How Public Health Funders Are Taking on the Epidemic of Gun Violence

Gun violence is often viewed as a matter of law enforcement, product regulation, or perhaps social work. But given the enormous human toll it’s taking in the United States, gun violence has clearly become a public health crisis, as well. In a country where there are more guns than people, deaths from firearms topped 45,000 in 2020 — the highest number ever recorded — according to a new report by Johns Hopkins.

Today, gun violence rivals other leading health threats, even for young people. “Guns were the leading cause of death among children and teens in 2020, accounting for more deaths than COVID-19, car crashes, or cancers,” the report concluded.

A number of funders and funding collaboratives are tackling gun violence prevention, as IP has reported. And several major health philanthropies, including the Annie E. Casey Foundation and the Robert Wood Johnson Foundation, for example, are explicitly addressing gun violence as a public health crisis that is not only extinguishing lives, but devastating families and communities.

This approach coincides with the growing tendency of health funders to look beyond wellness as simply access to healthcare, and going further upstream to the root causes of illness, injury and death. That includes a greater focus on structural racism, poverty and social determinants of health. Applied to gun violence, it’s a potentially potent framing and a funding strategy that unlocks different tools for an issue where progress has been hard to come by.

We recently talked to several health funders who employ public health strategies to address gun violence to see what that looks like and how it works.

The Wraparound Project

One illustrative example of how grantees carry out gun violence prevention with a public health lens is the Wraparound Project at Zuckerberg San Francisco General Hospital (ZSFG), affiliated with the University of California San Francisco. Prevention is an important public health tool, and it’s a primary goal of the initiative.

The Wraparound Project, which receives funding from the San Francisco General Hospital Foundation (SFGHF), is a hospital-based violence intervention program. As IP has reported, community violence intervention is an approach that the Biden administration supports, with backing from several philanthropies on the front lines of violence prevention including Ford, MacArthur, Arnold Ventures and the Emerson Collective. Intervention programs connect with and support individuals at the highest risk of becoming victims or perpetrators of violence.

Hospital-based programs like the Wraparound Project go right to the point of crisis, meeting patients in the hospital after a violent incident. Wraparound case managers, all of whom come from the communities where they work, offer patients initial support and continue the connection after the patient leaves the hospital, connecting them to mental health services, job training and employment resources.

The goal is to prevent the violence from spreading further. Research shows that people who have been violently injured are at high risk of suffering a second injury within a year, points out Kim Meredith, San Francisco General Hospital Foundation’s CEO. In some cases, a patient leaves the hospital and returns to the same violent situation; in other cases, they seek revenge for the initial attack.

“The Wraparound Project’s goal is to prevent that second injury,” Meredith said. “Wraparound does ongoing case management, giving people those supports in their lives that we all want and need.”

The Wraparound Project’s approach also acknowledges the link between gun violence, poverty and racism. “Victims of gun violence are overwhelmingly members of communities that are underserved and under-resourced, including our Black and Latinx communities,” said ZSFG trauma surgeon Rebecca Plevin, who co-directs the Wraparound Project, in a SFGHF video. “Structural racism and the resulting inequities in social determinants of health are the drivers of high rates of violent injuries in these communities.”

Since Wraparound started in 2005, there has been a 50% reduction in reinjury among patients at ZSFG. The project was one of the first hospital-based violence intervention programs in the U.S., and has been a model for similar programs around the country and internationally. Governors in both Connecticut and Illinois recently directed their states’ Medicaid programs to cover the cost of hospital-based violence intervention programs, and more state governments are expected to follow, according to The Trace.

Community focus and raising awareness

The California Wellness Foundation, which is the largest funder of gun violence prevention in California and among the largest in the country, has supported such work since its founding in 1992, and was an inaugural funder of the Hope and Heal Fund, which IP has reported on in the past.

In recent years, Cal Wellness has zeroed in more narrowly on community-based gun violence prevention efforts. “Communities are interested in addressing the root causes of gun violence,” said Cal Wellness Chief of Staff Alex Johnson. “They are also interested in looking at what happens after the incident, and thinking about how to reduce the trauma that attaches to gun violence. So we’ve directed a lot of our grantmaking in that way over the last couple of years.”

The foundation is also taking steps to include more diverse perspectives in gun violence research and policy development. It recently provided $250,000 to the Violence Prevention Research Program (VPRP) at UC Davis to host an inaugural Cal Wellness Fellow. Shani Buggs, a VPRP assistant professor who focuses on community-level gun violence prevention, was named the inaugural Cal Wellness Fellow.

Raising public awareness has always been a key tool of successful public health campaigns, from pointing out the health risks of smoking, to underscoring the effectiveness of vaccines. When it comes to gun violence prevention, one of the biggest barriers to change may be the widespread sense that it’s a problem too stubborn and intractable to ever fix.

That’s one of the reasons for the $1 million grant from Cal Wellness to The Guardian to support “solutions-focused” reporting. As an example of this work, see The Guardian series “Guns and Lies.”

“There are really impactful strategic solutions being developed and implemented on the ground by community organizations, partnerships, government and others to drive toward that North Star of ending gun violence,” Johnson said. “The more we can lift up and amplify the narrative of what it takes to solve this crisis, the more we get to a place where we can make an impact as our policies begin to better align with the needs we’re seeing.”

A bigger bang for your buck

The California Endowment, the largest private health foundation in the state, with assets of over $3 billion, has addressed gun violence as a public health issue for a long time. “We have a broad definition of health; we don’t consider it merely the absence of disease,” said Anthony Iton, senior vice president of programs and partnerships. “We take the same approach to violence prevention: We don’t see guns as the sole driver of violence. Clearly, guns greatly exacerbate the level of injury and the efficiency of violence. But we see it as a much larger and more complex problem and we are focused on root causes.”

To get to the root causes of violence, the foundation works to improve the lives of young people and strengthen the communities where they grow up. One way it does this is by investing in community resources that keep young people engaged and off the streets.

Iton points out that in California, tax cuts triggered by Proposition 13 have drained local budgets, slashing youth sports and recreational programs and summer opportunities for young people. “The available resources for localities to fund healthy youth development have been dramatically curtailed over the past several decades, and we consider that to be a root cause of violence,” he said. “We know that kids that meet healthy developmental milestones and have resources in their lives that support healthy development are substantially less likely to engage with the criminal justice system, to engage in the child welfare system, to engage in a variety of different systems that are associated with adverse outcomes.”

Along with local youth programs, the California Endowment supports community violence intervention strategies (it is part of the Biden administration’s Community Violence Intervention collaborative, as IP has reported). It also supports organizations that provide job training and employment opportunities, and programs that promote community cohesion by creating opportunities for social gatherings and events.

“Forgive the use of the term, but there’s no silver bullet to gun violence,” Iton said. “A public health approach involves a constellation of strategies. We are really focused on trying to enhance the healthy youth development infrastructure, in part by reinvesting resources that are currently being spent downstream on criminal justice and law enforcement, and shifting some of those resources to upstream investment and community-level prevention.” Cal Endowment calls this approach “justice reinvestment.”

“It gets back to that youth development infrastructure: As a society, we’ve moved money away from prevention into interdiction and law enforcement, and that has a consequences,” Iton said. “Just like in our health system, where we spend our money on treating people in the emergency room and the ICU, and move those resources away from prevention. At the community level, there are consequences when you try to manage issues downstream without investing in prevention upstream. Our whole philosophy is to move resources from downstream to upstream. Because upstream you get a much bigger bang for your buck.”

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