- There are certain injuries that cannot be made better by surgery or by medicine.

And that's why the tools of public health need to be used to prevent gun violence.

- Because it's not a name, it's not a statistic, it is a person.

You can see this person had family, they had memories, they had characteristic, they had a smile.

- In some neighborhoods of my hometown of Philadelphia gunfire is a constant.

And even if we're not literally hearing it, the stories and our own fears can be haunting.

When we talk about the crisis of firearm violence we're not just talking about mass shootings and homicides.

We're talking about violent crimes, suicide, attempted suicide, domestic violence, cops shooting civilians, unintentional injury and death.

The violence is far reaching and it's spiked here in Philly.

Record highs for three years in a row now with a disproportionate impact on Black low-income neighborhoods.

But this issue is bigger than my city, than communities of color, than urban areas alone.

Nationally gun violence deaths rose almost 10% in 2021.

Yearly we see more than 40,000 deaths.

On top of that, non-fatal firearm injuries are estimated over 100,000 per year, and there are millions of Americans living with trauma or fear.

What's more, research suggests all these shootings have become more lethal over time.

Clearly, the criminal approach to reducing gun violence, which is cops enforcing firearm possession laws, and responding to and prosecuting gun crimes isn't cutting it.

But some people say there is another way.

What if we treated gun violence with the tools of public health?

How would things look different?

And what can we learn from my home city of Philadelphia?

Public health.

It's the science of reducing and preventing death, disease, and injury, promoting the health of populations with a little help from data, research, and policy.

This kind of approach has led to some huge wins for our collective wellbeing, from eradicating diseases to decreasing smoking deaths and car crashes.

Experts think we may be able to do the same thing with gun violence.

- What a public health approach would look like is, you know, first of all, starting with the idea that gun violence is not inevitable.

It is preventable.

And then using data, using evidence, and the tools of public health to develop and implement and scale, where applicable, programs that can prevent gun violence.

It's distinct from the medical care that I provide to fire injured people in the hospital.

So it's not a medical approach.

And it's also distinct from a law enforcement approach, which kind of like trauma surgery responds after the shooting has happened.

- There was this change about, you know, in the '90s, where there was a new impetus to think about, "Okay, well, if we look at it from a public health, a population level standpoint, what are some of the risks?"

And when that was recognized that they became highly politicized.

There's something called the (indistinct) amendment passed, which was a ban on any research funded by the federal government.

So the CDC or the NIH, which, and really promoted gun control.

That was interpreted really broadly, such that many of these agencies were really afraid to fund health and public health research that talked about, even the word gun or even the word firearm.

- Those limits on federally funded gun violence research were lifted a few years ago, helping public health experts study risk factors and evidence-based solutions.

You know, I'm a nurse.

We offer evidence-based.

We know, for example, that just having a gun in the house doubles the chance of dying by homicide.

And we also know that exposure to violence, drug use, and a history of violent behavior are closely tied to gun violence.

Public health experts in Philly are leading this same kind of research.

- We have a research study that showed that the neighborhoods in Philadelphia that were redlined back in the 1930s, those are the places where modern or today's firearm violence happens.

Sort of a direct result of disinvestment in structurally marginalized people and places.

And so there really is this strong and enduring and continuing impact of racism on the incidents of firearm violence.

- These public health experts say, if you know the risk factors, then you can design interventions to reduce the violence.

The interventions can take place at three different levels of prevention.

- So primary prevention would be how do you create places and systems, in which firearm violence just won't occur?

Like really thinking long term and really deeply investing specifically in places that have been systematically disinvested in.

Investing in school systems, investing in social systems that we know help people to live and thrive.

Secondary prevention is to reduce the immediate harm on the person who's been injured.

Do you have ambulances or other sort of pre-hospital transports so you can get people to hospitals that can treat any kind of injury and can help people survive.

And then tertiary prevention is how do we prevent further harms.

There are really important ramifications, specifically in like the context of PTSD and depression and long-term disability that exist.

- Now, those long-term primary prevention strategies will take time.

But there are other more immediate public health solutions that may stop violence before it happens.

They're called Community-Based Violence Intervention programs, or CBIs.

And some models have been shown to reduce homicides by 60%.

One CBI method trains community members to go into the streets to mediate conflict in their own neighborhoods.

But what might work for Baltimore or Philly might not work in other cities or smaller communities.

(uneasy music) Here's another public health approach to primary gun violence prevention.

And it's right here out of Philly.

Researchers and community organizers here have shown that simple physical changes to the environment can make a huge difference.

The city has tens of thousands of abandoned or vacant lots.

And this green space that you see me standing in right now was once one of them, a symbol of the city's disinvestment in the community.

(light music) With help of community members, the Pennsylvania Horticultural Society has launched a citywide initiative to green these abandoned lots or turn them into parkland.

Now a study of over 500 of Philly's vacant lots compared treated green lots to untreated abandoned ones.

It showed that in the vicinity of the green lots gun violence dropped up to 29%.

And also that the residents felt safer.

- We don't really know how it works.

So the theories that have been applied to underlie that once you clean and green spaces, people are more likely to use outdoor spaces and that will increase social cohesion and a sense of community, which then creates more social control over things like crime and violence.

- And mental health may be an important piece of the puzzle.

The Philadelphia researchers also showed that restoring the abandoned lots was associated with a significant reduction in residents' depression.

And with suicide making up to 54% of gun violence nationally in 2021, these findings are meaningful.

So I wanted to have a conversation with Philadelphia gun violence activist, Zarinah Lomax who thinks a lot about the connection between gun violence and mental health.

How has gun violence in Philly affected you?

- Well, March 18th, 2018, unfortunately, a young lady named Dominique Oglesby was gunned down on 52nd and Market want to get something to eat.

I always say she was like my little sister, because, you know, they become family by default.

But I met her mother at the age of 17, Dom was five.

Dominique was the poster board kid.

She sang, she dance, she act.

She was very big on education.

To take someone's life like that, knowing the consequence, we all know the consequences.

You shoot somebody, you going to jail.

For that not to matter to you, you don't care about your life in the first place.

People don't feel like their lives are worth anything.

- And that's why gun violence is such a big issue, because mental health is the huge protagonist that's making this worse and worse and worse.

- Nobody is healing.

So the numbers are raising because there's more co-victims.

There's no survivors.

Every person that lose a person is a co-victim.

There are a lot of people that are still victims of what they've been through.

And it doesn't have to be gun violence but guns are very accessible now.

That's their way of fighting.

Hurt people hurt people.

- When my friend died, she was shot multiple times and, you know, it just makes you mad.

You know what I mean?

Like you're so angry, like not only did you take her from this world, but you took her from me.

And it's like you don't know how to recover from that, because the emotion of it is so overwhelming.

So we talk about victims but we also don't talk enough about co-victims and survivors and how that transforms our life.

- So when Dominique passed away, it changed my life, because, I mean, we lose people, that's life.

But I had never lost anybody in that way.

And I had a set of emotions that I didn't really know what to do with.

I don't know what co-victim was, I didn't even know it existed.

You always hear victims and survivors.

I found the term and it was naming myself, and I was like, "Oh wait, this is me."

When I was able to figure out what my grief was and how it made sense, it helped me to heal.

'Cause I almost felt like for a few years that I didn't have the right to grieve as much as I was, because I wasn't her blood relative.

- So, what led you to found Epilogues and what has been the experience in the community and the outcome?

- So.

I started the Epilogues back in October of 2018.

It's an organization on paper, but again, it is an experience.

We tell the stories of slave victims and survivors through fashion, music, and art.

So we use the art to pull the people in the room, but we also sit them down together, and we use their stories as a way to humanize the emotions of who's in the room.

We're going into every space and we're saying, "Hey, I am someone that looks like you.

I've experienced this as well.

How can my pain help your pain?

And how can we heal together?"

- I think that one of the things that I love about that is that I feel like when you're going through a painful process, you don't always want to verbally say it.

- Yeah, it's lonely.

When you are really grieving and you just feel like this is it, like you don't feel like anybody else gets it, but this has shown me that a lot of people get it.

I could have less shooting by figuring out where a person is and figuring out how can they learn coping skills so that they don't take someone's life.

But if you don't have a conversation with these people that are doing it in the first place, you're not gonna be able to stop anything.

We've lost this sense of community.

You didn't have this back in the day 'cause the communal sense was there, 'cause people talked.

You had dinner together, you had church, whatever it is that you went through, people were talking, so they knew how to help you.

- So a public health approach can give us a better understanding of firearm violence and how to prevent it.

But this model isn't without limitations.

- So we know things, like permit to purchase, universal background checks.

Those seem to be in states where they have been enacted associated with decreased rates of firearm homicide.

These are laws that may be disproportionately enforced against Black people, for example.

And so there is certainly a group of activists who are saying that these types of policies may also be racist.

- The public health informed advances we've seen around gun violence are exciting.

But the road ahead is long.

America doesn't yet have public health infrastructure to fully research the crisis and test and apply interventions.

- And if you can believe it, we do not have one national data source for non-fatal firearm injuries.

So when I do research and I do do research on the epidemiology of firearm violence in the city of Philadelphia, I have to use the police department's data that collects the information that they feel is relevant, and maybe less information about, you know, the social determinants of the person who was shot, things that would be of interest of public health.

- But understanding that the violence is a preventable, public health crisis not just an issue of crime, is what's key here.

So is believing in the power of community and individual action.

- Everybody can be a product of change.

I think what happens that people get caught up in the numbers of how many people lives that they change.

A lot of people are not talking about what they're dealing with, which is why I continue to give the safe space to talk.

And a hug is a change.

Your story changes people because you survived something.

It may not have been as traumatic to people, but it still can help them to say, "Listen, I've been through this," or "Listen, I see you.

How can I support you?

Do you need anything?

Can I come with you here?

Can I give this to you?

Can I give you a hug?"

- When my childhood friend and fellow nurse Ebony was shot numerous times and killed, it impacted me in a way that I know only other people who have experienced this can understand.

And sometimes I feel like we need to talk about these things to get through it.

This was a really tough episode for me to make.

Ah!

So, behind there are the tears.

(laughs) And I hope you can all understand how hard this is to deal with twofold.

Because on one hand I'm an inner city nurse dealing with seeing the effects of gun violence through my patients who I'm in charge of healing their body but also their mental space and their fears and their traumas.

But then also being someone who's experienced gun violence amongst my family members and amongst my loved ones, and the anger, the fear, the trauma, the tears, it all comes out with me, too.

So I hope you guys can understand.

So have you or a loved one been affected by firearm violence?

I believe that storytelling can teach us all how to thoughtfully and effectively respond to gun violence.

We all just want this to end.

So that's it for this week's episode of PBS Vitals.

Until next time.