Category Archives: Gun Controls;

Critical condition: The crisis of rural medical care, Guns and Knives and Medicare!

d day257[1467]I wanted to start with this article because our rural area of Maryland is going through the same scenario. We had 3 hospitals serving the mid and upper Delmarva Peninsula but 2 of the hospitals were barely making ends meet. In fact, one of the hospitals will be closed down replaced by an enlarged Urgent care type of facility. Another needs to be shut down and reconfigured as a stabilizing/urgent care center. This last hospital sometimes has an in-hospital census of 1 or 2 patients. You can’t pay the bills with that census and how do you pay your staff, keep the heat and air conditioning and electric running?

Tonopah, Nevada, is about as isolated a place as you can find – 200 miles south of Reno, 200 miles north of Las Vegas, with one road in or out. But to those who call it home, this scenic dot on the desert landscape once had everything they needed.

Emmy Merrow had no concerns about living in such a remote place: “It had a store and a gas station, and I was fine!” she laughed.

Merrow has lived here for four years. She has a two-and-a-half-year-old, Aleyna, and a newborn daughter, Kinzley.

They moved here when her husband got a great job offer from the sheriff’s department. But six weeks before she found out she was pregnant with Aleyna, she also found out Tonopah’s struggling hospital, its only hospital was shutting its doors for good.

“I’m frustrated, I’m mad, I cry, I’m upset about it because we would live less than a mile away from a hospital,” she said.

It was all the more worrisome when, shortly after she was born; Aleyna was diagnosed with Dravet Syndrome, a catastrophic form of epilepsy. “She’s just like any other typical kid, and our day is just like any other day, except for when she has seizures,” Merrow said.

“And how many does she have a day?” asked correspondent Lee Cowan.

“She’s at about 400 now.”

“So, is there anybody within a reasonable distance that can help?

“No.”

When the seizures are bad enough, which is about every six weeks or so, Merrow has to make a mad, desolate dash to the closest hospital, which is across the border in California, some 114 miles away.

She’ll never forget the first time she had to do it: “It was in the middle of the night, so it was dark and I couldn’t see her, so I did stop quite often to just check and make sure she was still breathing.”

“That must have been terrifying,” Cowan said.

“Yeah, I was sobbing the whole way. It is the worst feeling in the world.”

Elaine Minges lives in Tonopah, too. She came here with her husband, Curt, for a high-paying job at the nearby solar plant, and thought they’d retire here one day. “We knew that there was a hospital here and there were a few physicians, and we felt comfortable at the time,” Minges said.

But after the hospital closed, everything changed. “They shut the doors and that was it,” she said.

“And they didn’t give you any warning?”

There were rumors, she said, but “we thought no, that won’t happen. That doesn’t happen. Look, we’re out in the middle of nowhere!”

Curt, who had diabetes, tried not to think about it until one night he suddenly fell very ill. Minges recalled, “He woke up and I thought he was having a heart attack. He was gasping for air. He tried to get up, but he was just too sick.”

He was suffering a serious complication from diabetes. It’s a condition normally survivable with prompt medical attention, but in this case, prompt meant getting a helicopter. “That particular night, the helicopter was 45 minutes out before they could get to the airport, and in that time, he went into cardiac arrest.”

Cowan asked, “Had the hospital here been open, would that have saved your husband?”

“I would like to think so, yeah.”

It’s a grim tale repeating itself all across the country.

Since 2010, 99 rural hospitals like the one in Tonopah have closed; that’s almost one a month.

“Basically about half of the rural hospitals are losing money every year,” said Mark Holmes, a professor of health policy and management at the University of North Carolina, who has been studying the decline for more than a decade.

Cowan asked, “Is there an end in sight?”

“Every time that I’ve said, ‘I think we’re through the worst of it,’ we’ve been surprised,” Holmes replied. “You always have to wonder, who’s next?”

A whole cross-section of America is now facing the very real risk of having no local hospital to turn to. The causes are varied; the population in some of those towns has dwindled to a size that can’t support a hospital anymore.

In others, the hospitals are either mismanaged or they end up as table scraps in mega-mergers. Medicaid expansion would have helped some stay open, Holmes says, but not all, and even so reimbursement rates are often too low for hospitals to break even. Whatever the cause, the impact on the community is almost always the same:

“The hospital closes, the emergency room dries up, all the other services that went with that – home health, pharmacy, hospice, EMS – they leave town as well, and now you’re left with a medical desert,” said Holmes.

That’s exactly the fate residents of Pauls Valley, Oklahoma was worried about. The town, about 60 miles south of Oklahoma City, has only one hospital, but the previous management company had run it into bankruptcy.

The city brought in Frank Avignone to save it. When Cowan visited, Avignone was working the phones to find a generous donor to keep it open: “I’ve got 130 employees here that I’m going to have to tell they have no future,” he said.

“It’s literally day-by-day for this hospital,” Cowan asked.

“It’s minute-by-minute,” he replied.

“How much money do you have in the bank right now?”

“About $7,000.”

“Which gets you how far?”

“The next 15 minutes. I mean, it’s not enough to really make a difference.”

Townspeople rallied, especially those who had been treated here, like Susanne Blake. She and her husband pitched in half of their retirement savings – a gamble that to them, made some good-natured sense. “We got tickled about how much we should give, because he said, ‘Well, without a hospital, we don’t have to worry about as long a retirement!'” she laughed.

Employees were just as passionate. Linda Rutledge, who’s worked in the hospital’s cafeteria for nearly 20 years, baked over a thousand cookies – a bake sale with a lot riding on it.

Asked what will happen should the hospital close, Rutledge replied, “I’m going to cry. That’s just can’t happen.”

But it can happen. And last year, in response to the need for medical care, a massive free health clinic popped up at a fairground in Gray, Tennessee, set up by a non-profit called Remote Area Medical – originally founded to serve third-world countries.

But Chris Hall, the charity’s COO, says a rural hospital closure back in 1992 forced the organization to address the medical needs of the underserved here at home, too.

“Today alone, there’s seven states’ worth of patients that have come to this event,” Hall said. “People have gotten in their car and driven 200 miles to get here today just to be able to get a service that they couldn’t get in their local area, or [couldn’t] afford in their local area.”

Some who lined up overnight in the cold did, in fact, have a hospital; they just didn’t have the insurance to access it. But for others, like Leanna Steele, this is the closest thing they have to an emergency room. Her local hospital, which she used to go to when she got debilitating migraines, also closed.

Cowan asked, “So, what do you do now?”

“Mainly just sit and hope,” Steele said.

Usually, before a hospital closes entirely, administrators will try cutting back on non-emergency services, like maternity wards. That’s happened so often that more than half the rural communities in this country now no longer have labor and delivery units, leaving expectant mothers facing long drives at the worst of times.

  • But in Lakin, Kansas, population 2,200, they tried something different. The only hospital for miles decided to invest in obstetric care instead, the thinking being that babies can be a growth industry. They get patients in the door, and just as Kearny County Hospital’s young CEO Ben Anderson had hoped, they stay … and bring along the rest of the family, too.

“Moms came here and had a great experience, and they said, ‘You know, you’re gonna be my baby’s pediatrician, and you’re gonna be my women’s health physician, and you’re gonna take care of my husband as an internist. We’re all coming to you,'” said Anderson.

And that’s just what’s happened. Dr. Drew Miller has a bulletin board outside his office with pictures of the future patients he’s brought into this world – almost 500 in the last eight years, from all across the state.

“The most rewarding thing of what I get to do is to take care of families of multiple generations,” Dr. Miller said. “I could tell you stories of people I’ve delivered their babies, and taken care of their grandma or their great-grandma. That’s what I love about what I get to do here.”

And another thing: There are no high-priced specialists employed here, not even an OB-GYN. Instead, the hospital is staffed entirely by physicians trained in full-spectrum family medicine instead. “We determined we only have so many dollars to spend at a rural critical access hospital on medical care staff coverage, so it’s important that everybody is trained to do the same thing, and it’s important that everyone is willing to do it equally,” Anderson said.

A typical day for these rural doctors can include doing a colonoscopy in the OR in the morning and removing a skin lesion at a clinic in the afternoon. It’s a flexible, can-do approach to rural medicine that has kept these hospital doors open – at least for now.

“This last year we had the first profitable year in probably two or three decades,” said Anderson. “But we’re riding very, very close. We don’t have the margin for mistakes.”

It’s that razor’s edge that hospitals like the one back in Pauls Valley, Oklahoma, had ridden for too long. Cowan was there when CEO Frank Avignone brought the staff together to share some news: “You can only live on borrowed time so long,” he said. The hospital was closing, immediately.

“I’m not sure people really understand what’s going on,” Avignone told Cowan. “The story’s gotta get out. People have to see the faces of the folks in this community and the employees and what they’ve been through. People die because this hospital won’t be open.”

Back in Tonopah, Nevada, Emmy Merrow understands those risks firsthand after one excruciatingly long drive to a hospital with Aleyna that had irreversible consequences. “She fell into a seizure that lasted three hours long; it lasted the whole entire trip,” she said. “So, she has brain damage from that. She wasn’t breathing correctly, she lost oxygen.”

“I think people watching this are going to wonder if it’s that bad, and you’re so far away from a hospital, and you need help basically all the time, why not move?” asked Cowan.

“It would be great if we had the money to be able to move,” she replied. “We make enough to live, but not really enough to save up to be able to make that move.”

As for Elaine Minges, with her husband now gone, the rural life they loved so much is gone, too, and like so many who live in small-town America, she’s at a loss for what to do next.

Cowan asked, “Will you stay here knowing there’s not a hospital?”

“My home is here,” she said. “I feel my husband here.”

“What do you think he’d want you to do? Would he want you to stay?”

“No,” she said.

Right now, we all in our community are considering alternatives and more and more of our patients are going “across the bridge” to University or “better” hospitals. I suspect that this is going to be more of a problem in the future with more talk of Medicare for All.

These next two discussions are in response to a local senseless stabbing/murder in our small town. We were lucky that the murderer wasn’t carrying a gun or the deceased could have numbered in a much higher amount.

Angry young white men charged in America’s latest mass shootings

Annalisa Merelli noted that there have been 25 mass shootings in the US this year. Seventeen of the incidents were deadly and 11 killed three to five victims each—for a total of 45 fatalities.

Last week alone, 17 people (not including the shooters) lost their lives in four mass shootings. Three of the attacks were said to be carried out by 21-year-old white men:

  • Zephen Xaver allegedly shot and killed five women in the lobby of a SunTrust bank branch in Sebring, Florida on Jan. 23.
  • Jordan Witmer killed three in State College, Pennsylvania on Jan. 24.
  • Dakota Theriot has been charged with killing five: his girlfriend, her brother, her father, and both of his own parents in Livingston Parish and Baton Rouge, Louisiana on Jan. 25.

Investigators are still looking into motives yet it’s hard not to note some commonalities: All of these mass shooters were men, and they all targeted women. They had shown violent behavior and tendencies in the past or had been exposed to violence. None of this seemed to have stopped them from being able to acquire guns. It’s an all-too-familiar pattern in the US. The shooters’ identities are also consistent with the overall American trend: Mass shootings are nearly exclusively perpetrated by men, the vast majority of whom are white.

Xaver, ex-girlfriend Alex Gerlach told WSBT-TV, “for some reason always hated people and wanted everybody to die” and “got kicked out of school for having a dream that he killed everybody in his class, and he’s been threatening this for so long.” Gerlach said her warnings about Xaver were not taken seriously, even as he bought a gun it was not considered a warning sign. After the shooting, police chief Karl Hoglund described the targeting of five women a “random act.” Amongst Xaver’s interests were prominent right-wing figures such as Milo Yannopoulos and Alex Jones; when he was arrested, he was wearing a T-shirt with a print of the Four Horsemen of the Apocalypse, the New Testament figures of destruction.

Witmer, the Pennsylvania shooter, also took aim at a female victim. He was having drinks with Nicole Abrino, a woman identified a current or former girlfriend when the two argued. Dean Beachy, who was sitting across the bar, tried to break up the fight. Witmer shot him in the head, killing him, then fatally shot Beachy’s son. Witmer also shot Abrino, who survived. Witmer left the bar, later crashing his car and breaking into a home where he shot and killed a fourth person. He then killed himself. Witmer, who didn’t have a history of violent behavior, had recently returned from a three-year stint with the US Army. According to his family, he was planning to become a police officer.

Theriot, targeted his girlfriend of about two weeks, Summer Ernest, police said, and the murder in Louisiana seemed premeditated. The young man was living with Ernest and her family after he had been kicked out of his own home. He is said to have shot her dead, followed by her father and younger brother. Theriot then took the father’s truck, and drove to his parents’ home, police said, killing both of them. He was arrested as he tried to reach his grandmother, still carrying a gun. Theriot, his neighbors said, had a history of trouble with drugs and he had been arrested for minor drug possession. Though authorities say he didn’t have a history of violent behavior, some who knew him to seem to disagree. They say he had pulled a gun out on his mother, which was among the reasons he had been kicked out of the house.

ACCORDING TO THE FBI, KNIVES KILL FAR MORE PEOPLE THAN RIFLES IN AMERICA – IT’S NOT EVEN CLOSE

Columnist Benny Johnson noted that knives kill far more people in the United States than rifles do every year.

In the wake of the horrific school shooting in Florida last week, the debate over guns in America has surged again to the forefront of the political conversation. Seventeen students were killed when a deranged gunman rampaged through the Stoneman Douglas High School in Parkland Florida. Many are calling now for stricter gun laws in the wake of the shooting, specifically targeting the AR-15 rifle and promoting the reinstatement of the assault weapons ban.

However, recent statistics from 2016 show that knives actually kill nearly five times as many people as rifles that year.

According to the FBI, 1,604 people were killed by “knives and cutting instruments” and 374 were killed by “rifles” in 2016.

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The statistics match the trends seen in previous years, which show knife murders far outnumbering rifle statistics. In 2013, knives were used to kill 1,490 and rifles were used to kill 285. Handguns far outnumber both knives and rifles in American murders. There were 7,105 murders by handgun in America in 2016.

Handguns were not included in the assault weapons ban.

Writing on the issue of handgun violence, The Federalist makes this interesting point:

“But what about handgun murders?” you might ask. “They’re responsible for the majority of gun murders, so why don’t we just ban them and stop worrying about rifles?”

Easy: because gun bans and strict gun control don’t really prevent gun violence. Take, for example, Illinois and California. In 2013, there were 5,782 murders by handgun in the U.S. According to FBI data, 20 percent of those — 1,157 of the 5,782 handgun murders — happened in Illinois and California, which have two of the toughest state gun control regimes in the entire country. And even though California and Illinois contain about 16 percent of the nation’s population, those two states are responsible for over 20 percent of the nation’s handgun murders.

One of the difficulties in the FBI’s statistics is the pinpointing of the exact type of firearm used in the overall number of gun murders. In over 3,000 cases, the firearm is not “stated.” This means it could be a rifle, handgun or shotgun used in the crime.

Certainly, this could potentially add to the number of rifle deaths each year. However, if the ratios of weapons used in the uncategorized 3,000 number reflected the overall sample size, the number of rifle deaths would only rise by a small fraction, not nearly enough to surpass the number of knife deaths.

So, what next? Do we outlaw guns as well as knives? What do we use as cutting utensils……plastic knives????

And More About the Medicare Story!

For Medicare, the best progress was made thanks to Presidential candidate John F Kennedy. Kennedy along with Clinton P. Anderson of New Mexico, introduced a measure similar to the previous Forand bill in the Senate the summer of 1960. The measure was defeated in favor of the Kerr-Mills bill, but the Democratic platform contained a provision supporting an extensive hospital insurance strategy for the aged. Kennedy made this proposal a subject of his speeches during his stumping for the presidency and even before his administration took office a White House Conference on Aging again brought the issue of a government health insurance. They seemed to get more and more support, especially since Eisenhower’s Secretary of Health, Education, and Welfare was among several prominent Republicans who were in support of the enactment of a comprehensive measure.

Almost immediately following his inauguration, on February 9, 1961, President Kennedy sent a message to Congress calling for an extension of the social security benefits to cover hospital and nursing home costs. The bill would have covered 14 million recipients over the age of sixty-five was predicted to cost approximately a billion and a half dollars, but didn’t include the cost of medical or surgical treatment. It only covered for ninety days of hospital care, outpatient diagnostic services and a hundred and eighty days of nursing home care. Imagine the cost back then of adding on the medical and surgical treatment costs!

Because of Kennedy’s thin margin of victory in November, it was deemed expedient not to press for passage of the bill until the following year. But along comes the AMA creating the American Medical Political Action Committee, which was joined with the commercial health insurance carriers and Blue Cross-Blue Shield in opposing the bill and questioned the cost put forward by the administration. The opposition mounted a strong campaign against the King-Anderson using posters, pamphlets and radio, and TV extensively. The Association seemed to be angered by included fee schedule for hospitals, nursing homes, and nurses which could serve as a precedent should government insurance be expended to include.

There was a great deal of fighting as the Kennedy administration demonized the AMA, accusing the association of thwarting the public will with the interest of lining the pockets of its membership and of employing scare tactics against the government’s interest and only concern to extend to the aged and infirm needed medical benefits. The administration got support from organized labor and several new organizations which lobbied extensively in favor of the measure.

On and on went the supporters and the opposition until finally after Kennedy’s assassination when Congressional support for Kennedy’s legislation swelled, but that is for another day and next week.

And an impressive celebration of D-day. Thank you again Veterans who fought for us all!!

California Fire: What is the Impact on Health in the Long Run and the Relationship to Climate Change? Also, Consider What Happens When We are Outspoken on Gun Violence.

 

39500554_1676963889099930_3922787849857925120_nThis next interesting report struck a nerve when my daughter in northern California called me because she was having difficulty finishing her daily 7 miles run without getting short of breath. The administrators at her graduate school were advising students to exercise at the inside facilities.

“There is simply no president for this”Salynn Boyles at the International ACAAI Annual Scientific Meeting wrote that the short- and long-term health impact of environmental events, such as the Camp Fire in California, on large populations are not well understood, according to experts at the American College of Allergy, Asthma, and Immunology (ACAAI) annual scientific meeting.

The Camp Fire, which was still burning across more than 200 miles of Northern California on Sunday, ranked among one of the worst natural disasters in the U.S. this century, with the death toll continuing the climb and close to 1,300 people still counted among the missing.

After burning for more than a week, the fire elevated air pollution levels in San Francisco and the surrounding areas to the point where the region reportedly has the poorest air quality on the planet.

Most outdoor events in San Francisco (about 180 miles from the fire zone) on Saturday were canceled or postponed, including the game between football rivals Stanford University and the University of California Berkeley. San Francisco officials also took the city’s iconic open-air cable cars out of commission due to the poor air quality.

David Peden, MD, of the University of North Carolina Gillings School of Global Public Health in Chapel Hill, spoke about the Camp Fire at an ACAAI session on the impact of the environment on allergic disease.

“At these levels, any outdoor activity is dangerous for people with chronic diseases like COPD [chronic obstructive pulmonary disease] or heart disease,” Peden said. “Everyone understands the allergy risk and the risk for other airway diseases. But there is a clear signal of inflammation in cardiac disease and breathing pollution triggers inflammation.”

Peden, who studies the role of air pollution in the airway and cardiovascular disease, noted that while California has seen wildfires of increasing frequency and intensity, other regions of the country are also increasingly vulnerable as drought conditions intensify. These areas include eastern Montana, western portions of the Dakotas, and large parts of the Mexican border.

Peden, along with ACAAI attendee Katherine Gundling, MD, of the University of California San Francisco, told MedPage Today that current air quality in San Francisco — reported to be in the very unhealthy PM2.5 range of 201-300 on Saturday — compared unfavorably to some of the most polluted areas of China and India, which have average air quality PM2.5 in the range of 100-150.

Peden stated that during the 2013 California Rim Fire, daily air pollution exposure levels among people in urban areas affected by the fire were up to 35 times greater than the 24-hour PM2.5 standard (35μg/m3) considered safe by the Environmental Protection Agency (EPA).

Gundling agreed that it will take time to understand the short- and long-term health impact of events like the Camp Fire.

“There is simply no precedent for this,” she told MedPage Today. “We are used to wildfires, but not fires that kill large numbers of people who have no chance of escape. That is the new and horrible reality we are living.”

She added that the increasing frequency and intensity of the California fires should serve as a wake-up call for the country.

“These fires are different,” she said. “It’s not just that there are more of them and that they are more severe. It’s a number of factors. It’s climate change. It’s forest management. All of this has to be addressed.”

Forecasts were for air quality to remain in the unhealthy 100-200 range through Tuesday in San Francisco, the East Bay, and other parts of the Bay area. Rain bringing wind is expected in the area on Tuesday.

Public health officials advised residents to stay indoors whenever possible and wear N95 masks when outdoors. Some city governments and independent organizations are distributing face masks.

Now consider a research study, which looked at air pollution and intellectual disabilities in children.

Climate Change Is Already Hurting U.S. Communities, Federal Report Says

Rebecca Hersher discussed on All Things Considered that climate change is already causing more frequent and severe weather across the U.S., and the country is poised to suffer massive damage to infrastructure, ecosystems, health and the economy if global warming is allowed to continue, according to the most comprehensive federal climate report to date.

The fourth National Climate Assessment is the culmination of years of research and analysis by hundreds of top climate scientists in the country. The massive report details the many ways in which global climate change is already affecting American communities, from hurricanes to wildfires to floods to drought.

“Climate change is already affecting every part of the United States, almost every sector of the United States, be it agriculture or forestry or energy, tourism,” says George Mason University professor Andrew Light, who is one of the report’s editors. “It’s going to hurt cities, it’s going to hurt people in the countryside, and, as the world continues to warm, things are going to get worse.”

President Trump, numerous Cabinet members and some members of Congress have questioned whether humans cause climate change or whether it is happening at all.

“I don’t think there’s a hoax. I do think there’s probably a difference. But I don’t know that it’s man-made,” the president said on CBS’ 60 Minutes in October.

In an August interview about deadly wildfires in California, Interior Secretary Ryan Zinke told television station KCRA Sacramento: “This has nothing to do with climate change. This has to do with active forest management.”

The new report, mandated by Congress and published by the U.S. Global Change Research Program, is the latest and most detailed confirmation that humans are driving climate change and that Americans are already adapting to and suffering from its effects. Climate change is “an immediate threat, not a far-off possibility,” it says.

For example, large wildfires are getting more frequent because of climate change. The report notes that the area burned in wildfires nationwide each year has increased over the past 20 years, and “although projections vary by state and or region, on average, the annual area burned by lightning-ignited wildfire is expected to increase by at least 30 percent by 2060.”

Millions Of Acres Burned By Wildfires In The U.S. From 1985 To 2017

Screen Shot 2018-11-25 at 11.36.57 PMAlthough California and other Western states have made headlines for deadly fires, the report says the southeastern U.S. is also projected to suffer more wildfires.

Many regions are also experiencing more extreme rain — and ensuing floods — including the Midwest, Northeast, Southeast and Southern Great Plains, which includes Texas and Oklahoma. The most extreme example is Hurricane Harvey, which dumped 60 inches of rain on parts of southeast Texas in 2017 and flooded an enormous region from Houston up to the Louisiana border.

And the authors make clear that more extreme rainfall and flooding is widespread, going beyond major hurricanes. In the Midwest, runoff from heavy rains has depleted some cropland of nutrients. In the Northeast, towns are dealing with catastrophic flooding from summer thunderstorms.

“If you look at the whole U.S., the amount of precipitation overall may be less, but it’s delivered in these very intense precipitation events,” explains Brenda Ekwurzel, an author of the report and senior climate scientist at the Union of Concerned Scientists. “That’s how you get a lot of flash flooding, especially after a wildfire.”

In the Southwest, climate change is driving a particularly devious phenomenon: climate change is contributing to drought and flooding in the same place. Drought takes hold for months. When rain does fall, it’s increasingly likely to come as an extreme rainstorm, which causes flash flooding and landslides. Scientists predict that dynamic will only get worse as climate change progresses.

The report’s authors also focus multiple chapters on the health effects of climate change. In a section on air pollution, they write:

“Unless counteracting efforts to improve air quality are implemented, climate change will worsen existing air pollution levels. This worsened air pollution would increase the incidence of adverse respiratory and cardiovascular health effects, including premature death.”

And as the climate warms, disease-carrying insects such as mosquitoes and ticks are also expected to expand their territory.

The authors warn that those who are most economically and physically vulnerable will continue to be most severely impacted by climate change, whether it’s air pollution, disease, floods or fire disasters.

Climate adaptation is already taking place at the local, state and regional level, the report says. It gives examples including water conservation, forest management, infrastructure updates and agricultural advances.

“The real leading edge of action in the United States, now, to deal with climate change is at the non-federal level,” says Light, who also serves as a senior fellow at the World Resources Institute think tank. “It states, it’s cities, it’s businesses.”

But far more involvement is needed on all levels to change human behavior.

“Successful adaptation has been hindered by the assumption that climate conditions are and will be similar to those in the past,” the authors write, arguing that acknowledging climate change, adapting to its effects and working to limit global warming, while expensive, will save money and lives in the long term.

Those findings are in stark contrast to policies put forward by the Trump administration, which include announcing that the U.S. intends to withdraw from the 2015 Paris climate agreement, which set international targets for reducing greenhouse gas emissions.

While the new report does not make policy recommendations, it is designed to be a scientific resource for leaders at all levels of government.

“We’re putting a cost on inaction,” explains Ekwurzel, referring to future global inaction to significantly reduce greenhouse gas emissions and adapt to the effects of climate change. “There’s some really heavy duty news in here. I mean, we’re talking billions of dollars as the cost of inaction each year. I think a lot of people in the U.S. will be surprised by that.”

Study uncovers the link between air pollution and intellectual disabilities in children

The journal Wiley reported that British children with intellectual disabilities are more likely than their peers to live in areas with high outdoor air pollution, according to a new Journal of Intellectual Disability Research study funded by Public Health England.

The findings come from an analysis of data extracted from the UK’s Millennium Cohort Study, a nationally representative sample of more than 18,000 UK children born from 2000 to 2002.

Averaging across ages, children with intellectual disabilities were 33 percent more likely to live in areas with high levels of diesel particulate matter, 30 percent more likely to live in areas with high levels of nitrogen dioxide, 30 percent more likely to live in areas with high levels of carbon monoxide, and 17 percent more likely to live in areas with high levels of sulphur dioxide.

The authors note that intellectual disability is more common among children living in more socioeconomically deprived areas, which tend to have higher levels of air pollution; however, exposure to outdoor air pollution may impede cognitive development, thereby increasing the risk of intellectual disability.

“We know that people with intellectual disabilities in the UK have poorer health and die earlier than they should. This research adds another piece to the jigsaw of understanding why that is the case and what needs to be done about it,” said lead author Dr. Eric Emerson, of The University of Sydney, in Australia.

So, whether you believe in climate change and its relationship to the wildfires in California the extent of the fires, what we are seeing now with the physical damage is just the beginning.

Finally, after my post on gun control look at this news report: Milwaukee Girl Who Condemned Gun Violence Is Killed By Bullet

Jessica Reedy wrote that two years ago when sixth-grader Sandra Parks was at Milwaukee’s Keefe Avenue School, she wrote an essay about gun violence:

“We are in a state of chaos. In the city in which I live, I hear and see examples of chaos almost every day. Little children are victims of senseless gun violence. There is too much black on black crime. As an African-American, that makes me feel depressed. Many people have lost faith in America and its ability to be a living example of Dr. King’s dream!”

The essay titled “Our Truth” took third place in Milwaukee Public School’s annual Martin Luther King Jr. essay contest. In January 2017, Sandra told Wisconsin Public Radio, “All you hear about is somebody dying and somebody getting shot. People do not just think about whose father or son or granddaughter or grandson was just killed.”

She also said she looked forward to doing big things in her life. “I would like to stop all the violence and… negativity that’s going on in the world,” she said. “And stop all the black on black crimes, and all the rumors and stereotypes that’s been spread around.”

How horrible an outcome for this sixth-grade girl and just for her condemnation of gun violence!

Where are we going as a society?

 

Thousand Oaks and Our Peculiarly American Affliction. And will the Dems get Gun Control?

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Be shocked by the massacre at a bar. It’s not normal.

Tim Dominguez sits under the freeway after escaping the Borderline Bar and Grill in Thousand Oaks, Calif., where a gunman killed 12 other people Wednesday night.

According to statistics from the Gun Violence Archive, there have been 307 mass shootings in the 312 days of 2018. They are a commonplace occurrence. This is a horrifying thing to say, but it is the truth. We need to say this truth over and over. We need to face this horror without looking away. We live in a country where there are relatively few restrictions on gun ownership and where our cultural tolerance for mass murder appears to be infinite.

Less than a month ago an author visited California State University Channel Islands, not far from where the shooting on Wednesday night took place. A deeply engaged audience greeted her. They had a thoughtful discussion about sexual violence, justice, trauma, and healing. Some of those students might have been at the Borderline Bar and Grill in Thousand Oaks, Calif., Wednesday night, doing what college students are supposed to be doing — dancing and hanging out with friends, having fun. As she read the news Thursday morning, her chest tightened. She read quotes from students from that campus describing the sparks and the smoke they saw. She felt resignation creeping in.

Over the past two years, there has been increased security at his events, armed guards. Sometimes they are there because he had received a threat. Sometimes they are there because she is a black woman with opinions and the threat is already implied. Every time she goes on stage, she looks out into the audience and wonders if there is a man with a gun in the sea of faces. She is not scared of him. She is resigned to the inevitability of him pointing that gun at me, at the crowd, and pulling the trigger. She doesn’t want to be this resigned. She doesn’t want you to be, either.

In an interview, the father of one of the young women who escaped the carnage at the Borderline Bar said his daughter did what he has taught her to do in the event of a mass shooting. It took me a moment to realize what he was saying. We are raising generations of children who are prepared for this kind of crime.

It is a peculiarly American affliction that this epidemic of gun violence doesn’t move us to take any real steps toward curbing gun violence and access to guns.

It is painfully obvious that there is no shooting appalling enough to make American politicians stand up to the National Rifle Association and gun makers. A congressman was shot and critically wounded. Children at Sandy Hook Elementary were murdered. Revelers at the Pulse nightclub were murdered. Concertgoers in Las Vegas were murdered.

Our leaders think and pray their way through the horror. The politicians who rely on N.R.A. donations feign concern and continue taking that money. American voters keep these people in office, perhaps, because it isn’t their loved ones being murdered. Yet. And even if it were, I don’t know that their votes would change. Instead, people treat the Constitution like a fast-food value menu, choosing which amendments are sacrosanct (the First and Second) and which are disposable (any of those giving civil rights to anyone but white men).

The script following these shootings is too familiar — flags at half-staff, hollow words of sympathy — but what chills me is the relatively calm eloquence of the survivors speaking to reporters. How they don’t seem particularly surprised to have survived a mass shooting. That they are able, in the immediate aftermath of trauma, to articulate their experiences. They can do this because they have seen it done.

How do we change this script? How do we convince enough people that we are well past the time for radical action?

We must elect politicians who will ban assault weapons and at the very least enact legislation requiring federal, rigorous background checks for gun owners. But really, that’s not radical. It’s the bare minimum, and by the grace of that kind of legislation in California, the shooter was able to use only a handgun. This massacre where 13 people died could have been much worse.

In late September, I went to a gun range with my brother, who is a gun enthusiast. We spent about an hour shooting guns as he explained the merits of the various weapons. We wore safety goggles, and though it wasn’t my first time shooting a gun, he went over the safety protocols. Before we could even enter the range we watched a safety video. From the moment we entered the facility until the time we left, we were reminded of the danger of these weapons. Each gun was heavy in my hand, hot. Before long, the space around us was thick with the stench of oil and gunpowder. We were shooting at targets, metal, and paper. There was a certain satisfaction when I shot well. I understood the appeal of holding that kind of power in the palm of my hand. I also understood the responsibility of holding a gun. I was awed by it. I was not so enamored that I want to own a gun myself. Yet.

Today I held a 4-month-old baby. He is cute and strong and wide-eyed. He still smells sweet and new. I held him and for a few minutes, I forgot about everything terrible. I forgot about the man with a gun and the 12 other people he killed and the people he injured. I forgot about the man with a gun who walked into a yoga studio and started shooting. I forgot about the man with a gun who walked into a grocery store and started shooting. I forgot about the man with a gun who walked into a synagogue and started shooting. And then I looked at this baby’s tiny face and his wide, gummy smile. I remembered everything terrible. I understood the responsibility of holding a child. I was awed by it. I realized that as horrifying and commonplace and inevitable as mass shootings are, we cannot do nothing. Stare into the horror. Feel it. Feel it so much that you are moved to act.

Deaths From Gun Violence: How The U.S. Compares With The Rest Of The World

Nurith Aizenman reported these statistics about a year ago but I thought that the story and the comparisons were relevant regarding gun violence rates. The timing of that report couldn’t be more apt — or grimmer even today. The statistics were released just as Americans were waking up to the news that a gunman had opened fire the night before at the Borderline Bar and Grill in Thousand Oaks, Calif. He killed 12 people and was found dead at the scene.

The attack came just 11 days after the fatal shooting that claimed 11 lives at Pittsburgh’s Tree of Life synagogue. Eight months before that, a gunman shot 17 people dead at Marjory Stoneman Douglas High School in Parkland, Fla. And just over a year ago a gunman massacred 58 people at a music festival in Las Vegas.

As in previous years, the University of Washington’s latest data indicates that this level of gun violence in a well-off country is a particularly American phenomenon.

When you consider countries with the top indicators of socioeconomic success — income per person and average education level, for instance — the United States is bested by just 18 nations, including Denmark, the Netherlands, Canada, and Japan.

Those countries all also enjoy low rates of gun violence. But the U.S. has the 28th-highest rate in the world: 4.43 deaths due to gun violence per 100,000 people in 2017. That was nine times as high as the rate in Canada, which had 0.47 deaths per 100,000 people — and 29 times as high as in Denmark, which had 0.15 deaths per 100,000.

The numbers come from a massive database maintained by the University’s Institute for Health Metrics and Evaluation, which tracks lives lost in every country, every year, by every possible cause of death. The 2017 figures paint a fairly rosy picture for much of the world, with deaths due to gun violence rare even in many countries that are extremely poor — such as Bangladesh, which saw 0.07 deaths per 100,000 people.

Prosperous Asian countries such as Singapore and Japan boast the absolute lowest rates, though the United Kingdom and Germany are in almost as good shape.

“It is a little surprising that a country like ours should have this level of gun violence,” Ali Mokdad, a professor of global health and epidemiology at the IHME, told NPR in an interview last year. “If you compare us to other well-off countries, we really stand out.”

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To be sure, there are quite a few countries where gun violence is a substantially larger problem than in the United States — particularly in Central America and the Caribbean. Mokdad said a major driver is the large presence of gangs and drug trafficking. “The gangs and drug traffickers fight among themselves to get more territory, and they fight the police,” said Mokdad. And citizens who are not involved are often caught in the crossfire. Another country with widespread gun violence is Venezuela, which has been grappling with political unrest and an economic meltdown.

Screen Shot 2018-11-11 at 12.30.59 PMMokdad said drug trafficking may also be a driving factor in two Asian countries that have unusually high rates of violent gun deaths for their region, the Philippines and Thailand.

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With the casualties due to armed conflicts factored out, even in conflict-ridden regions such as the Middle East, the U.S. rate is worse.

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The U.S. gun violence death rate is also higher than in nearly all countries in sub-Saharan Africa, including many that are among the world’s poorest.

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One more way to consider these data: The institute also estimates what it would expect a country’s rate of gun violence deaths to be based solely on its socioeconomic status. By that measure, the U.S. should be seeing only 0.46 deaths per 100,000 people. Instead, its actual rate of 4.43 deaths per 100,000 is almost 10 times as high.

Dems vow swift action on gun reform next year

Mike Lillis and Scott Wong wrote that the nation’s latest mass shooting has rekindled the fire under Democrats to use their newly won majority to strengthen federal gun laws in the next Congress.

The issue was off the table for eight years of Republican rule, as GOP leaders have sided with the powerful gun lobby against any new gun restrictions.

But House Minority Leader Nancy Pelosi(D-Calif.), who’s seeking to regain the Speaker’s gavel, vowed to move quickly on gun reform next year, citing Wednesday night’s shooting massacre at a California country music bar as the latest reason Congress should step in with new restrictions on the sale and ownership of firearms.

Universal background checks, Pelosi suggested, would be the likely first step.

“It doesn’t cover everything, but it will save many lives,” Pelosi said Thursday night on CNN’s “Cuomo Prime Time” program.

“This will be a priority for us going into the next Congress.”

Rep. Jerrold Nadler (D-N.Y.), likely the incoming chairman of the House Judiciary Committee, said this week that he’ll “immediately get to work” on that legislation next year.

That position marks a shift from almost a decade ago when Democrats last controlled the House and party leaders declined to consider tougher gun laws despite entreaties from some rank-and-file members.

Rep. Mike Quigley (D-Ill.), a gun reformer from Chicago and member of the Judiciary Committee, had requested hearings on background checks in 2010, only to be refused.

The reasons were largely political: House Democrats, at the time, had a more conservative-leaning caucus, boasting more than 50 Blue Dogs in battleground districts the party was fighting to preserve.

After a 10-year ban on assault weapons signed by former President Clinton was widely viewed as a “third rail” that helped secure George W. Bush’s White House victory in 2000, Democrats didn’t want to repeat history.

Since then, the country has seen a long string of prominent mass shootings, including violence targeting a congresswoman in Tucson, Ariz., elementary school students in Newtown, Conn., nightclubbers in Orlando, churchgoers in Charleston, S.C., country music fans in Las Vegas, high schoolers in Parkland, Fla. and Jews praying at a synagogue in Pittsburgh last month.

The most recent tragedy occurred Wednesday night at a bar in Thousand Oaks, Calif., where authorities say a Marine combat veteran killed 12 people before fatally shooting himself.

One of the victims, 27-year-old Telemachus Orfanos, survived last year’s Las Vegas massacre but was killed in the Thousand Oaks shooting.

“I don’t want prayers. I don’t want thoughts. I want gun control, and I hope to God nobody else sends me any more prayers,” Orfanos’s mother, Susan Orfanos, said in an emotional interview with KABC that has been viewed millions of times on social media. “I want gun control. No more guns.”

The rash of devastating episodes shifted public sentiment in strong favor of gun reform, and polls show overwhelming support for measures like expanded background checks among voters of all political stripes.

Three Parts Brands Have Come Together

The Ford Motor Company reported that among the host of Democrats elected to the House on Tuesday in conservative districts, many embraced new restrictions on gun purchases without facing the previously feared backlash at the polls.

“The public has evolved on their belief about this, given the magnitude and disparity of gun violence and mass shootings,” Quigley said Friday by phone.

The Democrats’ plans for gun-reform legislation remain unclear.

Rep. Mike Thompson (D-Calif.), the head of the party’s task force to prevent gun violence, has taken the lead on the background check bill, and will likely do so again next year. There are also dozens of related proposals other lawmakers will surely promote, including bills to ban bump stocks, eliminate assault weapons, spike taxes on guns and ammunition and prohibit high-capacity magazines like the one allegedly used by the shooter in Thousand Oaks.

Quigley is all for pushing bold reforms, including a ban on assault weapons, but is promoting the idea of securing early victories on more popular measures.

“Let’s start where we have some commonality,” he said. “The vast majority of Americans, the majority of gun owners, the majority of NRA [National Rifle Association] members support universal background checks.

“That’s a good place to start.”

That the House will pass some kind of background-checks legislation is clear. But any new gun restrictions face tall odds in the GOP-controlled Senate, where Republicans are near unanimous in their opposition to such reforms.

In 2013, in the wake of the Sandy Hook Elementary School shooting in Newtown, Sens. Pat Toomey (R-Pa.) and Joe Manchin (D-W.Va.) authored legislation to expand background checks for firearms purchased online and at gun shows. It fell six votes short of overcoming a GOP-led filibuster, with only four Republicans — Toomey, and Sens. Susan Collins (Maine), John McCain (Ariz.) and Mark Kirk(Ill.) — supporting the measure.

Kirk lost his reelection bid in 2016 and McCain died this year, leaving just two Senate Republicans who back strengthening background checks. Manchin just won re-election this week and Toomey isn’t up for reelection until 2022.

“Senator Toomey is continuing to work with his colleagues in the Senate to find a path forward to 60 votes for his background check legislation,” said Toomey spokesman Sam Fischer.

Complicating the math for gun reform supporters, Tuesday’s midterms added to the GOP Senate majority, and the incoming Republicans are all gun-rights promoters supported heavily by the firearms lobby.

Asked about the appropriate response to the Thousand Oaks shooting, Sen.-elect Marsha Blackburn(R-Tenn.) was terse.

“What we do is say, how do we make certain that we protect the Second Amendment and protect our citizens?” Blackburn told Fox News on Thursday.

President Trump could be a wild card in the coming gun debate. The president has a long and conflicting history on the topic, from the promotion of an assault-weapons ban years ago to a more recent embrace of the Second Amendment protectionism advocated by the NRA.

Gun-reform advocates, long accustomed to congressional inaction on the issue, say they’ve been encouraged by what they’ve heard from Pelosi and other Democratic leaders so far.

“While so many other factors have not been settled, we believe that House Democrats will move universal background checks in early 2019,” said Robin Lloyd, government affairs director for the Courage to Fight Gun Violence, the gun-reform group led by former Rep. Gabrielle Giffords (D-Ariz.), the congresswoman shot in the head in Tucson in 2011.

Medical professionals to NRA: Guns are our lane. Help us reduce deaths or move over.

 Megan L. Ranney, Heather Sher, and Dara Kass, Opinion contributors, reported that after the American College of Physicians released a paper last week about reducing firearm injuries and deaths in America, the NRA tweeted the statement: “Someone should tell self-important anti-gun doctors to stay in their lane.”

A couple of days later, the Centers for Disease Control published new data indicating that the death toll from gun violence in our nation continues to rise. As the NRA demanded that we doctors stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death — gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must all come together to find meaningful solutions to this very American problem.

We bear witness to every gun-related trauma

The physicians, nurses, therapists, medical professionals, and other concerned community members signing this letter are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

As the professionals who manage this epidemic, we bear witness to every trauma and attempt to resuscitate, successful or not.

►We cut open chests and hold hearts in our hands in the hopes of bringing them back to life.

►We do our best to repair the damage from bullets to pulverized organs and splintered bones.

►We care for the survivors of firearm injury for decades after they’ve been paralyzed, lost a limb, or been disabled.

►We deliver mental health care to the siblings and parents of the children who have been shot as well as to the survivors of gun violence.

►We treat the anxiety of teachers and students who are already traumatized by the news of mass shootings who are then are asked to participate in active shooter drills in their own schools.

►We prepare for mass casualty shootings with drills ourselves and practice sorting victims by how life-threatening their injuries are while fervently hoping that a mass shooting never touches our own communities.

►We are asked by families, schools, employers and law enforcement to conduct mental health evaluations and threat assessments of individuals who demonstrate dangerous behaviors with legally-owned firearms — yet we have no protocols to decrease firearm risk when they present to us.

►We support our own medical colleagues as they themselves must recover from the psychological trauma of being first responders to mass shootings.

►We design trauma protocols to reduce the loss of life from even the most horrific gunshot wounds.

►We train civilians to carry and use tourniquets to #StopTheBleed, something that should be necessary on battlefields but not in American grade school classrooms.

►We try our best to conduct research to stop the epidemic of gun violence.

►We hold the hands of gunshot victims taking their final breaths.

►We cry, ourselves, as we tell parents that their child has been shot and that we did our best.

►We escort parents into our treatment rooms to take one last look at their dead child before they have been able to process the news.

►We see firsthand how a single moment ends a life and forever changes the lives of survivors, families, and entire communities.

NRA should help us reduce gun death toll

Our research efforts have been curtailed by NRA lobbying efforts in Congress. We ask that the NRA join forces with us to find solutions.

We invite the NRA to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane. We as a society must do something about gun violence NOW!

Also, I live in a region where about 70% of the population owns guns. But the homicide and suicide rate is very, very low. Why? I’m not sure at this time but I along with the majority of our country are tired and scared of the gun-related violence.

The holiday of Thanksgiving reminds us that we ought to be thankful for the blessings and the people in our lives. But what do we do when it seems that everything is going haywire? Maybe somebody recently wronged you. An unexpected expense has thrown off your budget. That new role at your job isn’t as shiny as you thought it would be. Or maybe you’ve been trying to do the right things, live the right way, but situations STILL aren’t working out in your favor.

How do you cope? How do you resist the urge to give up? How do you continue to do good even when you’re not seeing any immediate benefits from “living the right way? And HOW IN THE WORLD can you be thankful for all of this? Sometimes we have to be thankful for what we have and enjoy the day and family and friends.

 

Active Shooter Insurance: Sadly, It’s Needed-Or Is It? And the Effect of Gun Violence on Health Care.

42491634_1719865238143128_6077344969692020736_nI knew that we all were in trouble when I received a bulletin from one of my insurance companies. The first article reviewed workplace violence, which as they summarized is a threat that cannot be ignored and that as a difficult a subject that it is, it is important for businesses to consider active shooter/ workplace violence insurance to cover gaps in standard coverage insurance.

According to 2017 data from the Gun Violence Archive (GVA), America is averaging almost one mass shooting a day. GVA considers a mass shooting any incident in which a gunman shoots or kills four or more people in the same time and location. They recorded 345 mass shootings in 2017 and, as of the time of this blog post, 213 in 2018. How depressing and what it says about our society and humanity in general.

Consider this next article:

More hurt, killed in shootings with semiautomatic rifles

More people are wounded and killed in active shooter incidents in which semi-automatic rifles are used, according to a research letter published in the Sept. 11 issue of the Journal of the American Medical Association.

Elzerie de Jager, M.B.B.S., from Brigham and Women’s Hospital in Boston, and colleagues compared the number of persons wounded, killed, and either wounded or killed during active shooter incidents with and without semiautomatic rifles.

Seventy-six of the 248 active shooter incidents involved a rifle; a semiautomatic rifle was involved in 61 incidents (24.6 percent). The researchers found that 898 and 718 persons were wounded and killed, respectively. A higher incidence of

persons wounded (unadjusted mean, 5.48 versus 3.02; incidence rate ratio [IRR], 1.81; 95 percent confidence interval [CI], 1.30 to 2.53), killed (mean, 4.25 versus 44.9 percent; IRR, 0.99; 95 percent CI, 0.60 to 1.61).

“Semiautomatic rifles are designed for easy use, can accept large magazines, and fire high-velocity bullets, enabling active shooters to wound and kill more people per incident,” the authors write.

Gun Violence Threatens the Health of Our Nation

Why am I posting this issue again? Because it does affect the health care of our country with thousands being injured and killed and therefore needs surgical and medical care. Fed up with excuses for why policymakers cannot do anything to stop gun violence, Families USA–along with more than 170 national and state partners–are demanding action. They sent a letter to leaders in Congress urging full repeal of the ban on federally funded research into gun violence.

Last month, 17 people, including 14 students, were killed in a mass shooting at Marjorie Stoneman Douglas High School in Parkland, Florida. While the increased incidents of mass shootings are shocking, they are only the most visible instances of gun violence. Tragically, more than 35,000 people, including nearly 3,000 children, die from gun violence each year in the United States.

Gun violence disproportionately affects children of color

Gun violence knows no barriers. The shooting in Parkland was just the latest in a surge of mass shootings in places as diverse as a country music concert in Las Vegas, an LGBTQ nightclub in Orlando, and an African-American church in Charleston, SC. All people can be affected by this violence but is particularly felt in low-income and racial and ethnic minority communities. African American, Hispanic, and American Indian boys are all significantly more likely to be killed by gun violence than white children.

Families USA recognizes gun violence as a severe threat to the health of our nation. As an organization focused on health care, we have not engaged previously in the vigorous national debate on gun violence. We are entering that debate today because our nation is at a turning point.

While the numbers of people hurt are staggering, we know too little about the causes and effects of gun violence in our community. This is in part due to the “Dickey Amendment” — an effective ban on federally funded research into gun violence. It is past time for that ban to end.

As health care policy experts, we know that effective policy relies on evidence-based research. Despite gun violence is a leading cause of death for children, in 1996 Congress forbade any funding for the Centers for Disease Control and Prevention (CDC) that “may be used to advocate or promote gun control.” The Dickey Amendment, named after its congressional sponsor, has effectively stifled meaningful federal funding for research on the causes and effects gun violence. A recent study published in the Journal of the American Medical Association found that “in relation to mortality rates, gun violence research was the least-researched cause of death.”

Across the country, students are rallying to urge policymakers to take action against gun violence. They are asking adults to enact policies to stem the rising tide of gun violence against children. There are many policies that Congress should enact to protect young people and all Americans against violence, but the healthcare community is united in calling for the end of one policy that is clearly indefensible.

America’s gun culture in 10 charts

Students across the United States will join a national march to call for tighter gun control and to highlight the issue of school safety.

The March for Our Lives was organized by pupils at the Marjory Stoneman Douglas High School in Florida, where a former student is accused of killing 17 people last month.

The shooting, one of the worst in US history, renewed debate about gun laws and the rights of gun owners.

What do young people think about gun control?

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When looking at the period before the Parkland shooting, it is interesting to track how young people have felt about gun control.

Support for gun control over the protection of gun rights in America is highest among 18 to 29-year-olds, according to a study by the Pew Research Centre, with a spike after the Orlando nightclub shooting in 2016. The overall trend though suggests a slight decrease in support for gun control over gun rights since 2000.

Pew found that one-third of over-50s said they owned a gun. The rate of gun ownership was lower for younger adults – about 28%. White men are especially likely to own a gun.

How does the US compare with other countries?

About 40% of Americans say they own a gun or live in a household with one, according to a 2017 survey, and the rate of murder or manslaughter by firearm is the highest in the developed world. There were more than 11,000 deaths as a result of murder or manslaughter involving a firearm in 2016.

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Homicides are taken here to include murder and manslaughter. The FBI separates statistics for what it calls justifiable homicide, which includes the killing of a criminal by a police officer or private citizen in certain circumstances, which are not included.

Who owns the world’s guns?

While it is difficult to know exactly how many guns civilians own around the world, by every estimate the US with around 270 million is far out in front.

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Switzerland and Finland are the European countries with the most guns per person – they both have compulsory military service for all men over the age of 18. Cyprus, Austria, and Yemen also have military service.

How do US gun deaths break down?

There have been more than 90 mass shootings in the US since 1982, according to the investigative magazine Mother Jones.

Up until 2012, a mass shooting was defined as when an attacker had killed four or more victims in an indiscriminate rampage – and since 2013 the figures include attacks with three or more victims. The shootings do not include killings related to other crimes such as armed robbery or gang violence.

The overall number of people killed in mass shootings each year represents only a tiny percentage of the total number.

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There were near twice as many suicides involving firearms in 2015 as there were murders involving guns, and the rate has been increasing in recent years. Suicide by firearm accounts for almost half of all suicides in the US, according to the Centers for Disease Control and Prevention.

AA 2016 study published in the American Journal of Public Health found there was a strong relationship between higher levels of gun ownership in a state and higher firearm suicide rates for both men and women.

Attacks in the US become deadlier

The Las Vegas attack was the worst in recent US history – and five of the shootings with the highest number of casualties happened within the past 10 years.

The Parkland, Florida, the attack is the worst school shooting since Sandy Hook in 2012.

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What types of guns kill Americans?

Military-style assault-style weapons have been blamed for some of the major mass shootings such as the attack in an Orlando nightclub and at the Sandy Hook School in Connecticut.

Dozens of rifles were recovered from the scene of the Las Vegas shooting, Police reported.

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A few US states have banned assault-style weapons, which were totally restricted for a decade until 2004.

However, most murders caused by guns involve handguns, according to FBI data.

How much do guns cost to buy?

For those from countries where guns are not widely owned, it can be a surprise to discover that they are relatively cheap to purchase in the US.

Among the arsenal of weapons recovered from the hotel room of Las Vegas shooter, Stephen Paddock were handguns, which can cost from as little $200 (£151) – comparable to a Chromebook laptop.

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Assault-style rifles also recovered from Paddock’s room, can cost around $1,500 (£1,132).

In addition to the 23 weapons at the hotel, a further 19 were recovered from Paddock’s home. It is estimated that he may have spent more than $70,000 (£52,800) on firearms and accessories such as tripods, scopes, ammunition, and cartridges.

Who supports gun control?

US public opinion on the banning of handguns has changed dramatically over the last 60 years. Support has shifted over time and now a significant majority opposes a ban on handguns, according to polling by Gallup.

But a majority of Americans say they are dissatisfied with US gun laws and policies, and most of those who are unhappy want stricter legislation.

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Some controls are widely supported by people across the political divide – such as restricting the sale of guns to people who are mentally ill, or on “watch” lists.

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But Republicans and Democrats are much more divided over other policy proposals, such as whether to allow ordinary citizens increased rights to carry concealed weapons – according to a survey from Pew Research Center.

In his latest comment on the shootings, President Donald Trump said he would be “talking about gun laws as times goes by”. The White House said now is not the time to be debating gun control.

His predecessor, Barack Obama, struggled to get any new gun control laws onto the statute books, because of Republican opposition.

Who opposes gun control?

The National Rifle Association (NRA) campaigns against all forms of gun control in the US and argues that more guns make the country safer.

It is among the most powerful special interest lobby groups in the US, with a substantial budget to influence members of Congress on gun policy.

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In total, about one in five US gun owners say they are members of the NRA – and it has especially widespread support from Republican-leaning gun owners, according to Pew Research.

In terms of lobbying, the NRA officially spends about $3m per year to influence gun policy.

The chart shows only the recorded contributions to lawmakers published by the Senate Office of Public Records.

The NRA spends millions more elsewhere, such as on supporting the election campaigns of political candidates who oppose gun controls.

I’m not sure the correct answer to all these shootings but something has to be done. I’m not sure how we read the minds of those with mental issues but we need to find ways to evaluate and give them help and treat them and keep guns away from them, especially automatic weapons.

Back to our discussion on single payer systems and Medicare for All next week.