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Gun Violence: St. Louis’ Other Public Health Crisis

As the global pandemic affected populations all over the world, another public health crisis impacts Americans each day: gun violence. In 2020, firearms took the lives of nearly 44,000 Americans and in Missouri, 689 people were shot and killed in one of the state’s deadliest years on record. The St. Louis region often ranks number one in the nation for deaths caused by gun violence, and during the pandemic, firearm ownership has increased.

Though the theoretical and sociopolitical roots of gun violence are widely debated, Mark Hoofnagle, MD, PhD, Assistant Professor of Acute and Critical Care Surgery, Erin Andrade, MD, MPH, PYG-3 General Surgery resident, and their multidisciplinary team are working to better understand this public health crisis. Hoofnagle appeared on Fox 2 St. Louis this April to discuss the team’s findings.

At Barnes-Jewish Hospital’s trauma center, acute and critical care surgeons like Hoofnagle and residents like Andrade oversee the care of all adult trauma patients, including gun violence victims. As first-hand witnesses to gun violence’s impact on their patients, the team felt a sense of duty to research obstacles to addressing this public health crisis and apply the findings to optimize patient care.

One of the biggest battles against gun violence is the patchwork of gun regulations between individual states. “Firearm movement across states plays an important role in the relationship between state firearm legislation, firearm fatalities and homicides,” Hoofnagle explains. “Though most legally acquired firearms are purchased with no intention from their owners to use them with ill intent, they are often sold between parties and not properly registered after they leave their original owners’ possession.”

The team identified a distinct iron pipeline that feeds firearms from low regulation states to high regulation states, which undermines public health efforts to restrict firearm ownership to noncriminals.

The social and legal discourse surrounding firearms, gun legislation and safety education make this public health issue more complex. According to Hoofnagle, the lack of bipartisan support for stricter gun regulations at state and federal levels exacerbate this crisis.

“These less strict regulations allow people to be armed and transfer these guns throughout the city,” Hoofnagle says. “Having firearms in a person’s possession increases opportunities for escalating potentially nonviolent situations into that of extreme violence. The research shows that carrying a concealed weapon does not make you safer and instead increases the risk of homicide. The same is true in gun owner’s homes.”

According to Hoofnagle, this sense of security is not supported by empirical research, and most research indicates people who have guns in their home are more likely to die of homicide or suicide, or cause harm to their family members. Hoofnagle suggests that it is time to disrupt the narrative assigned to gun ownership and the false sense of security it gives individuals.

“Firearm ownership is a big responsibility, and there are many things that can be done to keep yourself and your family safe,” Hoofnagle states.