Violence Prevention: Q&A with David Satcher

Nov 6, 2013, 10:21 AM



David Satcher, MD, PhD, was a four-star admiral in the U.S. Public Health Service Commissioned Corps and served as the 10th Assistant Secretary for Health and the 16th Surgeon General of the United States—at the same time. He was Surgeon General from 1998 through 2001, and under his tenure he tackled disparities in tobacco use and overall health equity, sexual health and—critically—youth violence.

Satcher was a key speaker in a recent American Public Health Association (APHA) Annual Meeting Town Hall Meeting on a global approach to preventing violence. NewPublicHealth spoke with Satcher about approaches to preventing violence as a public health issue.

NewPublicHealth: How do you take a public health approach to preventing violence?

David Satcher: When you take a public health approach, public health experts pose four questions:

  • First, what is the problem and what is the magnitude, the nature and distribution of the problem?
  • The second question is: what is the cause of the problem or the major risk factors for the problem?
  • The third question is: what can we do to reduce the risk of the problem?
  • And finally, how can we then implement that more broadly throughout society?

So, when we say we’re taking a public health approach, that’s what we’re talking about.

What we’ve tried to do and what we need more of is to really study the different causes of violence and violent episodes. They’re not all the same. I’ve dealt with a lot of the mass murders; I was Surgeon General when Columbine took place and the Surgeon General’s Report on Youth Violence in part evolved from that. And obviously there, as in most mass murders, we’re dealing with, among other things, mental health problems and easy access to weapons combined. I don’t think the same is necessarily true for gang violence, which causes thousands of deaths each year. With youth violence and gangs, I think there you’re dealing with a culture of insecurity where young people feel that in order to protect themselves they need to be members of gangs and they need to be armed.

And suicide is also a gun violence issue. As Surgeon General I released the first report from that office on a call to action on suicide. What we find is that people who are suicidal are not often homicidal. But if somebody is depressed and they have easy access to a gun, they’re more likely going to be successful in a suicidal attempt, whereas if they don’t, they’re more likely to attempt suicide and then we see them in the emergency room can hopefully diagnose their mental health problem and often can treat them.

NPH: Where are we on research on gun violence?

Satcher: I don’t think we’ve had enough research on gun violence. CDC published some early studies by Art Kellerman and others showing that people who own guns, and had them in their homes, were actually less safe than people who didn’t own guns because they were more likely to use the guns against themselves or their family members in a rage of anger or depression.

After that and until recently, there was no money at the CDC to continue that kind of research. So I would have to admit that our research in this area is inadequate.

NPH: With your experience as the top public health officials, what approaches do you think might effectively reduce mass shootings?

Satcher: What I’ve been talking about for years, and I think we’re getting closer to, is ease of access to mental health services and creating a kind of environment that is stigma–free, or at least reduced stigma so that people don’t have as much hesitation about seeking treatment for mental health concerns. Stigma doesn’t just affect a person with a mental illness—it affects the whole health care system. People sit in the emergency room for hours waiting for mental health emergency care. Society is not supportive of easy access to mental health services and often it really leads people to hesitate to seek help. But I also think the other part of it is we’ve got to reduce the easy access to weapons.

NPH: Should we be taking a different approach for different kinds of violence, like mass violence versus community or gang violence?

Satcher: I’m not sure we fully understand that difference yet, and I think this is the kind of thing we need more research on. There is a huge problem with violence in the community where thousands of children even are killed every year. I think it’s more likely among poor, insecure populations where people feel that they need to protect themselves and so we see gang violence and such. That is different from somebody who feels safe and secure but who may be suffering a mental disorder.

NPH: Do the solutions, in part, lie in further research?

Satcher: Yes, the questions we need to ask are what is the nature of the problem, what’s the magnitude of the problem and how is it distributed in society? And what are the risk factors? Then we can develop real and evidence-based solutions.

>>Read the related post, "Violence: Can We End the Epidemic?"

>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.

This commentary originally appeared on the RWJF New Public Health blog.