I'm William Brangham, and this is "Horizons."

America has an epidemic of gun violence, one that claims over 120 people every single day, from suicides to homicides to accidents.

The country has debated what to do about this for years, but little has changed.

From safe storage of guns to better firearm education, we talk with two doctors about some of the prevention measures they argue every American can get behind.

Gun safety and public health, coming up next.

♪ Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

From the David M. Rubenstein Studio at WETA in Washington, here is William Brangham.

Welcome to "Horizons."

We have a gun violence problem in America.

When you compare the U.S.

to other high-income countries, our rate of gun violence is off the charts.

It's unfortunately one of America's unique and tragic characteristics.

Look at this 2019 graph.

These are other similar wealthy nations, everywhere from Japan to Germany, South Korea, France, Australia.

These are the numbers of people killed by a gun in each of those countries for every 100,000 citizens.

America is by far the outlier.

The same goes for children.

Firearms are the leading cause of death for kids in America, but not in any of those other countries.

American children are 15 times more likely to die from guns than kids in those other nations.

Why is this?

There's no evidence that this is because America is more violent than other places or that we have higher rates of mental illness.

It's not because Americans watch more violent movies or video games.

It's principally because we have more guns than those countries.

The U.S.

Supreme Court has repeatedly ruled that the Second Amendment protects Americans' right to own guns, and about 30 to 40% of Americans say they do.

Estimates vary, but it's believed there are anywhere from 300 million to 400 million firearms in the country, and the vast majority are owned by law-abiding citizens.

So, we have to reckon with this reality and wrestle with the public health implications.

And that's what we're talking about today, how we can try and save lives and make this a safer society.

For that, we're talking with two doctors who are part of a campaign to do just that.

Dr.

Sandy McKay is chief of the Division of General Academic Pediatrics at McGovern Medical School at UTHealth Houston.

And Dr.

Joseph Sakran is executive vice chair of surgery and director of clinical operations at Johns Hopkins Medicine in Baltimore.

They come to this issue from different parts of the country and personal histories.

Dr.

McKay is a gun owner, and Dr.

Sakran is a gun violence survivor.

They're both part of an education campaign called Agree to Agree.

It brings people with different views about guns together to try and make our society safer.

Here's a clip of their ad campaign.

It's really a social issue that we should be able to address as a country.

There is no adult in this earth that wants children to die.

Man: We need to stop fighting about who's right and wrong and start focusing on the health and safety of our children.

It's a wake-up call for adults to be adults.

I hope that we come together to find a real resolution that works for everyone.

Brangham: Dr.

McKay and Dr.

Sakran, so great to have you both here on the program.

I would like to ask you each this question.

And, Dr.

McKay, I'll start with you first.

What is Agree to Agree?

What is the campaign all about?

And why is a medical professional like yourself, a pediatrician, involved in a campaign like this for?

Thank you so much for having me.

Agree to Agree really gets down to the heart of what this issue is, is gun violence is something that we all, gun owners and non-gun owners, can agree upon, is that we don't want to see people die by firearms.

And when we can come together collectively to find the points that we agree together on, then we can start to move forward and find those actionable solutions where we can collectively make change.

And I think as physicians and as a pediatrician, we know that we can identify those areas where we can move the needle and we can influence public health.

So, it's critically important for us to be at the table and to lend our voice and to give that guidance, so that we can help save lives.

Dr.

Sakran, the same question to you.

You're a trauma surgeon, in addition to all of your other responsibilities.

What are you doing?

Why is this campaign important to you?

Yes, well, thanks so much, William, for having us.

I would say a couple of things.

When we think about Agree to Agree, it starts from a simple premise.

We agree on much more than we think we do.

And I think we can all agree that children shouldn't be dying from firearm injuries.

We can agree that someone in crisis shouldn't have easy access to a firearm.

We can agree that a child shouldn't be able to find an unsecured gun in a drawer.

And I think we can agree that every community deserves to be safe.

When I think about why it's important for myself as both a trauma surgeon and a survivor, I think about this in terms of the fact that bullets aren't political when they enter the human body.

My colleagues at Pediatrician, you know, I'm a trauma surgeon.

We see what happens after prevention fails.

We take care of the child who finds an unsecured firearm, a teenager who attempts suicide, the young person shot in their neighborhood, and the families whose lives change in seconds.

Medicine has always had a responsibility to prevent injury, not simply treat it.

We did that with automobile crashes, with smoking, with drowning, and countless other causes of preventable death.

And firearm injuries shouldn't be any different.

Dr.

McKay, just picking up on what Dr.

Sakran is saying there, do you think that...?

I mentioned some of these statistics that really do make us a standout nation in all kind of the worst ways.

Do you think the general public has a sense of the reality of gun violence the way that you all in the medical profession...?

You can't avoid it.

It comes through the doors of your offices and your hospitals.

Do you think the general public appreciates what we're talking about here?

Yeah, I believe that the general public does have an appreciation for this.

I think we see this in some of the... especially the qualitative data where parents are scared to send their kids to school because they're concerned of mass shootings.

Where, you know, we do know that the leading cause of firearm death is suicide.

What I think the disconnect actually comes in is, where can we act?

I think that, when we talk to people, people have this understanding of like, "Oh, well, "this is just going to happen," or "I don't know how to make this intervention change."

And that's really where we can come together collectively and look for those solutions.

If we've learned anything from the car industry is that we can make cars safer.

And we did that.

And we saw a significant decline in motor vehicle injury and death.

And we can take a similar public health approach in addressing firearm injury.

That is something that we can predict.

It is something that we can prevent.

And we have so many different minds working on it from a variety of different levels, from a community violence intervention level, from a suicide prevention level, from unintentional injury level.

And collectively, we know that we want to stop people from having these types of injuries.

And, you know, even gun owners, they know that they want to be responsible.

They want to make sure that people don't have unintentional or unintended injuries from their firearm.

I think a lot of this is finding those solutions for people.

Brangham: Well, let's talk very specifically about some of the things.

Dr.

Sakran, I wonder if you would just start us off with, well, what...?

When you look at this, at the... What is the low-hanging fruit that you think we can do to move the needle in a meaningful way when it comes to protecting people?

Yes.

So I think a couple of things.

I just want to add to Dr.

McKay, because I think we have to recognize that for the past five years in a row, firearm injuries have been the leading cause of death for American children and teens ages 1 to 17.

And when we think about the aspect of how do we approach this, we don't have to agree on every aspect of gun policy to agree that our children should not be dying from firearm injuries.

What we need to do here is, we need to be able to identify the risks, and we need to intervene.

What does that look like?

That could look like promoting secure firearm storage, reducing access during moments of crisis, investing in community violence intervention programs, supporting survivors and their families, conducting rigorous research, and perhaps most importantly, having the conversations that bring people in, rather than push them away.

Because the goal here isn't to win an argument about guns.

The goal is to save lives.

Dr.

McKay, let's pick through a couple of those details.

What is safe storage?

You hear this term a lot in the gun violence prevention community.

Safe storage to a lay audience means what?

And so I think the terminology is incredibly important, especially to firearm owners.

Is it safe or is it secure?

I think that's really the terminology there.

We think of safe as, is this firearm accessible to someone who should not have access to it?

When we think of something that's secured, it is something that is locked.

Did we store this firearm locked?

Did we store this firearm unloaded?

Did we store this firearm with its ammunition locked separately from the device?

Then we think of different layers of security as well.

Something can be stored safe in that it's not accessible to someone, but it's not necessarily stored secure.

When you talk to firearm owners, language really matters.

And that's something that we've learned a lot when talking with various individuals, because one terminology might mean something different to another as well.

Certainly, it is incredibly important to be clear in our language as well.

We want to make sure that people are practicing secure storage in all areas that they might be having a firearm, so in their home, in their car, when they're carrying, because firearms can be mishandled when they're carrying, but also in their car.

It is not stored securely if it's not stored locked.

So a firearm that might be put in a glove box is not stored securely, and those can be at risk for theft as well.

So when we talk to firearm owners, we really must be specific and then offer solutions, readily available solutions, that's going to meet the need of that firearm-owning family, because we want to make sure that firearms don't fall into the hands of someone who should not have access to those.

Dr.

McKay, just staying with you for a second.

Please, Dr.

Sakran, go right ahead.

Yes, if I can just add to that, William, because I think Dr.

McKay's point is so critical.

The conversation matters.

This isn't about whether someone owns a firearm.

It's about whether that firearm can be accessed by a child or by someone experiencing a moment of crisis.

And so, you know, at the simplest kind of terms, firearms should be inaccessible to children and unauthorized users.

So you want them locked, ideally unloaded, with the ammunition secured separately.

And this is no different than if you had a child who had a peanut allergy.

The parents are going to routinely ask, "Are there peanuts there where my child is playing?"

Whether there's allergies, or "Is there going to be someone supervising?"

Asking, "Are there firearms in the home?

And are they secured "storably"?," should just become part of the normal conversation that parents have.

Right.

Dr.

McKay, the question I was pursuing for a second was, in some conversations I have had over the years with gun owners, one of the things that they bristle about with regards to, say, keeping their guns and their ammunition separately, or having the gun or part of the gun, the firing pin taken out, is that it defeats the purpose in their minds of having the gun for self-protection, that if you have to then go rooting around for keys and a magazine or a firing pin, that defeats the purpose.

Do you ever have that difficulty that people might say, "I understand the desire of keeping guns "out of the hands of a child, "but I also need to have my gun accessible "because this matters to me for protection?"

First of all, I always like to highlight to families, I love that you are prioritizing protecting your family, and that's important, and firearm owners are protectors, naturally, and that's commonly cited as a leading reason for owning firearms.

And I want to protect your family too, and one of the things that I know on how to best protect your family is to make sure that that firearm does not fall into the hands of someone who should not have access to it.

And so the best way that we can do that is to store it securely.

That is what we know.

And what I also know is being a firearm owner, I can take my firearm that is unloaded and remove it from a safe and load it in under two seconds.

If you need less than two seconds to access your firearm and load it because you're that concerned about your protection, then we also need to talk about layers of safety to your home as well, because we want to make sure that we're prioritizing those layers of safety, thinking about alarms in your home, locks on your doors, big dogs, et cetera, because then we have other things to be concerned about with that.

Also, from a protection perspective, an unsecured firearm in your home is at risk for theft when you're not there.

Dr.

Sakran, you mentioned before also the issue of not having a firearm available to someone who might be in an emotional moment of crisis.

As we have been talking about, this is clearly, we know, is a huge issue.

Suicide is, I believe, 60% percent of the deaths from firearms in America.

How is it that you have that conversation?

Because we know there is stigma talking about mental health issues in this country.

People are reluctant to admit that they are in crisis, let alone admit, "I'm in crisis, "and maybe I should have my firearm put somewhere else, "given to someone else, given to my local gun dealer."

Like, that's a very fraught conversation to have.

Yes, it is a really difficult conversation.

And it's also an important one, because it can save lives.

And that's why there's been a lot of work, William, around what's called extreme risk protection orders, or they're sometimes called red flag laws, because those laws are designed for exactly what you're describing, moments of crisis.

If there is credible evidence that someone poses an imminent risk to themselves or others, a family member, law enforcement, or another person authorized under that state's law can petition the judge.

And when you think about the public health concept behind those type of laws, it's time and distance.

Suicidal or violent crises can be acute and temporary.

So, temporarily separating someone at high risk from a highly lethal means can create an opportunity for the crisis to pass and for treatment or other interventions to occur.

So, when you think about this, this isn't about necessarily, these laws are not about predicting who will become violent.

It's about responding to clear warning signs during a period of acute risk and creating time and distance between the person in crisis and the firearm, and the people that know that the best are your loved ones and the people that you're surrounded by.

Right.

Dr.

McKay, I know a lot of your work is also working with firearm dealers, stores and retailers who sell firearms.

What is the nature of that conversation?

What are you hoping to, maybe inject is the wrong word, but what are you hoping to put into their minds or to encourage them to do with regards to this mission?

So, a lot of the work that we've developed over time has been relationships to increase the firearm retailers' knowledge about education at the point of sale.

We want firearm retailers to feel comfortable promoting secure storage options, reminding people to promote that education at point of sale with the person who's purchasing the safe.

"Did you get a safe?"

"What's the right safe option for you, for your home?"

But then also to start promoting that suicide prevention awareness at the point of sale, to say, "We care about you.

"We care about your loved ones.

"Here are the warning signs of suicidal thinking.

"Here are some actionable steps that you can take "with your loved ones.

"Here are some places that offer "temporary out-of-home storage if it's needed."

There are networks of firearm retailers that offer temporary voluntary storage, which is that one step before that extreme risk protection order, where it's family members and individuals that are firearm owners that can do that voluntary out-of-home storage to remove those firearms that might not need to be in their homes when there's someone who's at risk inside the to say, "We need a cooling off period.

"We need a period of time to figure out "how we're going to get help for our loved one."

And this is something that a lot of our veterans that we've worked with have really said that they enjoy knowing that they have control over this aspect of it.

And our retailers really like feeling a part of this because they feel like they're contributing to the ability to reduce firearm injury.

They care about their customers.

They care about the people that they work alongside with.

And they want to make a difference as well.

And they feel like this is their opportunity to.

That's right.

I remember talking with a gun retailer in Colorado once who was saying the difficulty they had where someone rented a firearm, went onto the range and took their own life, and that the trauma that that just went through for their staff, it was one of these moments where they felt like, "Ok, we know "that we are at the tip of the spear here "with regards to this.

"This is a good moment to intervene."

Dr.

Sakran, on that same issue, you do hear about this issue of finding key moments to intervene.

As someone who works in a hospital in a trauma setting, are there places within the hospital setting where these messages are particularly resonant or a moment where you can step in and say, "This might be a time to pass this message along?"

Yeah, I mean, this really gets to something that we have been doing at Johns Hopkins and is being done in many other trauma centers, where we're not just treating the physical injuries, but we're also treating the psychological and emotional aspect of what it's like to be injured, and ensuring that we're providing trauma-informed care and wraparound services.

And we do this through our hospital-based violence intervention programs.

At Johns Hopkins, it's called Break the Cycle.

And when you think about these moments and these community violence intervention opportunities, it means having trained people, often from the same neighborhoods, who step in to be able to provide those type of wraparound services to the people at the highest risk.

And in some places, the programs have shown large reductions in violence.

So it's incredibly promising.

And we continue in Baltimore, because of the comprehensive approach that we have taken to see year after year over the past five years a decline in our homicide rate.

In fact, last year, it was 133 homicides, which was the lowest number in nearly 50 years.

Now, it doesn't mean the work is done, but it just demonstrates what you can do when you take a public health approach to this issue.

Dr.

McKay, I hear everything both of you are saying.

I want to ask a devil's advocate question, though, which is, some viewers might be listening to this and understanding the statistics that we have been talking about and thinking, I "appreciate everything "that these good-spirited and well-intentioned doctors "are doing, but isn't the cat already "out of the bag in this country?

"Don't we already have "so many firearms in this country?"

And, yes, most of them are owned and held by law-abiding citizens who want to do all the things that you are describing.

And yet we still have these calamitous statistics in this country.

To someone who would be despairing at what this country does with regards to firearms, Dr.

McKay, what would you say to them?

First of all, we have a great opportunity in front of us to make change.

We have really engaged bright, insightful individuals that are making change right now.

We have incredible programs that demonstrate the ability to reduce firearm injury and death.

We have a wide variety of engaged stakeholders that maybe five, 10 years ago, I would have never thought would have been engaged.

We have community violence intervention programs.

We have such a depth and breadth of expertise.

We have networks of firearm retailers who say the same thing that we do, that no child should die from a firearm.

This is an incredible time to be in firearm injury prevention research.

And I think that right now is the optimal time for us to be talking about this and to say, "Yes, there are "a lot of firearms in this country.

"That's not going to change."

And the goal is not to remove anyone's firearm rights.

I enjoy my firearm rights.

But what the goal is, is to reduce death and to reduce injury from firearms.

And we can get there together collectively, because that's what the purpose of especially the Agree to Agree campaign is.

We can get together and find out the points that we agree on and to start moving forward together, so that we can continue to protect each other and to protect what we know is right, which is that children should not die by firearms.

Dr.

Sakran, last minute is for you.

Do you share that same optimism?

Again, imagine that some of our viewers could be really despairing at what is happening in this country with the carnage brought on by firearms.

Do you share that optimism that the tide could and or is turning?

Yes, I absolutely share that optimism.

In fact, as I was talking about, we have seen the numbers in cities like Baltimore and other cities all across the country head in the right direction, and that people who disagree about a lot are willing to start from the same place.

I'm here because someone refused to give up on me, right?

And that's the kind of hope I'm trying to pay forward.

So I think Dr.

McKay is spot on.

And we all have to start with our own sphere of influence.

If there's a firearm in your home, store it securely.

If your child is going to someone else's home, ask how the firearms are stored.

If someone you love is in crisis, create distance between that person and a firearm.

So we're trying to do all of those things in a way that allows us to demonstrate responsible gun ownership.

Brangham: Dr.

Joe Sakran, Dr.

Sandy McKay, thank you both so much for being here.

Really appreciate your time.

Sakran: Thank you so much for having us.

McKay: Thank you.

And that is it for this episode of "Horizons."

Thank you so much for watching.

We'll see you next week.

Narrator: Support for "Horizons" has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore Foundation.

Additional support is provided by Friends of the News Hour.

♪ This program was made possible by contributions to your PBS station from viewers like you.

Thank you.

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