We Must Stop Failing our Children

As we mourn the deaths of yet more American children following Colorado’s most recent school shooting (and even more adults after Friday’s tragedy in Virginia Beach), it is time to acknowledge a real, damning truth:

As parents, pediatricians, and frankly as grown-up adult humans, we are fundamentally failing our children.

According to the Naval Postgraduate School’s Center for Homeland Defense and Security, in just my lifetime the U.S. has suffered 654 gun-related deaths in schools.  These numbers capture all school shootings including gang-related violence, targeted gun attacks, suicides, and mass shootings, and include the shooter if he or she was also killed.

To put that figure in perspective, since my parents were born only 35 people in the continental United States have been killed in shark attacks.  This means Americans are at least 18 times more likely to be fatally shot at their school than be fatally bitten by Jaws during their trip to the beach.  And the trend is rising:

Not only was 2018 the worst year on record, but the problem is clearly national in scope. As the map below shows (again using CHDS data highlighted in a recent NY Times piece), since 1970 the only states without at least one gun-related school injury or death are North Dakota and Idaho (Alaska and Hawaii were both affected but aren’t pictured):

Outside of schools, the problem only exponentially increases. CNN noted earlier this year that the risk of being killed by a gun is three times higher for a five year-old child than it is for an on-duty police officer.

You read that right. 

In our America, a kindergartner on a backyard swing-set is markedly more likely to die from a gunshot wound than a law enforcement officer on patrol.

And according to a study in the American Journal of Medicine, if you happen to be a teenager the multiplier rises to 20X:

So What to Do?

[Beware graphic story to follow]

The only pediatric gun shot wound victim I’ve ever cared for was a child I encountered early in training. She had been shot in the head, and rolled into the emergency department in full cardiac arrest. CPR was being performed, but the emergency medicine attending physician quickly stopped the team’s efforts. Why? Because when the resident tried to intubate, she found brain matter where the girl’s vocal cords were supposed to be.

I realize this story is graphic, but THIS is what pediatric gun violence looks like first hand. Somewhere in America, medical teams, bystanders, victims, and victims’ families are living through this hell every three hours of every day all year long.

Gun violence against children is clearly a national problem, and national problems demand national solutions. With our country’s extreme polarization on all firearm-related issues, the answer clearly will not be “eliminate all guns” nor will it be “give everyone AR15s.” Instead, there are two evidence-based, widely-popular steps we could take right now where the only barrier to making progress is political will:

1. Expand mental health access and coverage.

By definition, anyone who wields a gun against a child is in desperate need of psychiatric care. Serious mental illness (a diagnosis per NAMI that “substantially interferes with or limits one or more major life activities”) affects one in 25 Americans each year and will affect 1 in 5 children sometime during their lives. Despite the massive need, fewer than half of Americans living with mental illness in 2017 actually received any kind of treatment (as defined by the National Survey on Drug Use and Health) including barely two-thirds of Americans experiencing serious mental illness.

This means that of ~11 million Americans with a mental health condition debilitating enough to impact their day-to-day ability to function at home or in public, more than 3.5 million receive exactly ZERO support.

Though the “Mental Health Parity and Addiction Act” took effect January 1, 2010, coverage for American’s struggling with serious mental illness is by no means equal. Federal law still does NOT require health plans to cover mental health treatment – rather, the parity law states that if a health plan offers mental health coverage it’s limits must be no less generous than medical or surgical benefit limits. As soon as possible, we must make the treatment of mental health conditions as core to any American’s health coverage as primary care.

I’ll acknowledge that broadening coverage alone will not reach every American with serious mental illness. The National Council for Behavioral Health projects that by 2025 the demand for psychiatrists will outstrip supply by between 6,000 and 15,000 doctors (not to mention shortages of specialized nurses and other clinicians).  Yet true universal coverage is a lever that requires only political will (and funding) to enact AND can take effect immediately. It’s a first step we absolutely must take to make any impact on America’s pediatric gun violence epidemic.

2. Enact uniform, evidence-based firearm safety laws

I’m a doctor, and in medical school I was taught to go to the evidence to figure out the next best step in treating my patients. The medical literature is filled with studies that compare one treatment course against another for nearly any disease imaginable. It therefore shouldn’t be surprising that the firearm safety literature is similarly filled with evidence around which laws actually result in fewer homicides.

It turns out there are a variety of evidence-based actions that have been shown to significantly decrease gun-related homicides while controlling for factors like gun ownership rates, poverty, and substance use. Quoting from a study in March’s Journal of General Internal Medicine, two of the most powerful laws are:

Universal background checks [which] were associated with a 14.9% (95% CI, 5.2–23.6%) reduction in overall homicide rates, [and]

Violent misdemeanor laws [which] were associated with a 18.1% (95% CI, 8.1–27.1%) reduction in homicide.

Not surprisingly, both interventions already share widespread popular support. The vast majority of Americans support universal background checks, as do more than 80% of gun owners and three-quarters of NRA members. Moreover, more than 80% of Americans agree with preventing violent criminals from owning handguns.

However, despite such widespread support as of 2016 only 12 states required universal background screenings and only 5 had passed violent misdemeanor handgun restrictions. Without even touching political flashpoints – issues like assault weapon bans or “stand your ground” laws – enacting just these two basic firearm safety regulations would significantly reduce the number of pediatric gun deaths in America.  Once again, the only thing standing in the way is political will.

Conclusion

Today’s epidemic of gun violence against children will not be cured in one giant leap. But to borrow from Theodore Roosevelt, sustained progress isn’t won by theorizing about giant leaps – rather, it’s won by those who take the next step. And the one after that. And the one after that.

After all, to get to “eliminating gun violence” we must first progress through “reducing gun violence.” Since progress begins where enmity ends, let’s focus on making headway where we already agree – by getting to the roots of our nation’s mental health crisis and universally enacting two widely-supported, evidence-based firearm safety laws.

All politics aside, we have failed our children for too long. Now is our opportunity to begin making it right.

Dr. Chris DeRienzo is a physician leader from North Carolina and author of the book Tiny Medicine – One Doctor’s Biggest Lessons from His Smallest Patients.  All views expressed here are his alone and are not attributable to any entity with which he may be affiliated.  Follow him on Twitter at @ChrisDeRienzoMD and on LinkedIn.