The Public Health Approach To Reducing Shootings With Dr. Megan Ranney

“We should treat gun violence like a public health problem” is a phrase that is often used but rarely defined. 

My guest today is Dr. Megan Ranney, an emergency physician, injury prevention researcher, and the Dean of the Yale School of Public Health .

She sees firearm injury as part of a much broader health issue, one that affects not just the person who was shot, but families, communities, health care providers, and the systems that are supposed to respond afterward.

In this episode, we talk about what a public health approach to firearm injury actually means, why that framework is often misunderstood, and how public health researchers think about prevention differently from the way these conversations usually happen in politics or media.

Dr. Megan Ranney is Dean of the Yale School of Public Health, a practicing emergency physician, and leading voice for innovative approaches to public health. For more than two decades, she has worked on the frontlines of emergency medicine, caring for patients impacted by firearm injuries, overdoses, and other preventable crises while advocating for solutions that bridge science, policy, and public trust. Her work focuses on rebuilding the connection between science and society and advancing evidence-based solutions that help people live longer, healthier lives.

Transcript

SPEAKER_00 0:00

I'm Jeff Asher, and this is the Jeffalytics Podcast. We should treat gun violence like a public health problem, is a phrase that is often used but rarely defined. My guest today is Dr. Megan Ranny, an emergency physician, injury prevention researcher, and the dean of the Yale School of Public Health. She sees firearm injury as part of a much broader public health issue, one that affects not just the person who was shot, but families, communities, healthcare providers, and the systems that are supposed to respond afterwards. In this episode, we talk about what a public health approach to firearm injury actually means, why that framework is often misunderstood, and how public health researchers think about prevention differently from the way these conversations usually happen in politics or the media. We also get into firearm suicide, the challenge of building better data systems, and what public health learned from both COVID and the recent decline in violent crime nationally. This conversation is about what changes when you stop treating violence as a moment of crisis and start treating it as a long-term problem that can be studied, understood, and systemically eliminated. Let's dive in. My guest today is Dr. Megan Ranny. Dr. Ranny, thank you so much for joining the program.

SPEAKER_01 1:07

Thanks. It's an honor to be here. I've been listening to Deathalytics for a bit. So it's a real privilege to get to be a guest on this show. Well, great.

SPEAKER_00 1:15

That's great to hear. It's a good show. We all like our listeners. So first question, same to every guest. If you've listened before, you've heard it. But what is your background? What brings you here today?

SPEAKER_01 1:25

So I am by background an emergency physician, have practiced clinically for over 20 years, as well as an injury prevention researcher. I've spent my career working on violence and particularly gun violence as a health problem.

SPEAKER_00 1:41

And what brought you to this work? What motivates you to do all of this?

SPEAKER_01 1:45

Oh, I've worked on violence as a problem that can be fixed since long before I went into emergency medicine. I actually was a Peace Corps volunteer after college, working in West Africa, where gender-based violence was a major issue and was a major factor in transmission of HIV. Continued that interest and that work when I returned to the US and went to med school and then into emergency medicine, but really started working on gun violence as a health problem based off of my experiences working in an urban emergency department for my entire career. Back in the early to late 2000s, that was when we were starting to see firearm homicide rates increase in the United States. I was taking care of folks who were coming in, uh, having been shot through community violence on an almost daily basis, started questioning why we weren't doing anything for them. And then the event that really changed my trajectory, Jeff, was actually taking care of a firearm suicide. As I'm sure we'll talk about, firearms suicides make up, on average, two-thirds of gun deaths in the United States. But it wasn't until the late 2000s that I took care of a firearm suicide in the emergency department. That case changed my conception of what firearm injury looks like in the United States. It led me to asking why we don't talk about firearm suicide and firearm homicide as preventable in the same way that we talk about suicide in general, or in the same way that we talk about any other health problem that comes through my doors in the emergency department. And then it led me down this path of pushing to make sure that folks across the United States thought of firearm injury as something that is both preventable and that can be addressed by using a health or public health approach in the same way that we have addressed dozens, if not hundreds, of other problems over the course of our country's history quite successfully. And so that has really then become the career journey for me is making sure that we have awareness, but also trying to develop rigorous science and scalable tools that can be used in every community across this country to reduce this truly daily scourge of firearm injury and death in the United States.

SPEAKER_00 3:54

And so, sort of big picture right now, what is your role with Yale? What are you guys hoping to accomplish? And what do you do specifically within that sort of ecosystem?

SPEAKER_01 4:02

Yeah, so so a little more about myself. So, yes, I'm an emergency physician and injury prevention researcher. I am also now privileged to be uh the dean of the Yale School of Public Health. I came here to Yale just about three years ago now to launch our school into independence and to chart um the future of public health for our country and thinking now on a global scale as well. Within the Yale School of Public Health, um, we have a firearm injury prevention initiative that we've been building over the last few years. It includes folks from a variety of different disciplines, not just my own, of injury prevention, but we have epidemiologists, economists, psychologists, and community members. Quite importantly, we have a community scholar who is herself a survivor of firearm injury and brings that voice, that lived experience into the work that we do. Our aim is to drive high-quality research using the public health approach, which I'm happy to talk about, things that can help both illuminate the problem, but also again, drive us towards solutions, to grow education around firearm injury as a health problem, something that again had been abandoned for a long time. Um, I know from listening to your podcast around all the different disciplines out there uh that are working on this topic. But in general, the American public and even many of the people who have responsibility for policies or for social interventions, right? They don't understand how to conceptualize and think about firearm injury. So education on a policymaker level, but also on a community level. And then finally, thinking about how we do scale what works, because I am a deep believer that research only matters if it is used. Uh, I don't want the work that we do to sit in the pages of our journals or within the walls of an academic institution. That's part of the reason we have a community scholar, but it's also part of my core mission across the school. So within our firearm injury prevention program, we're really pursuing all three of those goals along the full spectrum of firearm injury. So homicide, including domestic violence, suicide, as well as unintentional injury and mass shootings.

SPEAKER_00 6:08

So you you stole my next question, but what when we talk about gun violence as a public health issue, it's a talking point. We hear it all the time from obviously from researchers like like yourself, down to council members and mayors and police chiefs, but we don't really define it, I feel like, very well. So, what is it with in your mind when we say gun violence, we should treat it as a public health issue, what does that mean?

SPEAKER_01 6:30

So that means two things. And I'm gonna talk through each of them in turn. The first is thinking about the health problems associated with gun violence. And the second part is the methods that we used to define and fix it. So let me talk about the first part first. Why is gun violence a health or public health issue? Well, obviously, when a bullet hits a body, when you end up in my emergency department because you've been shot, right? That is an obvious physical health problem and something that I am well trained to help reduce the bleeding, save your life, reduce the after effects of that bullet hitting your body. But there are other health problems associated with firearm injury as well. When a trigger is pulled, even if you are not hit by the bullet, there are emotional effects, right? We know that there's post-traumatic stress, anxiety, substance use disorder amongst people who are present at a shooting, also amongst family members or friends of someone who is shot or present at a shooting. So there are those psychological health effects. There are also community-wide health effects. We know that after a shooting, people, whether it's a suicide, a homicide, a mass shooting, we know that people in a community are more likely to have lots of different both physical and emotional after effects, ranging from increased rates of headaches to increased substance use disorder. Um, and of course a decreased sense of safety, which then leads to all kinds of other health problems like obesity and loneliness and things like that. So the first part of talking about firearm injury as a health problem is thinking about the full spectrum of health effects that firearm injury causes. And we want to measure and document those. Those also give us things to work on, to try to intervene on that go beyond just trying to stop a crime. Okay. So then the second part of calling firearm injury a health or public health problem is that it gives us some very structured, well-defined, evidence-based methods to figure out what the heck we do about this problem. I feel like here in the US, we are too often caught in either numbness or hopelessness, right? We hear that kind of the one side is like ban all guns, the other side is give everyone a gun. And the public health approach provides us some nuance, some direction, and honestly some hope within that. So public health approach is four steps. First, you measure how common a problem is. This, of course, is shared with criminal justice or econ as well, right? Saying what is the incidence and the prevalence. Second, we look at risk and protective factors. So all other things being equal, what increases the chance of someone shooting someone else or themselves, what increases the chance of them experiencing injury, either physical or mental, right? What helps to protect them, all other things being equal? Once you've done those first two steps, then you can go into the third one of designing and evaluating interventions. And within the public health approach, one of the things that I think is gorgeous about it is that that step of interventions is informed by trying to reduce risks or improve protective factors, but it can occur across a huge suite of different potential strategies. Everything from policy or partnership with law enforcement to educational interventions or economic incentives or changing of the built environment. Those are strategies that we've used successfully to, for example, reduce car crash deaths, to reduce tobacco-related deaths, to change nutritional outcomes. And we use that full suite of strategies in that third step of the public health approach as well. So measure it, determine what the risk and protective factors are, develop and evaluate interventions. And then the fourth step, of course, is scaling or disseminating what works. And then it goes right back around to measurement again. The other part about the public health four-step approach that I think is rather unique to public health is that we always do it with community at the center. Each of those steps, in a best possible practice, should be informed by the lived experience of folks who are living in a community. And so you can imagine that the way that we apply this public health approach in a rural community that is primarily affected by firearm suicide and where 60 to 80% of folks have a firearm in the house may be different from how we apply the approach in, say, an urban community where the vast majority of firearm injuries are community violence and where a much smaller proportion of households have firearms in the house. And so that kind of community-lived experience, awareness of what resources are present is core to each of those four steps across public health.

SPEAKER_00 11:05

And how important is trust from the community and trust in the research to successfully implementing this?

SPEAKER_01 11:13

Well, if I put on my dean hat rather than talking to you about firearm injury, I would say that I actually think trust is our number one public health issue right now, not just in the United States, but across the globe. If you do not trust the people that are doing the research or the folks from whom interventions are being proposed, none of the work that's being done matters. We're seeing that right now with vaccines. Gosh, look at the debate about hontavirus right now. We're seeing it in uh interventions for nutrition and fluoride, and certainly it's present in firearm injury work as well. It's why I and my own work have made a really concerted effort over the entire course of my career to work deeply with communities to make sure that the questions that I am asking are informed by their priorities and that we are co-creating the answers to help build that trust from the get-go. And that trust has to be present regardless of which community I'm working in, regardless of whether folks are firearm owners or not, regardless of whether someone themselves has been affected by firearm injury, which of course we know most American adults have been, or whether they're someone who is just trying to avoid firearm injury for their family members and loved ones. But that trust in how we do the work and in believing in the importance of scaling and intervention, without that, the rest of it is kind of pointless.

SPEAKER_00 12:37

And sort of how do we measure that work? I know you've been involved with, or at least have spoken about, the Edelman trust barometer. I wanted to bring that up and things like that. How do we measure this as a quantifiable concept of it needs to be improved? Here's how we can measure it and know whether or not we're succeeding in rebuilding and building better trust.

SPEAKER_01 12:56

Yeah, so you can you can measure trust as a mechanism, right? So you can say, is it present and is that a mediator or moderator of outcomes? You can also measure trust as an outcome. It's usually measured through surveys right now, although some folks are working on alternative metrics. The other thing that I'll suggest though is that you can measure trust through uptake of information. So for example, if we're talking about vaccines, we can measure a vaccine delivery as a proxy for whether or not folks trust recommendations around vaccines. Ditto for firearm injury work. I can measure trust. And we've actually worked on this in one of my projects where we've been working with 4-H in uh 20 plus states, both red and blue, rural and suburban communities across the United States. We're measuring trust by qualitative data, but also by rates of interest in the intervention, by completion of the intervention. If people don't trust us, they're not even going to be willing to have the conversation about whether or not to participate in research, and they're certainly not going to finish the study.

SPEAKER_00 14:02

So you raised this question and then we didn't answer it. Why do we treat firearm injuries, especially like firearm suicide, so differently from everything else in this country?

SPEAKER_01 14:10

I think it's a few different reasons. And I'm, of course, Jeff, curious in your perspective as well, having led this podcast for a bit. I think, you know, one is honestly that we've had 24 years of not funding firearm injury as a health problem in any sustained way. From the Dickey Amendment up through 2020, when I and others succeeded in getting firearm injury funding reappropriated under the first Trump administration, 25 million to CDC, 25 million to NIH. Between 1996 and 2020, there had been no formal appropriations for this issue. So there was no body of researchers who were trained in how to think about applying this four-step approach, nor were there people out there talking about why it was a health problem. So I think that's the first and biggest thing. The second one is I think it's kind of our American identity. We like to think of things as kind of black and white. And this is a much more nuanced approach to how we fix firearm injury than the kind of political extremes to which we we like to hue. And then the third part is because no one was talking about it and because it's not extreme, I think many people, when they think about firearm injury, they think exclusively about either community violence or they think about mass shootings. And they don't talk about kind of that full spectrum of firearm injury, which of course is all interrelated, right? You can't talk about homicide with without including domestic violence. You can't talk about mass shootings if you don't also talk about firearm suicide. You can't talk about a sense of safety in a community if you don't talk about whether or not firearms are moving around illicitly, or whether or not kids are able to get them from their parents without other parents knowing, right? These are, they're each intertwined. And be but as a because we didn't have those first two steps, people weren't talking about that full spectrum of firearm injury. And so I think that's part of the problem too.

SPEAKER_00 16:04

Yeah. I see it often as we've created this system, especially at the local level, but also at the statewide and the the national level, where the solutions that we think of are always law enforcement. And if the things are going up, we need more law enforcement or more jails or whatever. And if things are going down, it's because we did all the law enforcement and all the jails, and we don't consider the complexity of the issue and the possibility that there is enormous role for law enforcement, but not the sole role inherently in the system and the way that we can bring things down. That's how I sort of contextualize it.

SPEAKER_01 16:35

I totally agree with that. And I think even within working with law enforcement, and I've done a fair amount of that, right? There is these public health kits. So, first of all, thinking about the likelihood of law enforcement themselves being shot, thinking about whether or not law enforcement believes in and is willing to enforce a given policy, and then thinking about those larger cultural norms that determine whether or not a law that is passed is ever used or paid attention to. And I think one of the worst things that we can do from a criminal justice and legal perspective is pass laws that we're not following. I also find that people think about policy or or laws or law enforcement as these magical things that somehow are gonna fix every problem. And the reality is uh in the US, that's not how it works. I don't think it works that way anywhere, but I know our US setting better than most.

SPEAKER_00 17:25

Yeah, absolutely. So when you think about this issue, and we've seen an enormous drop in gun violence, especially from a sort of a criminal homicide, yeah. Homicides and sort of nonfatal shootings, not necessarily as much in the uh firearms suicides, but looking just at the homicide and the nonfatal shootings, what do you think is driving that down? And do you think that these changes are sustainable, or are we inevitably gonna bottom out and possibly start to see an increase?

SPEAKER_01 17:53

So I'm gonna answer that question with the caveat that there are lots of smart people looking at that right now, and we don't have definitive answers yet, right? So these are my best ideas that that could be disproven. I think it's two things. One is is kind of the regression to the mean. We had that huge spike in homicide during COVID, largely due to loss of those social structures that help to keep people safe and kind of general disorder and fear in society. And so I think part of it is just what kind of going up and then coming back down as society more or less writes itself. I also think that there much of that decrease is thanks to a number of interventions that were put in place over the past few years that helped drive that kind of regression back to our mean. Things like the incredible investment in community violence intervention programming, of which there's a few different types, but which have been shown to be quite successful in some communities, Chicago being one of the ones that's best studied, but Baltimore, Sacramento as well. So, so community violence intervention programs, increased investment in mental health services, rollout of extreme risk protection orders, and increased willingness to use them. I think those all have played a part as well. The question to me as to whether we sustain it is are we willing to keep doing the work? Um, and I'll say it's the same question for me for firearm homicide as I'm having right now around opioid overdose deaths, which we also saw spike during the pandemic, probably for many of the same reasons as we saw firearm homicide increase. We've seen a dramatic drop in opioid overdose deaths over the past couple of years. Preliminary data has just been released showing that it's decreased again. Uh, but but that's both, you know, we've again put some social structures back in place to help support people who are at highest risk of shooting someone else or of over using opioids. We've also put structures in place with opioids with like naloxone and suboxone. Are we going to keep investing in those? For firearm homicide, are we gonna keep investing in those community violence intervention programs, in those adult mentorship programs, in the mental health programs, and in the policies that have surrounded some of that work? That to me is an open question and where I am so enthusiastic about this podcast, hopefully driving us to keep implementing the programming that is showing promise in good trials, you know, against CBT interventions, community violence uh programs, um, hotspotting, et cetera.

SPEAKER_00 20:21

I can't claim that the podcast can move, you know, tens of millions of dollars of research. I would love to have that, but certainly I agree that the more that we talk about it and just sort of communicate it clearly that these are the steps that we think are driving it, and these are the things that we need to be thinking about and investing in, absolutely is critical. Why haven't we seen the same thing with firearm suicides?

SPEAKER_01 20:42

Great question. There's a few part things there. One is is that unfortunately one of the strongest correlates of rates of firearm suicide is presence of a firearm. And we know that there are more firearms in private hands now than there were two years ago or five years ago and ten years ago. So from a sheer numbers perspective, the number of folks that have intent to hurt themselves and have access to a firearm is higher than it was. We have good data from other countries, for example, from Israel, showing that when you separate people from a firearm, so like they did studies with the Israeli Defense Force, showing that when you forced soldiers to keep their um weapons on base over the weekends, they saw firearms suicide rates drop. Um, and and so there's just that sheer access to a firearm and a moment of hopelessness is such a huge driver. And we've not addressed that in any substantive way. The other side is that we're having a growing number of people who are suffering mental health problems in the US. I think this is deeply tied to both if we go back to that trust conversation, right? Loneliness, isolation, lack of folks to check in, increased economic hopelessness and despair. Um, those all play into drivers of suicide as well. I know there are a lot of folks who are doing a lot of great work on this problem, particularly. With some communities that have very high rates of firearm ownership, such as military or veterans, and are showing some promise in those discrete communities, but there's a lot more to be done.

SPEAKER_00 22:12

So moving to a similarly depressing but differently depressing topic, I just want to talk about sort of the COVID experience. Obviously, COVID was traumatic for a lot of people for a lot of reasons, and especially so in your field. To what degree have you sort of internalized the lessons from that? And I was just curious, what are the biggest takeaways that you sort of apply to your work today from what you experienced then?

SPEAKER_01 22:34

How long of a podcast is this?

SPEAKER_00 22:37

We got what, 15, 20 minutes?

SPEAKER_01 22:39

Fair enough. Uh oh my God. I mean, yes, I think COVID was traumatic in a thousand ways for all of us. And I don't think that our society has processed that at all. Whether it was the trauma for those of us working as frontline healthcare workers who didn't have adequate personal protective equipment, whether it was the trauma for those of us who had little kids who were stuck at home, and whether it was having loved ones who were isolated or who died, who we couldn't say goodbye to. And of course, the political trauma, the can the continued and perhaps even worsening division that was hastened by the COVID pandemic. I think that's its own kind of trauma. I think for me, some of my lessons from the COVID pandemic are first being really clear, as I just was with you, about what is my best guess at the moment based off of the data that I have and the fact that that might be disproven in the future. Um as well as thinking a lot about how the work that we do, right? When I talked about that four-step public health approach and community being at the center, I think when I go back to uh kind of not necessarily the very earliest days of the COVID pandemic, but getting kind of into months like three through 12, um, thinking about how we needed to help our local public health officials and local public health officials make decisions that were appropriate for their communities, knowing that, for example, rural Nebraska is going to be really different from downtown Brooklyn, right? In terms of population density, in terms of prevalence of COVID, et cetera. So how you localize um recommendations and help support public health, but also other officials and making decisions appropriately. And then finally, thinking a lot about communication and whether or not we in schools of public health are helping our students and faculty to be trained appropriately in contextualizing their data in both the ability to distinguish values versus what overlay values have on top of our interpretation of data, but also teaching and training us in how to communicate in ways that are appropriate for the communities in which we are communicating, if that makes sense, right? So, like that cold cut idea did messengers. What I have taken from COVID informs everything that I am doing as dean, all of the ways that I am working with my faculty, staff, and students to think about what the future of our field looks like. We've put in courses on communication. We're developing more uh leadership coursework and more um intensive partnerships with folks who are in positions of decision-making power in different sectors, whether religion or education or criminal justice, and thinking about how we give people space to think about kind of those rapid sequence decision-making, right? When when you do have incomplete information, like we've seen with hontavirus or Ebola recently. And then it, of course, it informs my work on firearm injury too, because it's in some ways the same problem. But I'll also, one final thing, Jeff, I'll say the opposite, which is everything I learned over the last 20 years by working on firearm injury as a health problem, informs how I personally try to respond to COVID, but also how I am trying to work as dean. Because in the spaces and places where I've succeeded in creating partnership on this issue and in changing awareness of what the public health approach can do to fix the issue. To me, those are examples, again, of hope that can then be brought to other problems. So I'm doing the opposite as well, which is extrapolating forward from this work.

SPEAKER_00 26:15

So, what would your advice be to someone like me that's I take data, I want to communicate it effectively, dispassionately, remove the bias, but also remove sort of that political taint that comes whenever you're looking at any issue. What's the best way to communicate this to a public that generally doesn't believe crime data or crime statistics? For they want to believe their priors and they never want to believe anything is different.

SPEAKER_01 26:38

Right? It's the, oh my God, crime is horrible, it's getting worse. And you're like, no, our data shows it's getting better. So a couple of things. One is I think you're already doing a great service by having the podcast, right? You are slowly within your sphere of influence, changing the way that people think and talk about the data, which is step one, right? You have your sphere of influence. And the second step, though, would be thinking about who you can connect with who has a different sphere of influence from you. Who on the ground might you be able to partner with who may have a different way of thinking about data or talking about it, uh, who may have a different experience than you do and a different way of making sense of the world. So that becomes the second step. And then the third one, and this is the toughest part, but I think people believe things when they feel them. And so it's about maybe this won't be you, but again, it's that partnership part is thinking about how do we help people really kind of touch and feel and appreciate what these changes are. And sometimes that's around volunteer work, sometimes that's around kind of storytelling and their community. That to me is is the third and biggest part, as I know we're both parents, right? If I tell my children something, the likelihood of them believing me is like this, right? It's it's through the actions.

SPEAKER_00 27:55

Immediately believe the opposite.

SPEAKER_01 27:57

Exactly. So it's it's kind of like parenting. You've got to prove it right by what you do.

SPEAKER_00 28:01

I'll note that my COVID experience started with potty training triplets, two-year-old triplets on the first week of COVID, thinking that we only had two weeks until they'd be back in school, and now would be a good opportunity. So different kind of trauma, but did it work? I just had to throw that in there. I'm not gonna say which, but it worked for two of them. They're all potty trained now. It's been six years, so I guess eventually it worked. It added stress that I did not need. Sorry, I wasn't that swapping.

SPEAKER_01 28:23

I mean, my guy, you just answered that that's your lesson for life. Also, you're not gonna get everybody, right?

SPEAKER_00 28:28

Right. Two out of three is not bad. Two out of three is good. I'd be the Hall of Fame if I hit 670 as a baseball. You're right. So uh getting back to my very serious questions, if you were advising sort of at the I want to take all three of these, the local level, the state level, and the federal level, of concrete steps that policymakers, a mayor, a governor, the people in the White House should be taking. What do you think are those policies? And I found that in just in doing the podcast that the feedback that I get is usually, oh, that was really interesting when somebody had these ideas for how we can solve gun violence or things like that. So I'm really interested in the concrete steps. Do you have those things that you've worked through that you might recommend?

SPEAKER_01 29:09

Yeah, it's a great question. Okay, let me start with federal and then I'll do state and local. Um, so federal, I think it's the whole of government approach. And I actually will look at the White House Office for Gun Violence Prevention. Under the last administration, they did a great job of bringing people together in a truly bipartisan way across the United States, bringing together ATF, uh community, SAMHSA, right, community mental health, department of education, in addition to health services in ways that, to me, deeply informed those drops in firearm homicide. And so, were I to have the chance on a federal level, I would encourage that whole of government approach. I would of course, of course, also urge for continued strong funding of NIH and CDC, in addition to NIJ, to take a nonpartisan, scientifically driven approach to firearm injury as a health problem because we don't yet fully know what works and it needs to be studied well so that we can move past emotion, which we all have, and into the realm of reproducible data. And we just have not had the time as a field to do that. So that'd be on a federal level. On a state level, funding offices of gun violence prevention that have well-trained people leading it, who understand both evidence and policy and who are committed to working on both homicide, including again domestic violence, homicide, mass shootings, and suicide prevention are core. On a state level, those red flag laws make a big difference. Supporting law enforcement officers to understand what red flag laws are, as well as within domestic violence, what domestic violence restraining orders consist of. And then funding, again, those local programs becomes a key. And then there are a number of very specific policies that we know make a difference on a state-by-state level. On a local level, this is the toughest one, right? Because an individual city or county is not going to be able to control sale of firearms very well. They're not going to be able to, they're going to be able to do some work around enforcement. This is where on a local level, investment in some of those structural things, things like adult mentorship programs, things like mental health services, things like making sure that firearm owners know how to safely get a firearm out of the house in a moment of crisis, things like bystander intervention training so that you can recognize risk and then know what to do about it, particularly important in communities with high numbers of firearms. Things like urban greening, right? Those are all steps that we have evidence behind that local leaders can invest in. And of course, community violence intervention programs too. They can those can all be invested in with that caveat that implementation is everything. So people will go, well, you know, X program worked here, but not there. Understand those local leaders are the ones that are going to understand their local context. Which of that suite of policies is most likely to be effective and get political buy-in? And which one is also most cost effective for their community? I will say that feel free to reach out to us at Yale. There are a number of other uh centers across the United States as well that are doing great work on local levels, happy to think with people about what makes sense for them. And again, especially on that very hyper-local level, thinking beyond legislation around firearms into all the other things that we know drives the likelihood of someone acquiring a firearm or using it against themselves or against someone else. And those are modifiable risk factors.

SPEAKER_00 32:38

Is there a data set when you think about these policies at all these levels? Is there a single data set that shaking your head wildly no? I'm gonna make you think about this though. If you could wave a magic wand and have one data set that was fully available, it was collected, it was, it was something that you could do research on, what would that be? You know, certainly if if you want to say there's nothing and that that's not answerable, I'll I'll take that as well.

SPEAKER_01 32:59

I mean, we can talk about kind of FBI data and all the trouble with that, right? I can talk about a vital statistics data and how delayed it is and how problematic that is. I will say our our national violent death reporting system is a great step forward, but it's only deaths. And our injury data on firearms is totally unreliable, you know, in an ideal world. And I will say, okay, I'm gonna put in a little plug for my school. We are working on trying to create some of this. We have uh a website called Pop Hive Population, and then POP like population, hive like a beehive, pophive.org, bringing together multiple different data sources for different diseases or health problems, both chronic, infectious, and injury related. And we have firearm injury on there. We're pulling in CDC data, but we're also pulling in Google search data, working on bringing in local community surveys about safety, bringing in emergency department data, using data from National Electronic Medical Records. Um, it's still in a the firearm injury part is still in a beta form, but that would be my dream is that you have a place that brings together injury, death, crime, but also some of those psychological and safety measures and some of those markers of, you know, is everyone, are people searching for firearm safe storage or firearm suicide, right? Those things as well. That would be my ideal data set. And in a great world, we would have it able to be updated on a monthly or quarterly basis so that you can implement and then do real-time evaluation of interventions. One of the things that makes me sad as a researcher is when I see a spending time and money, like really precious taxpayer dollars or philanthropic dollars, on things that don't work. And so that rapid cycle of evaluation matters a lot. So that would be my ideal scenario. I know we are very, very far from it right now with lots and lots of incomplete data sets. To me, though, that's where putting a bunch of data sets together helps to fill in the gaps that, you know, one data, you know, FBI data has one crime data has one whole, emergency department data has a different whole. And when you triangulate, you can see where they're similar and where they're different.

SPEAKER_00 35:08

Yeah, absolutely. Uh just pulled up pophive.org. Very interesting. I'll I'm excited to play with it. And give me suggestions too, as you as you I will for sure. Well, you've got me thinking. So we did a shooting dashboard tracker that goes out and it scrapes daily shooting data from 30 cities, some of which publish data uh daily data like Philly and Chicago that have their sort of victim-level data. Only a handful do that. Others that get weekly data or do aggregated daily data, and then some do monthly data. But that it's like an enormous undertaking to just get 30 agencies of data. It's ridiculous how hard it is.

SPEAKER_01 35:43

Well, we'd be happy to bring that in and put it on Pophive too, and kind of give you credit. Like we're working with Carnegie Mellon, with Delphi. Like we're we've got a bunch of partners across the country.

SPEAKER_00 35:52

Absolutely. We'd we would we would love that. That would be awesome. This this conversation will be taken offline at this point. Uh so my last question, I I know that you're busy and I don't want to take up too much time, but this is a very serious question, which is what is the best hospital/slash emergency room television show? I just finished watching the most recent season of St. Dennis. Um, I don't know if you've seen that. I love Scrubs. I obviously like comedies. Which of these is the best one? And you can grade based on realism or you can grade based on entertainment value. I'll leave that completely up to you.

SPEAKER_01 36:21

So, based on realism, the pit, hands down. It is, I mean, I know some of the folks that are writers and consultants and they are real live emergency physicians. It is so real to the point that I almost sometimes can't watch it because it gives me some PTSD myself. That's why I love the feel though. For humor, gosh, I think nothing beats Scrubs. I love Scrubs. Me too. Read the reboot was was pretty decent. It's entertaining. What's your best crime show?

SPEAKER_00 36:49

I don't watch any of them. Um, I I guess I re I really enjoyed we we run this city, the Baltimore Gun Gun Trace Task Force miniseries on HBO. I really enjoyed that. I thought that was entertaining and well done and was telling the the true story truthfully. If you've read the book. If not, I'm gonna add it now to my list. It's it's a very it's a good show and it's a good read, and they're very similar and it's it's cool. My my actual last question, I'm really interested to see your response to this is is there a role? I'm sure there is, for AI in improving your work and how you approach it?

SPEAKER_01 37:21

Uh, I mean, yes. We are already with Pop Hive, we're already using AI to help us ingest and normalize our data. Um, it's been a huge help, saves so much time. I think uh there's some interesting work to do around kind of the data analysis that feels the most straightforwards. There may be work to do, and we're doing some thinking about this with some of the AI chatbots, thinking about how you create definitions of risk and linkages to help. And knowing that a lot of folks, I've done work with social media in the past, um, and a lot of folks are turning to social media or now increasingly chatbots, both as sources of help, but also potentially as instigators of harm. And so I think there's a really important body of work to do around that. And then the rest is still kind of right, I feel like there's a lot of AI propaganda and hype and trying to sort through what's real versus what isn't. I'll tell you, we've been trying to use chatbots to make sense of some data in real, like to provide real-time interpretations, and we've not found that to be particularly useful yet. But there's a lot more to come. And I think it's gonna be knowing how to use AI well and ethically and responsibly is gonna be a core skill set for all of our students going forwards. Um, hopefully not in a way that removes the human side of what we do.

SPEAKER_00 38:37

Absolutely. Great. Dr. Any, this was wonderful. It loved this conversation, really appreciate it. And uh thank you for coming on the show.

SPEAKER_01 38:44

Thank you. Thank you again for doing the show. Fills a much needed hole uh in our civil discourse.

SPEAKER_00 38:50

Thanks for listening to the Jeffalytics Podcast. Be sure to subscribe and to learn more, head on over to ahdatalytics.com for more information and previous episodes. If you like what you heard, please leave a glowing review, which will help others to discover the show. Until next time, I'm Jeff Asher.