Dr. Deborah Prothrow-Stith was working in an emergency room as a medical student more than four decades ago when she realized that victims of violence were getting treated and then released — unlike other patients — without any sort of preventative care.
"And one night, at 3:00 in the morning, a young man just very specifically said to me that he was going to go out and cut the guy who cut him," she says. "I thought, this is not adequate. My response is not adequate. My profession's response is not adequate."
Prothrow-Stith has played a key role in defining youth violence as a public health issue in the years since (her 1991 book Deadly Consequences is considered a classic in the field). That means focusing on prevention efforts — not only in emergency rooms, but in doctor's offices and schools, too.
And guns are increasingly a part of that conversation.
Prothrow-Stith, who is dean and professor of medicine at the Charles R. Drew University of Medicine and Science in Los Angeles, remembers that when she first started out, stabbings were "the number-one way that young men were killed" in Philadelphia. The picture of violence changed dramatically in a matter of years.
"Guns in America play a huge role, especially as we start looking at weapons of war being available and the mass shootings that are taking place," Prothrow-Stith tells Morning Edition's Michel Martin.
The Centers for Disease Control and Prevention recorded 48,830 U.S. firearm deaths in 2021, the last year for which complete data is available. Those include suicides — which have long accounted for the majority of U.S. gun deaths — as well as homicides.
Culturally, suicide is more common in white America and homicide more common in Black America, Prothrow-Stith notes. But she stresses that violence in general is a learned behavior.
"We don't come out of the womb ready to commit suicide or homicide," she adds. "And I think as a culture, [we need an] understanding that children who are hurt, hurt others or hurt themselves. And our job is not to give them a gun, but our job is to figure out how to help them heal."
The role of guns in America, as told by a doctor
Prothrow-Stith says it's clear that guns turn "an everyday emotional situation" into fatal encounters.
"We know that sometimes people act differently when they have a gun in a situation, feeling invincible or escalating a situation that they might otherwise de-escalate," she added.
And at least when it comes to teenagers, she says, there are some similarities in the contributing factors that can lead to homicide and suicide.
Most homicides are the result of arguments between people who know each other, whether family members, friends or romantic partners, she says.
"I remember some youth workers saying, 'Well, it doesn't surprise me that he killed somebody because he didn't care anything about himself, so why would he care anything about anybody else?'" Prothrow-Stith says. "If you think about that, not caring anything about yourself is a symptom of depression. It's a symptom of a clinical illness and should be explored that way."
What preventing gun violence could look like
How would prevention work from a public health perspective? Prothrow-Stith uses the analogy of cigarette smoking and lung cancer.
First, there's primary prevention, which involves informing the general public of the consequences of smoking. The second phase is helping smokers quit, and the third is treatment for those who have lung cancer.
When it comes to gun violence, Prothrow-Stith says the primary phase should be raising awareness and trying to increase safety.
The secondary phase is about understanding the risk factors. "How do we help children who are hurt, either because they're victims of violence or they're witnessing violence, especially domestic violence or gang violence, on a regular basis?" she asks. "How do we help them heal from the anger, the guilt, the pain, but also give them the strategies to move forward?"
Programs like "Big Brothers Big Sisters" are a great example of a secondary intervention because they give kids distractions, purpose and opportunities. Don't underestimate the power of staying busy, Prothrow-Stith adds.
She shares the story of a high school student who, when asked how he stayed out of trouble, said he played football even though he didn't especially like it. Sports gave him an excuse to stay late and bail out of late-night social events as needed.
"He had developed his own strategies for dealing with the peer pressure," she says. "Those are the things that are very, very important for kids 'in the thick', if you will."
Focus on what works: an assault weapons ban
Many people are used to thinking about guns as a political issue rather than a public health issue. But Prothrow-Stith says a more productive way to talk about it would be to start where the U.S. has seen success in the past: in banning assault weapons from 1994 to 2004.
Studies have shown a decrease in gun massacre deaths during the decade the federal ban was in place — and an increase after it expired, which Prothrow-Stith attributes to the gun industry strategically "flood[ing] the market" with assault weapons.
There are many more deaths in mass shootings when high-powered assault weapons are available, she adds.
"They are like the movies and the sequel where more people get killed in the sequel than in the first movie with these assault weapons, weapons of war," she says. "We are seeing more and more people killed with each episode."
Practically speaking, guns are here to stay in the U.S., Prothrow-Stith says.
"But we don't need assault weapons," she adds. "And I think we just zero in on that argument. And I think that's a matter of time."
Back to the cigarette analogy. Prothrow-Stith remembers that smoking was ubiquitous and glamorous when she was a kid, and that it took roughly half a century after the first report on its health effects for the public understanding to follow.
She is confident that the U.S. will have the same transformation with guns. "It is time again to treat this epidemic, reduce our rates and stay with it," she says. "We've done it before. We can do it again ... just make our children safer."