美国国家公共电台 NPR--One way to prevent gun violence? Treat it as a public health issue

One way to prevent gun violence? Treat it as a public health issue

Transcript¹

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 invincible² or escalating³ 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 helping⁴ smokers⁵ 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 awareness⁶ 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 guilt⁷, the pain, but also give them the strategies to move forward?"

Programs like "Big Brothers Big Sisters" are a great example of a secondary intervention⁸ because they give kids distractions⁹, 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 bail¹⁰ out of late-night social events as needed.

"He had developed his own strategies for dealing¹¹ 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 massacre¹² 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 glamorous¹³ 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 transformation¹⁴ with guns. "It is time again to treat this epidemic¹⁵, reduce our rates and stay with it," she says. "We've done it before. We can do it again ... just make our children safer."

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 invincible   

adj.不可征服的，难以制服的

参考例句：

• This football team was once reputed to be invincible.这支足球队曾被誉为无敌的劲旅。
• The workers are invincible as long as they hold together.只要工人团结一致，他们就是不可战胜的。

3 escalating   

v.（使）逐步升级( escalate的现在分词 )；（使）逐步扩大；（使）更高；（使）更大

参考例句：

• The cost of living is escalating. 生活费用在迅速上涨。 来自《简明英汉词典》
• The cost of living is escalating in the country. 这个国家的生活费用在上涨。 来自辞典例句

4 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

5 smokers   

吸烟者( smoker的名词复数 )

参考例句：

• Many smokers who are chemically addicted to nicotine cannot cut down easily. 许多有尼古丁瘾的抽烟人不容易把烟戒掉。
• Chain smokers don't care about the dangers of smoking. 烟鬼似乎不在乎吸烟带来的种种危害。

6 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

7 guilt   

n.犯罪；内疚；过失，罪责

参考例句：

• She tried to cover up her guilt by lying.她企图用谎言掩饰自己的罪行。
• Don't lay a guilt trip on your child about schoolwork.别因为功课责备孩子而使他觉得很内疚。

8 intervention   

n.介入，干涉，干预

参考例句：

• The government's intervention in this dispute will not help.政府对这场争论的干预不会起作用。
• Many people felt he would be hostile to the idea of foreign intervention.许多人觉得他会反对外来干预。

9 distractions   

n.使人分心的事[人]( distraction的名词复数 )；娱乐，消遣；心烦意乱；精神错乱

参考例句：

• I find it hard to work at home because there are too many distractions. 我发觉在家里工作很难，因为使人分心的事太多。
• There are too many distractions here to work properly. 这里叫人分心的事太多，使人无法好好工作。 来自《简明英汉词典》

10 bail   

v.舀（水），保释；n.保证金，保释，保释人

参考例句：

• One of the prisoner's friends offered to bail him out.犯人的一个朋友答应保释他出来。
• She has been granted conditional bail.她被准予有条件保释。

11 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

12 massacre   

n.残杀，大屠杀；v.残杀，集体屠杀

参考例句：

• There was a terrible massacre of villagers here during the war.在战争中，这里的村民惨遭屠杀。
• If we forget the massacre,the massacre will happen again!忘记了大屠杀，大屠杀就有可能再次发生！

13 glamorous   

adj.富有魅力的；美丽动人的；令人向往的

参考例句：

• The south coast is less glamorous but full of clean and attractive hotels.南海岸魅力稍逊，但却有很多干净漂亮的宾馆。
• It is hard work and not a glamorous job as portrayed by the media.这是份苦差，并非像媒体描绘的那般令人向往。

14 transformation   

n.变化；改造；转变

参考例句：

• Going to college brought about a dramatic transformation in her outlook.上大学使她的观念发生了巨大的变化。
• He was struggling to make the transformation from single man to responsible husband.他正在努力使自己由单身汉变为可靠的丈夫。

15 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。