April 17, 2023

Special message from Dr. Jeff Balser, President and CEO, about public health and gun violence

Jeff Balser, MD, PhD

by Jeff Balser, MD, PhD, President and Chief Executive Officer of VUMC and Dean of Vanderbilt University School of Medicine

In recognition of the Linking Arms for Change event today in Nashville, VUMC is publishing an updated version of Dr. Balser’s earlier comments on recent mass shootings.

On a Monday morning just three weeks ago we stood ready in our emergency departments to save victims of a school shooting. But we were rendered powerless to intervene. A tragedy taking the lives of six innocent people, including three nine-year-old children, has shaken all of us at VUMC and throughout Nashville while for a time consuming the nation’s airwaves.

As the region’s largest provider of trauma care, virtually every day our people are center stage on the frontlines of gun violence, caring for hundreds of adults and children mutilated by gunshot wounds. Every year it seems to get worse. In 2022, we learned that gunshot wounds in the US are the leading cause of death for our children and teenagers.

While gun violence is a public health threat that is almost entirely preventable, progress on solutions has been hopelessly ensnared in public debate. It reminds me of vaccination. We saw millions of deaths in the pandemic. Yes from COVID, but also from a host of treatable conditions as hospitals became overcrowded. As ICU’s reached capacity limits, the CDC found 80,000 excess deaths could be expected 2 weeks later due to strain on resources and personnel. Yet despite copious evidence for effectiveness at reducing hospitalizations and deaths, COVID-19 vaccination has been mired in controversy.

For decades, America has been willing to spend more money on health care than any other country in the world – by a factor of two. Nearly all of this goes for health care services, the care we seek as individuals when we are sick or injured.  Compared to most of the world’s successful economies, we spend much less on public health services that protect and promote the health of our population as a whole. An uncomfortable difference between these two kinds of health expenditures is that public health spending is often perceived as largely for others, including people we don’t even know. It may not impact us individually.

Both gun violence and vaccination are public health problems. As such, both entail solutions not only involving economic expense, but at times a perception of personal sacrifice or risk. Yet the personal risks attendant to the needed public health measures are extraordinarily low.  Serious side effects with COVID vaccinations, much like other modern vaccines, are rare – less than 5 per million doses. In fact, the risk of dying from a firearm is far higher. Americans are 25 times more likely than people in other high-income countries to be killed in a gun homicide.  And countless studies have shown that despite a sense of being safeguarded, owning a gun doesn’t reduce the risk of being shot to death.

While we could quibble about the statistics, the personal risks we are attempting to avoid in these cases are certainly lower than those we experience driving to work every day.  So is it possible that our country’s relative de-emphasis of public health measures reflects a cultural shift?  Are we prioritizing our own individual needs, anxieties, or simply desires, over the wellbeing of our communities?

Consider America’s pervasive adoption of the polio vaccine in the late 1950s. Only about 15,000 Americans per year experienced the dreaded paralysis from polio before vaccines were available – less than half the number of firearm deaths. Yet despite more challenges with side effects (including deaths) than we see with modern vaccines, at that time it wasn’t even necessary to require the vaccine – Americans embraced it with enthusiasm.

There are countless other examples. Consider the disgraceful rate of maternal mortality in our country, with women dying from pregnancy more often than in nearly all countries in the developed world. Over 80% of these deaths are preventable – not arising from failure to deliver care as women deliver babies, but from our ineffectiveness at ensuring that women receive basic preventative care services while they are pregnant. Sadly, the chances of dying during pregnancy in our country – roughly 25 deaths for every 100,000 live births – is similar to the risk of death from a firearm in many of our states.

America continues to be the envy of the world in many respects. Yet as a society, we seem to be increasingly unwilling to make even marginal sacrifices to ensure the health of our own communities – even our own children. One wonders whether this, not wars or pandemics, will be the undoing of us. Like a latent malignancy that grows unseen until it is too late to cure.

Sadly, over the past week mass shootings in Louisville, Kentucky, and Dadeville, Alabama, have taken more lives. If history repeats itself, media coverage will gradually subside and the public outrage will fade. Except for those who lost a child, a spouse, a sibling, a parent, a grandparent or a friend – their anguish is endless.