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Chana A. Sacks, MD, MPH an internist at Mass General and instructor in medicine at Harvard Medical School, is a vocal advocate for gun violence prevention. In 2012, she was a resident at Mass General when her cousin’s seven-year-old son, Daniel, was killed during the shooting at Sandy Hook Elementary School. Since then, she has dedicated her career to tackling gun violence as a public health epidemic and developing a research program focused on the issue. In 2015 she co-founded the Mass General Gun Violence Prevention Coalition, a multidisciplinary initiative dedicated to reducing morbidity and mortality from firearm-related violence and promoting great gun safety through research and education and in 2019 was named the Co-Director of the new MGH Center for Gun Violence Prevention. She participated in a panel discussion on the challenges of student activism to end gun violence during Boston’s 2018 HUBweek. Dr. Sacks has published extensively on the topic of gun violence prevention. She earned her BA in history from Georgetown University, her MD from the University of Chicago Pritzker School of Medicine, and her MPH from Harvard School of Public Health.
Lindsay Gearheart: I’d love if you could start by telling me the story of how you got started in advocating for gun violence prevention.
Chana Sacks: I think many physicians these days think about this issue often. I’m certainly not alone in that. But when my family was personally affected, it definitely changed the way I thought about and how I understood this issue. I was a second-year resident when my cousin Mark’s seven-year-old son Daniel was murdered at Sandy Hook Elementary School. In the aftermath of that, for my cousin Mark, it almost didn’t feel like a choice. For him, it just seemed clear that if he could do anything to prevent any family from going through the hell he was living through every day, then that’s what he was going to do. Thinking about the position that I was in as a physician, and the platform that I had as a physician in the Harvard system, at Mass General, I have just tried to follow in his footsteps, asking what I can do to try and take on this issue in a meaningful way. And that’s what I’ve been working on in a lot of ways ever since.
LG: It would be great if you could talk about why this is considered a public health crisis. I think many people would be surprised to link the two.
CS: Cutting through all of the complexity, the reason we have to talk about this is very simple: we have an obligation to take on the issues that are facing our patients. We try to be driven by data in everything that we do. And when you look at the numbers here, what else would you call it? Forty-thousand people a year die from gun violence. Many more suffer nonfatal injuries and become our lifelong patients. Many, many times that number witness this violence or know people who’ve suffered from gun violence and are deeply affected by it. Those are people that we’re seeing every day in our clinics, not just in our emergency departments and in our operating rooms, but in our primary care practices and with our physical rehabilitation specialists and mental health clinicians. This touches every field of medicine. Thinking about how we can prevent those injuries and that suffering is, to me, the cornerstone of what we do in healthcare, medicine, and public health. We can’t afford to treat this issue any differently.
LG: Are healthcare specialists taught to approach the topic of gun violence prevention nowadays, or is that something we’re still working on?
CS: It’s absolutely something we’re still working on and it’s a cornerstone of what we do here at the Center for Gun Violence Prevention. That 40,000 people a year who die from gun violence is the same number for example as those who die from liver disease in this country. Yet in my medical training, I had lecture after lecture on how to approach that problem medically and how to intervene and recognize those who are at risk.
I’m not alone in saying I remember not one lecture or discussion in any part of my medical education or curriculum about how to think about what it means to bring gun violence prevention and violence prevention more generally to the bedside, to clinical care. That’s something that we are recognizing is both a big problem but also a solvable one, and it’s a big part of what we do.
LG: I think something that’s important to this conversation is the large percentage of gun violence deaths that are the result of suicide. Can you talk about that?
CS: The discourse about gun violence in this country is too often very shallow. We think about and talk about gun violence as if it’s one thing, and it’s very much not. I think of gun violence and deaths and injuries related to gun violence as due to four different types of violence.
One is the mass shootings that really dominate the headlines. A second is other types of homicide or interpersonal violence that for example disproportionately affects communities of color, both in Boston and around the country. There are unintentional injuries like when a five-year-old finds an unlocked and loaded gun and shoots a sibling or a neighbor. And then there’s suicide, which we don’t talk about much at all.
When you look at the data, like I said, and I intend to sound like a broken record of following the data where they lead, the numbers are the exact opposite of how we talk about them. The mass shootings that we talk about that dominate the news account for less than one percent of all gun deaths in this country. Unintentional injuries, those accidental shootings, account for two percent. Other types of homicide, about a third. And suicide, arguably the least talked about type of gun violence, is responsible for 60 percent of all firearm-related deaths. When we think about that, what could be more right in our lane as clinicians than thinking about how to recognize who among our patients is at risk, how to think about harm reduction, and how to think about intervening to prevent those deaths and that suffering. I think once we start to talk about it and frame it in that way, it becomes so clear that it could not be farther away from this hyper-politicized discussion that other people seem to be having. But it really is a public health, medical discussion about how we take care of the people right in front of us.
LG: I’d also love to learn about what the Center is doing itself in terms of education and community outreach. Could you also talk about the research you do and how that connects with advocacy?
CS: Our center has three fundamental pillars that mirror the mission of our academic medical center. We focus on clinical care and education, research, and community engagement. When we’re doing our job right, all three of those intersect in important and fundamental ways. But let’s talk about them one by one just to be clear.
As I mentioned, we’ve done a lot of work looking at how often physicians are having conversations with patients about firearms. What we learned was even among really high-risk patients — we’re talking adolescents who come into our emergency department with active suicide ideation, for example — physicians were commonly not talking to patients about guns. Which to me as an internist is like someone coming into the hospital with a heart attack and not asking if they smoke. It’s one of the most modifiable risk factors for death from what we know that they have. So that really needs to be a never event.
When we started talking to doctors around the hospital and around the country, it wasn’t rocket science. We learned that people weren’t talking to patients about firearms because they were never taught to and they never knew how to. I think clinicians are very good at what we’re trained to be good at, and we’re less good at things we’re not trained to be good at. That felt like a real need to us and a real solvable problem. So we brought groups together to think about what that educational programming would look like, and we developed a case-based simulation curriculum.
Every intern that started here at Mass General this summer across six departments went through a curriculum about how to talk to patients about firearm safety and gun violence prevention, really teaching just some concrete basics. How to talk about safe storage, how to talk about the links between access to firearms and suicide, and empowering frontline clinicians with some of the tools and language that they need to care for patients and have these conversations in a thoughtful, culturally competent way. We hired a group of standardized patients, or patient actors, to work through scenarios. We trained 148 interns last summer, and we’ve now been at Harvard Medical School, we’re partnering with the physician’s assistant program at Boston University. That program is really building, and we’re learning a lot and teaching a lot along the way. So that’s one example of the clinical and education programs.
Another example is that we are distributing free gun locks, no questions asked, in our primary care clinics and other places, the same way we hand out bike helmets and condoms.
This space has changed so much over the last six years. Clinicians absolutely recognize that we should be part of this conversation and that we should be doing what we can to prevent gun violence. People really are hungry for this information and people want to be empowered with what to do. We’re trying to bring all voices into this conversation to do it in the right way, and it’s been an amazing effort by a lot of people who are involved.
Gun violence research has really been systematically dismantled and defunded over the last couple of decades in this country. For so long, there was a small group of researchers that managed to keep research careers alive and funded over a few decades with shoestring budgets, but that’s really just no way to solve a public health crisis. For so long, that lack of funding has been an (understandable) excuse for inaction. There are so many people who’ve been trying to do this work, but we’re really thinking about how we can raise money in other ways. We’ve had some great investments from Mass General and Harvard Medical School and some others to try to build a research program in this area.
A couple of areas of focus. First of all, it takes good research to evaluate these educational programs and iterate and evaluate what works. We’re building a larger epidemiology focus on nonfatal gunshot injuries, for example. The CDC has not accurately tracked nonfatal gunshot injuries in years, so I can tell you with precision how many people died from firearm-related violence, but for how many people are injured and survive it, we really don’t know. In so many ways, I think that’s such a critical issue because those are our lifelong patients.
We’re also developing a focus in suicide prevention. For example, older adult men in this country have among the highest suicide rates. It’s really a staggering fact when you think about it. In the Mongan Institute here at MGH, there’s a center for serious illness and aging run by Christine Ritchie, who’s a phenomenal researcher, and we’re working on developing a research program around suicide prevention in older adults. An incredible amount of work to be done, and again, an incredible privilege to work at a place like Mass General with so many amazing researchers across method areas that are really coming together to take on this problem.
LG: Absolutely, it definitely sounds like a center of excellence for this issue. I’m curious, are there other institutions that are tackling this in a similar way in other cities or across the nation?
CS: It’s a great question. There are a lot of people who are doing great work. Right across the city at the Harvard School of Public Health, there’s an incredible group there that’s been doing work in this space for a long time, and they have taught us a great deal. As far as hospitals that are taking on this work, there’s a growing number, and that’s really great to see. For example, Northwell Health in New York just proposed to build a Center for Gun Violence Prevention. The co-director of our center here, Peter Masiakos, sits on their advisory board now to help develop it. We’re at this moment where the commitment and momentum is building, where people aren’t going to sit on the sidelines on this issue any longer. We’re proud to be part of a growing group that is taking on this issue.
LG: It’s really nice to feel a sense of optimism in this heavy topic.
CS: I really do. Six years ago, when I started in this space, we were trying to convince people that this is a public health problem and that this is a place that we should be. That is not the discourse anymore. People know that this is an issue, and are really hungry for change here. There’s so much common ground here, so many areas where people agree, and that’s a big part of our focus as we move forward.
LG: A word you used in a couple of your different answers was “solvable.” I wanted to conclude by asking, do you think this overall problem is solvable? If so, how soon?
CS: Absolutely, I think this is solvable. It’s why I’m so committed to being at a place like Mass General to take this on, because research is going to be a critical component of learning what’s going to work here. There are more guns than people in the U.S., so we’re going to have to figure out in concrete ways what works, and how to reduce rates of morbidity and mortality. I think about it as I get to go to work everyday surrounded by people who are optimists like I am, who are trying to take on big problems, whether that’s heart disease or cancer, and who are developing new treatments for a range of problems. I get to be one of those people trying to take on this issue that affects far too many people in the country.
So I don’t have an exact timeline for you, but I hope the level of engagement, activation and commitment from academic medical centers is an important step. It is long past time that we join those who have been on the front lines, working to prevent violence and work for peace in communities in this city for decades. I cannot stress that enough. There are so many leaders who have been on the front lines for decades doing this work. For example, Chaplain Tina Chéry, the founder and President of the Louis D. Brown Peace Institute – her work and the work of her entire team to create a place of healing to support families impacted by murder and trauma is an inspiration. Our Center is honored to take part in the Peace Institute’s annual Mother’s Day March for Peace, which is one of the most incredible, powerful events in Boston every year. We have so much to learn from so many, and we have an obligation to use our platform to uplift their work. We are here to do our part, recognizing that taking on this crisis will take all of us.
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