The Root Cause. A Policy Investigation.

**IMPORTANT: This article contains mentions of mental health, depression, gun violence, and acts of gun violence. If you feel uncomfortable with these topics, please refrain from reading.

In June, I wrote an article titled “Treating the Untreatable? Societal Stimulants Affecting Health.” (1) In this article, I argue that mental health is untreatable by conventional health policy strategies and that policymakers must look to reduce the prevalence of stimulants in order to tackle the problem. A few days ago, I read an article titled “How gun violence affects the mental health of Philadelphia children.” (2) This article, the content of which I hope to further explore in this journal entry, has implications for many cities across the US that have high rates of gun violence (including Chicago, Baltimore, and Detroit) as well as cities in other nations.

So what did the article say? Well, a new Penn Medicine study finds that children living within 2-3 blocks (or ⅛ of a mile) of a gun violence incident are more likely to visit the emergency department for a mental health condition. In fact, 31% of the 2,629 gun violence incidents included in the study had at least one mental health related hospital visit in the 60 days after the initial incident. (3) Unfortunately, gun violence has greater effects on young children and African American families; African American families specifically identify gun violence as having a major negative impact on their quality of life as compared to other demographics. (4)

What causes gun violence to be more prevalent in cities like Philadelphia and what are some common measures used by policymakers to reduce gun violence?

Let’s start with a closeup of Philadelphia itself: in 2021 alone, the city saw 486 fatal and 1846 non-fatal acts of violence. (5). Gun violence is an extraordinarily complex issue; I hope to explore a few factors that influence the rate of violence in this section.

1. Access: The state of Pennsylvania authorizes open and concealed carry of weapons. (6) The less-restrictive state policy makes it easier for individuals to access firearms resulting in more cases of gun violence.

2. Illegal Trade: Many large cities around the US, Philadelphia included, have large underground networks for trading illegal firearms. This secondary market makes it easier for individuals to access firearms when they may not have been able to purchase weapons via conventional means.

3. Societal Issues: Philadelphia has struggled with high rates of poverty and inequity, making gun violence more likely. Societal factors that correlate with gun violence include long-term unemployment, few education opportunities, and structural marginalization.

Firearm legislation is sometimes federal and sometimes state/district-level in origin. Some policies instituted at the Federal level include the 1934 National Firearms Act which 1. restricted the sale of the most dangerous firearms 2. put taxes on the buying and selling of firearms 3. required some firearms to be registered with the government when purchased. (7) The 1968 Gun Control Act was another Federal policy that regulated the purchase of firearms, specifically limiting their sale to adolescents and individuals with a criminal history. (8) Finally, the 1993 Brady Handgun Violence Prevention Act required gun buyers to undergo a background check while also mandating a waiting period before handguns are sold.

State and county governments are not required to enforce federal law and local laws differ greatly in terms of restrictiveness and enforcement. Some districts have imposed their own legislation in addition to Federal Law; the 1976 D.C. legislation is one such example as it bars private residents from owning handguns. (9)

In Philadelphia, several plans have been put in place to curb gun violence. The Office of Violence Prevention has been developed to prevent and reduce gun violence by organizing specialized task forces including the Community Crisis Intervention Program and the Rapid Response Team. (10) In 2017, the Special Committee on Gun Violence Prevention was established to gather community input for state and city-level policy. (11) The “Philadelphia Roadmap to Safer Communities” has been created to build partnerships with local organizations, police forces, and community members. (12) Finally, in 2006, the Gun Violence Task Force was implemented to prosecute individuals involved in trafficking, gun violence, illegal purchasing, and straw purchasing (a middleman buying a firearm for someone who is legally unable to). (13)

As you can tell from this article so far, gun violence is an issue with many policy “solutions”. The issue with each of these solutions is that the factors affecting gun violence differ in every community, and there is no real one fix to the issue. Philadelphia, like many cities, has had to adopt a variety of initiatives to curb gun violence and even these have only been partially successful. Let’s turn our focus back to the connection between gun violence and mental health.

We Love Philly is a Philadelphia nonprofit working to make sure high school-aged students graduate. The Executive Director has stated that “at least once a month one of my students knows someone who's been shot. It affects their mental health because they do not feel safe and secure… it’s almost getting to the point now where it’s just a ‘yeah, well, this is how it is’.”

The Penn Medicine study which I discuss at the start of this article suggests that gun violence creates a “cycle of violence” in cities like Philadelphia. Individuals who experience violence are likely to struggle later in life and perhaps become more violent, passing this violence down through generations. While most individuals who experience gun violence do not become violent themselves, research shows that conditions such as anxiety, PTSD, sleep problems, and personality changes are more prevalent in individuals who have experienced violence; these conditions, when combined with other risk factors such as substance abuse, increase the risk of gun violence. (14, 15)

Before I conclude this article, I do want to highlight a few measures cities like Philadelphia may implement that could reduce this problem:

1. A Penn study from August 2020-May 2022 finds that Group Violence Intervention Programs reduce gun violence committed by participants by approaching high-risk individuals and connecting them to support resources while informing them about the risks and consequences of violence. (16)

2. Penn researchers have also found that increasing surveillance and prosecution for individuals involved in gun violence reduces violence itself (the study states that increasing enforcement reduced violence by 42.8%).

3. Philadelphia legislators could invest in marginalized communities (with the goal of reducing poverty, disparities, etc.) while increasing access to mental health and therapy programs for affected individuals. (17, 18)

4. Philadelphia legislators could also proactively reach out to children in high-violence areas, educating them about gun violence and increasing social support. (19)

In my earlier article titled “A Can of Worms. Is Education Health?”, I discuss the Social Determinants of Health (SDoH), “non-medical” factors that affect health outcomes. (20)

Policymakers invest billions of dollars into direct medical or primary care. Yes, primary care is important to ensure positive outcomes for individuals with acute illness, yet this is only half the story. Improving the social determinants of health is crucial to resolve health disparities and improve long-term population health.

Take this analogy: If policymakers decide to put 1 billion dollars into hospitals and primary care, to sustain that level of care, policymakers must put in roughly that amount on a yearly basis. However, if policymakers put 1 billion dollars into addressing the root cause or the social determinants of health, that amount might be the only taxpayer money spent. To end this “cycle of violence”, the Philadelphia government must work to make communities safer, ensuring children stay healthy and families thrive.