By Breanna Lathrop

On the radio this morning they were discussing the shootings and people were calling up and sharing their thoughts on whether this is a gun problem or a mental health problem. Any discussion is at least discussion versus simply moving on and accepting mass shootings as an unavoidable reality in our country. Still, I found myself frustrated thinking, “yes, all of it is a problem.”

When I speak on social determinants of health I describe the concept using the image of a target with health at the center. Health care is the first circle around the bull’s eye. If we want a healthy population, we need a robust and accessible health care system. Yet, health care is just a small factor representing a downstream approach to health. It’s often the last line between health and illness or death. The next circle is health behavior surrounded by a larger circle yet with determinants such as housing, employment, education, food access, environment, and income. Finally, the largest circle contains the most upstream and arguably most important determinants of health inequity including racism, classism, poverty, and oppression.

The same model applies to our nation’s epidemic of gun violence. The small circle is gun control. No matter how much we improve society and people’s access to support systems, there will still be hateful people who make horrible decisions. Basic gun control prevents or at least limits the damage caused by their hate. It’s a downstream approach but like a good health care system, it’s necessary and life saving. The next circle includes violence prevention and access to mental health care. We could start teaching anger management and non-violent communication in the school system. Mental health services should accessible and de-stigmatized regardless of someone’s location or insurance status. Instead of active shooter drills, schools could teach young people how to recognize signs of depression and aggression and how to get help for their friends. Finally, we won’t fix gun violence until we also address the outermost circle, those ideologies feeding the problem including racism, nationalism, and toxic masculinity.

When I talk about addressing social determinants of health, I stress that every circle matters if we are going to reach health equity. The best health care system in the world can’t fix the health problems causes by systemic, generational poverty. However, even in a just and equity society, people get sick and need a health care system that provides quality care to everyone.

If we are going to end gun violence, we can’t spend our time arguing over whether it’s a gun control problem, a mental health problem or an issue of male violence. It’s all a problem and it all has to be fixed.

My husband and I donated to Everytown for Gun Safety and I will continue to do anything I can to vote out my representatives who refuse to support basic gun control legislation. Today, every single patient I saw was asked about their social needs and mental health. I had conversations with two of them challenging the stigma around mental health care. Tonight, like every night, I climbed into each of my boys’ beds and cuddled them and sang their lullabies as we strive to raise boys who can both receive and give love. It’s not enough but I’m not going to wait until the next shooting is in my neighborhood. No one should have to die this way.

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