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A doctor's perspective on gun violence


Now we want to talk about another major issue roiling the country. We're talking about gun violence. Gun violence has been a feature of American life for decades, if not longer. But a recent spate of mass shootings has put new focus on the issue, and today, President Biden signed the first gun control legislation in nearly 30 years into law. We're going to look at the potential impact of those measures in a moment. But first, we want to talk about gun violence as a public health issue. And for that, we called Dr. Deborah Prothrow-Stith because she wrote one of the first books for a general audience describing gun violence that way, especially considering the impact on teenagers. She's currently serving as dean and professor of medicine for the college of medicine at Charles R. Drew University of Medicine and Science in Los Angeles, and she is with us now. Dr. Prothrow-Stith, welcome. Thank you for joining us.

DEBORAH PROTHROW-STITH: Thank you so much. It's a pleasure.

MARTIN: You know, it seems that now more people are willing to see and talk about gun violence as a matter of public health. But you first wrote about this in 1991 in your book "Deadly Consequences," when most people weren't talking about it that way. What made you see it that way when so many other people didn't?

PROTHROW-STITH: You know, I think it was my training in the emergency rooms and my interest in serving urban adolescents as a physician and realizing that we were stitching people up and sending them out after episodes of violence and not really attending to the risk. And one night, one young man said, hey, I'm going to go out and get the guy who cut me. And I was like, OK, we are not preventing this and everything else we were trying to prevent. So fortunately, I found others. That was really the beginning of it. And that was the, you know, early '80s that we started doing this.

MARTIN: So more than 30 years ago, you created a violence prevention curriculum for young people and the adults who work with them and surround them and support them. Drawing on that work - and my recollection is that you actually had some very significant results. I mean, my recollection is you were in Boston. You were at Harvard for many years. You actually went two years in Boston without a youth gun homicide.


MARTIN: So what do we know or what can you tell us about the policies and practices that work...


MARTIN: ...And those that don't?

PROTHROW-STITH: Sure. I mean, it actually was a little longer than that. It was no one program. You're right. We did have a curriculum in the high schools, and that became widely used. We also trained coaches and clergy, outreach workers and even took on a national portfolio. And other cities began to have violence prevention leaders who were training and working. When you look at this as a health problem, you really then focus on what are the risk factors? Of course, one of the risk factors is guns.

MARTIN: Can you just talk a little bit about, on a practical level, what do you do to intervene in this? I mean, you've made the point that with, you know, smoking, if you look at smoking as a public health factor that the country kind of mobilized around, we wouldn't tolerate just, like, giving - waiting for people to get, you know, lung transplants. You say, how can we stop people from smoking to begin with? How do you apply that logic to gun violence?

PROTHROW-STITH: Well, that's exactly what we did, looking at primary, secondary, tertiary prevention, or, as the kids in Philadelphia renamed it, upfront, in the deck and after the fact. So upfront is about attitudes and social norms. And with violence prevention, it's really about, you know, the celebration of that violent super hero. How do you get kids to understand that nonviolent strategies for handling problems, especially their anger and their emotions, those strategies are possible? And that works. And we know it works because most kids don't want to get killed. That's not their goal. Then you've got in the deck, and these are kids who have been exposed to a lot of violence, maybe even victims of violence. They're Certainly kids in under-resourced neighborhoods, not a lot of Little League activities, not a lot of after-school activities. And what we know about that group is that things like Big Brother, Big Sister, other ways of investing in those kids, those things work.

MARTIN: You know, there are a lot of jurisdictions have talked about these violence interrupter programs and things like that. Does that work? Because a lot of what you're talking about so far sounds kind of like common sense, which is give kids, something to do, something to belong to that's positive. I think what I hear you saying is that these are sort of commonsense strategies. We just don't actually do them. But what about after a violent incident has already taken place where a kid's already gotten involved or been exposed in violence? What about then?

PROTHROW-STITH: Well, I think we don't do them for all children. And I think when it comes to youth violence, we have gone down this path of get tough, lock them up, spend a lot of money after the fact. And that's just not as effective. However, spending money early just makes a lot more sense. And you think about these 18-year-olds with these military weapons acting out their emotional problems or anger, and you have to know that we knew those kids. We know those kids. They are young kids in school, and they are making it very clear to us that they need more.

MARTIN: Before I let you go, and forgive me for sort of pressing this point, but I just wonder if you feel surprised in a way that it's - I mean, in a way, the country's caught up with you in thinking about this problem in this way. And I just wonder, like, how does that land with you? On the one hand, do you feel sort of validated that people are sort of seeing what you've seen? On the other hand, it seems frustrating. Like, why don't more people care?

PROTHROW-STITH: It's very interesting because Sandy Hook was, for me, a real low. The frustration for me was tremendous because I just felt, OK, this is going to make this very clear. But when we didn't do anything as a society, it was a real low for me. So on the long trajectory, I'm not surprised, and I won't be surprised when we take two steps back again. But we'll get there. We have to.

MARTIN: Dr. Deborah Prothrow-Stith is dean and professor of medicine for the College of Medicine at Charles R. Drew University of Medicine and Science in Los Angeles. Dr. Prothrow-Stith, thanks so much for talking with us today and sharing this expertise.

PROTHROW-STITH: My pleasure. Transcript provided by NPR, Copyright NPR.