Saving Our Kids: The Role of Pediatric Clinicians in Preventing Gun Violence

Year after year, tens of thousands of lives in the United States are lost to homicide due to a gun and, according to the CDC, in 2020 guns became the leading cause of death for children and teenagers. Dr. Marc Gorelick, CEO of Children’s Minnesota, has been a consistent and fierce advocate for gun violence prevention and lends his expertise about this ongoing epidemic and how we can start to address this public health crisis.

Go to savingourkidsbook.com to learn more about Dr. Gorelick’s book, “Saving Our Kids: An ER Doc’s Common-Sense Solution to the Gun Crisis.”

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host Dr. Kade Goepferd. Year after year, tens of thousands of lives in the United States are lost to homicide due to a gun, and according to the CDC, in 2020 guns became the leading cause of death for children and teenagers. Dr. Marc Gorelick, CEO of Children’s Minnesota has been a consistent and fierce advocate for gun violence prevention. And he’s here to talk to us today about this ongoing epidemic and how we can start to address this public health crisis. Dr. Gorelick, welcome to Talking Pediatrics. Thanks for joining us today.

Dr. Marc Gorelick: Thank you for having me. It’s a pleasure.

Dr. Kade Goepferd: So, you’re the CEO of our hospital, which is how most people probably know you. However, you are also an emergency medicine physician, that’s your area of practice. I’m guessing that your interest and passion around gun violence and prevention stems somewhat from that part of your career. Could you let us know a little bit about how you came to be so passionate about this issue?

Dr. Marc Gorelick: I think the rational, Vulcan side of me would say it’s just logical as somebody who’s spent my entire career taking care of kids, I should care about one of the biggest threats to their life and health, which is gun violence. But of course, I also have a human side and it is tied in with the things that I have seen over my career. I think all of us as pediatricians have those patients that stay with us. And for me, some of the most jarring and vivid images are of some of the kids that I’ve taken care of who have been victims of gun injury.

And I had forgotten just how long I’ve been advocating about this. My wife reminded me recently that in 1988 when I was a second-year pediatric resident in Washington D.C., I actually had a letter to the editor in The Washington Post on the issue of gun violence against kids. So, it is something I have been advocating about for quite some time.

Dr. Kade Goepferd: And I imagine that many of your colleagues in emergency medicine have seen horrific injuries, deaths due to gun violence. Not everyone picks up the torch and becomes such an advocate. Do you have any sense of why for you this became something that you felt was really important to speak out about and raise awareness about?

Dr. Marc Gorelick: I think what has always bothered me is knowing that every single one of those children that I took care of, or my colleagues took care of, with a gun injury, every single one of those was preventable.

Dr. Kade Goepferd: So, you mentioned 1988. You’ve been at this a while. Just as a parent, I’ve been a parent for a decade now, I’ve really seen the culture that my children are growing up with, with regard to gun violence, their awareness of guns, doing school lockdown drills. That is so different than how I grew up and from how I imagine you grew up. What have you seen shift over the course of your career relative to this issue?

Dr. Marc Gorelick: Well, of course, the most obvious is just the sheer numbers. And interestingly, in my three-and-a-half decades, initially up through about the mid-2010s, the numbers were declining. Child deaths from guns were going down, down to about 2,500 in 2014, and then we saw a sharp increase now up to almost 5,000 a year. So, that’s been a shift.

I think the cultural milieu has certainly shifted. The ubiquity of guns, both real guns, the number of guns in circulation in the United States has certainly increased substantially. The ubiquity of guns in popular culture has shifted a lot over that time. Another disappointing shift has been the policy approach to it.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: I think early on in the ’90s and the early 2000s, we did see some policies coming out at the state level and at the federal level. And then, after the 2008 Heller decision from the Supreme Court, I think they put a bit of a chill on legislative approaches. And so, we’ve seen both a decrease in new gun safety legislation and repeal of some existing gun safety legislation or overturning of gun safety legislation.

Dr. Kade Goepferd: And for those who aren’t familiar with that decision in 2008, could you tell us a little more about that?

Dr. Marc Gorelick: Yes. District of Columbia versus Heller, and it ruled on the constitutionality of a District of Columbia law that restricted handguns. And what was important about this decision was it was the first time ever that the Supreme Court found that there was an individual right to gun ownership. And through that lens called into question many of the existing legislative approaches that would put restrictions on types, numbers of guns, who can own guns and so on.

Dr. Kade Goepferd: I suspect that some of that shift in policy then has led to the change that we’ve seen in gun violence.

Dr. Marc Gorelick: Yes. I believe so.

Dr. Kade Goepferd: So, let’s talk about policy a little bit and some solutions to this problem that we’re facing. I’ve heard you talk about common sense firearm legislation, and I wonder if you could explain what you mean by that and what we’re looking for and how that would make a difference?

Dr. Marc Gorelick: When I think of things that are common sense, I start with the word sense. Is it backed by evidence? And we do have a lot of evidence to support a variety of approaches to reduce gun injury in everybody, including children.

First of all, we know legislation works. There’s been logic studies that show there’s an inverse correlation between the number and strength of gun safety laws in a state and the rate of gun deaths in that state. And we have evidence to support specific types of legislation. And my comment, I think the level of support among the public for many of these evidence-based proven approaches, is far higher than the policy enactments would suggest.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: Just in Minnesota last couple of years, we’ve seen some new gun safety legislation. Universal background checks on gun purchases, red flag laws. Huge majorities of Minnesotans across the board support those kinds of approaches. Urban, rural, Democrat, Republican, independent.

Dr. Kade Goepferd: I mean, it’s interesting to hear you talk about that. I see a lot of parallels to the work that I do in pediatric care and for sure in the care of trans and gender diverse kids and that sort of disconnect between evidence and public opinion and what actually happens at the legislature in many cases.

I wonder, in your position of understanding that these are the types of laws that actually help with this problem, we know they work. They’re not as often enacted as we would want them to be. I wonder if you ever, in your position, particularly as a leader, get pushback around this issue as being too political or it’s something that you shouldn’t be talking about or children shouldn’t be talking about?

Dr. Marc Gorelick: I definitely do. And I try to make a distinction between things that are political and things that are partisan. Gun safety, gun injury is a public health issue, and one of the tools in the toolbox is policies.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: And so, it is political in the purest sense of related to enacting policies. What I try to stay away from is when it becomes partisan. And so, if a particular policy is a good idea that’s well-supported, it shouldn’t matter who endorses it, for example. And so, some of the things I try to do, I try to avoid referring to a person’s legislation-

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: …but refer to the legislation itself. It doesn’t always work, but I do think that that is an important distinction to make. And I don’t think we should apologize for being political in the sense of trying to enact policies that support the health and wellbeing of children. That’s our job as pediatricians.

Dr. Kade Goepferd: Switching gears just a little bit. So, emergency medicine physician, CEO of a hospital. Another title you’re about to add to your CV is bestselling author. I hear you have a book coming out specifically about this issue. Could you tell us a little bit about it?

Dr. Marc Gorelick: You’ve used the phrase, “This is a public health crisis.” And I think we’ve seen a number of things in the past few years we’ve called a public health crisis. Opioids were a public health crisis. Systemic racism is a public health crisis, mental health, now gun violence.

And in most of the cases, we’re not acting like it’s a public health crisis. And it’s not because we don’t know how to respond to a public health crisis. I think we did that with COVID-19 pandemic. I think if you look back, we did that, albeit in a belated way with the AIDS epidemic. So, it’s not that we don’t know how to respond, we just haven’t done it with this. And so, I thought, “What would it look like if we actually acted like gun violence was the public health crisis we say it is?” And that’s what the book is meant to do. It’s to paint a picture of what a public health approach would look like and to try to motivate pediatricians in their roles both as clinicians with individual patient families, in their roles as advocates for children, could help to spur that public health action that we need to address this very real public health crisis.

Dr. Kade Goepferd: I want to talk a little bit more about the public health angle, but before I do, can you let us know what the name of the book is that you have?

Dr. Marc Gorelick: It’s called Saving Our Kids.

Dr. Kade Goepferd: Okay. And when is it coming out?

Dr. Marc Gorelick: Any day now.

Dr. Kade Goepferd: All right. Perfect. So, when you talk about this being a public health crisis, what are some of the public health solutions then that we should be looking at?

Dr. Marc Gorelick: I think anytime we think of something as public health, we have to recognize that it’s multifactorial, multifaceted. We think about the public health triangle, or triad, or three-legged stool. Sometimes we talk about the biopsychosocial model, which we know from clinical care. But typically with a public health crisis, there’s an agent of disease or injury. In this case, it’s the bullet/gun combination. There are individual factors, behavioral factors, and then there are societal or infrastructure factors, and there’s an interplay among them. And a public health approach would say there’s a combination of both policies and education that can address each of those, and we put those pieces of the puzzle together so you maximize the impact.

So, when we say, “Well, we just need to put more money into mental health spending.” That would be helpful. That’s not going to solve the problem.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: “We just need to limit guns.” Maybe. That’s not going to solve the problem. So, a public health approach is by definition, a comprehensive approach that includes, again, policies, individual actions, education.

Dr. Kade Goepferd: When it comes down to the individual pediatrician or clinician level, say you’re in an emergency department or you’re in a primary care office, what are things that we can be doing on a day-to-day basis to help with this crisis?

Dr. Marc Gorelick: There are a number of things. First is to normalize the fact that this is a health issue.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: We ask about vaccine status. We ask about allergies and medications. We should normalize asking about risk factors, which include exposure to firearms. So, that’s one thing.

The second is specific suggestions about ways that individual families …Again, a public health approach is a combination of policies, education, and individual actions. One of the most important individual actions that a parent can take to keep their kids safe is around safe storage. We know that safe storage prevents all types of gun injury, unintentional injury, intentional interpersonal injury, and intentional self-inflicted injury. And safe storage includes the safest storage is a gun is stored unloaded, separate from the ammunition, and locked. Families may or may not be able to achieve all of those, but education about what that means and referral for resources, where can you get a gun lock or a gun safe, et cetera? That’s probably the single biggest intervention that an individual clinician can take.

And normalizing asking about safe storage. If your patient had a severe pet allergy, that family would probably ask about pets in the home when their kids go someplace else. Do they ask about whether or not that family has a gun and is it stored safely?

Dr. Kade Goepferd: No, absolutely. I was just going to mention that, that anecdotally I mentioned I have three kids and I sort of likened it to a food allergy. So, often when I’m sending a kid over to someone’s house and the parents may say, “Well, we’re going to have a snack. Do they have any food allergies?” And we have that conversation. So, I just preemptively send a text message when I’m sending my kids to someone’s house for the first time and say, “They don’t have any food allergies. And do you have a gun in your home?” And every single time I’ve asked that question … I’ve never gotten a yes so far, if I got a yes, I would ask about safe storage, but what I usually get is, “Thank you for asking that. And I should probably ask that more often.” Because I think that people just aren’t thinking about that.

And the rationale that I often give is not just that guns are not safe and kids can come across them, but my kids have no exposure to guns, so they don’t understand gun safety. They’ve never been taught what a locked or an unlocked gun looks like or how to know if there’s ammunition in it or not. And so, I have zero faith in their ability to be safe around a gun, and I just don’t want them encountering it.

Dr. Marc Gorelick: And the research would suggest you shouldn’t feel confident that they would know what to do if they found a gun.

Dr. Kade Goepferd: Yeah. We’re here in Minnesota, and several people that I know, that I work with here at the hospital are regular hunters, and they may have guns in their home or their children may be taught to use guns and things like that. What would be an example of how you would lead a conversation with a family who says, “Yeah, we do have guns in our home. We use them for hunting.” How would you approach that?

Dr. Marc Gorelick: Yeah. I think, first of all, not being judgmental. I think guns are neither good nor bad. They’re inanimate objects. There’s no morality attached to a gun. So, I think it needs to be a very neutral conversation in that way. I think exploring more about what guns they have, what types of guns, the reasons they have guns, because that can influence how the family might approach it. Families that keep guns for hunting might approach storage, for example, very differently than a family that has it because they want it for self-defense.

Dr. Kade Goepferd: Sure.

Dr. Marc Gorelick: And so, that can help then craft the conversation because it’s not a one-size-fits-all.

Dr. Kade Goepferd: Coming up on the end of the podcast, but before we wrap up, I want to know if you could impart to the listening audience the most important thing that you would want them to know about gun violence, about, “This is a public health crisis.” What’s the take home message that people should be taking away?

Dr. Marc Gorelick: I think there’s two things. First is, if you’re wondering whether this is relevant to you and your practice, it absolutely is. There’s a Kaiser Family Foundation poll that found that 54% of Americans have personal experience with gun violence. Either they themselves have been injured or threatened, or they have a family member who’s been injured. This is urban. This is rural. In fact, the most rural counties have higher rates of gun death than the most urban counties. So, if there’s a perception that somehow this is somebody else’s thing, it is not. It applies to you and it applies to your patients. That’s number one.

Number two is we absolutely have a role in this. As I mentioned earlier, this is 100% preventable. Nobody needs to die from a gun injury. We have a role to play in prevention, just like we do in preventing lots of other things. I mean, that’s in our core DNA as pediatricians is prevention. We have roles both as individual care providers, as we talked about, and as advocates, as trusted experts in what is going to keep kids safe. So, messages are, this is absolutely applicable to you and your patients. Please use your voice to help them.

Dr. Kade Goepferd: Well, thank you so much for joining me today. Thank you for your advocacy. It is really remarkable to have someone on your position who’s been such an outspoken advocate for this issue for so long. I look forward to picking up your book hopefully any day now, and taking a read. And just really appreciate you taking the time today.

Dr. Marc Gorelick: Thank you for inviting me.

Dr. Kade Goepferd: Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.