firearm injuries. So we need exponentially higher levels of federal funding for research to address this public health crisis. And I heard someone, Dr. Cunningham actually say once, that we have never solved a public health crisis in this country without help from the federal government. And this is not going to be any different, we can’t do it without that research funding.

John Driscoll:

Where would you put the dollars Annie, if you were to kind of just throw a dart and say we need to, because it was drained, it was very low. There’s a modest amount now, but it’s trivial relative to the burden of firearms, suicide, accidental shootings, and then obviously homicide.

Annie Andrews:

If I could pick, I mean, I think we’re at maybe 1/1000th of the funding we need. I mean, we’re just really nowhere even in the same ballpark universe that we need. And there’s so much that we can learn even about the epidemiology of firearm violence in this country. And a lot of the data sets that we use are so limited because they’re either only deaths or they’re only hospital based data so you can’t follow patients longitudinally. And there’s a lot of work going on in the country, people trying to really improve the quality of data we have to study, to understand this problem. The other thing we need is we need to understand the effects of legislation and we need good data to do that. And we need funding to support scientists to do those studies.

John Driscoll:

Well, we really appreciate your work clinically and in public health. Thanks so much for making some time for us today.

Annie Andrews:

Well, thank you for having me.

David Williams:

Great. Well, that’s it for yet another addition of CareTalk, this time with Dr. Annie Andrews, expert in gun violence prevention. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. Thanks for listening and please subscribe.