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Massachusetts Medical Society's Physician Focus

July 2015

Guns and Public Health


  • Keeping a gun in the home significantly raises the risk of homicide, suicide, and unintentional injury.
  • Unintentional injuries are the number one killer of youth age 1-24, and firearms are a major cause of those injuries.
  • The safest home for a child is one without a gun, but one-third of all households with children younger than 18 has a firearm.

Deaths and injuries from firearms continue to shine a spotlight on gun violence as a public health issue, and physicians are becoming increasingly concerned about the growing incidence of gun violence, especially its impact on children.

Michael Hirsh, M.D., Surgeon-in-Chief of UMass Memorial Children’s Medical Center and Medical Director of the Public Health Department in Worcester, Mass., puts some perspective on the issue.

“Since April 4, 1968, the day Martin Luther King Jr. was killed,” says Dr. Hirsh, “more people in the U.S. have been killed through domestic firearms violence than the number killed in all of the wars the U.S. has fought since its independence in 1776. It is a huge problem, and it is an epidemic in every way you would classify an epidemic such as an infectious disease.”

Dr. Hirsh and pediatrician Robert Sege, M.D., Vice President of Health Resources in Action in Boston and a member of the American Academy of Pediatrics Committee on Child Abuse and Neglect, join program host and primary care physician Bruce Karlin, M.D. for the July episode of the Massachusetts Medical Society’s Physician Focus to discuss the sometimes controversial topic of guns and public health.

“Children are safer in a home without guns,” says Dr. Sege, a nationally recognized expert on childhood violence, “and if there is a gun in the home, children are safer if the gun is kept locked and unloaded with ammunition locked separately. That’s basic information every family with a child needs to know. And that comes from public health studies. And we need to get that message out better, so we can do better at stopping this epidemic.”

With an estimated 300 million plus guns in the U.S., Dr. Hirsh says we have to “make sure that those who have them in their homes are aware of the dangers of having unsecured weapons -- when you’re around kids, or despondent or depressed, or when domestic violence circumstances elevate the likelihood that the weapon will be an instrument of homicide or suicide.”

Dr. Hirsh, who established a gun buyback program in the City of Worcester in 2002 that has removed some 2,500 guns from the streets of the city, notes that 2015 is the year that the “lines will cross” -- when there will be fewer motor vehicle crash deaths nationally than there will be firearm deaths.

Physicians are clear that their message is about gun safety and not gun control or possession. Yet the topic of guns and public health has sparked controversy. Laws have been passed prohibiting physicians from discussing gun ownership with their patients, and the nomination of the current Surgeon General was delayed for months because of his positions on guns.

Attempts to prevent doctors from talking about gun safety with their patients rile both physicians. Dr. Hirsh says we’ve got to focus on the health aspects. “There is no unsecured weapon that is not a threat to the family that lives in the home. And that’s the message that physicians must deliver.”

Dr. Sege agrees: “You can’t take something that is one of the major threats to the life and well-being of a child and say you can’t talk about it. My patients wouldn’t like it, and I wouldn’t think I’m doing my job. I’m very concerned about the creeping politicization of what we do with our patients and their families.”

The physicians remain optimistic, however, about making progress. “The witnessing of violence, the experience of violence,” says Dr. Hirsh, “can be avoided with some simple steps. We can make a difference, and physicians have to be able to advocate for that fully and unfettered.”

Adds Dr. Sege: “I’m very optimistic that people are really beginning to take much more seriously the issue of guns in the home. Gun violence is terrible, but it’s on the way down.”

He concludes by repeating an important, straightforward prescription: “Every parent should know that the safest home for a child is a home without gun. If there’s a gun in the home, the gun should be kept locked and unloaded and the ammunition locked separately. Just those alone steps would save so many lives of young kids and adolescents.”

View the video above for more conversation, including discussion about how guns in the home can lead to homicide or suicide, how technology can help to make firearms safer as it did with motor vehicles and reduce unintentional injuries, and gun buyback programs as a way to reduce the violence.

MMS/Richard Gulla

Center to Prevent Youth Violence

American Academy of Pediatrics

Be Smart for Kids

Massachusetts Medical Society

Goods for Guns, Worcester

Harvard Injury Control Research Center

"Guns and Public Health" PSA

From left, Bruce Karlin, M.D.; Robert Sege, M.D., Ph.D.; Michael Hirsh, M.D.
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