GETTING STARTED IN ADVOCACY

Vivien Sun, MD MPhil

I came of age in the shadow of the 1999 Columbine High School shooting. As a high school freshman on the East Coast a year later, we started practicing Code Silver drills in case of a gunman on campus. Instead of learning about the Cell Cycle, we locked the door, turned out the lights, covered the windows, and hid in the closet of our Biology classroom. The threat of gun violence felt as normal as the threat of fire or extreme weather.

A generation later, my eight-year-old niece recently experienced her first lockdown due to reports of an active shooter at her suburban elementary school. While the incident turned out to be a false alarm, the reality that this normalization of gun violence amongst our children has not changed over the last two decades is both sad and infuriating.

In 2020, there were 45,222 gun deaths in people of all ages, the highest number ever in the United States. In 2019, gun violence became the number one cause of death among children and adolescents in America, surpassing motor vehicle crashes. Among youth under 20 years old, homicide was the most common cause of firearm death, though suicide contributed to 41% of deaths in kids 10-14 years old and 33% of kids 15-19 years old. While children of all races and ethnicities are affected by firearms, the burden of firearm deaths are not shared equally across groups. Black youth are disproportionately affected; firearm deaths were 4.3 times higher in black youth as compared to white youth in 2019. Addressing pediatric gun violence is an urgent public health and equity issue.

As a pediatrician, I have long recognized the importance of screening for firearms in the home and discussing safe storage of firearms with patients and their families. However, I was reluctant to take the next step to become an “advocate” about gun safety. I felt uncomfortable discussing gun safety outside of a one-on-one clinical encounter. In contrast to clinical pediatric medicine, where I had received years of formal training, explicit teaching, and onthe-job experience, I had never been taught explicitly about gun violence, done research in the field, or had personal experience with gun violence. I felt unqualified to be an advocate given my lack of formal training on the topic.

When I spoke to friends outside of medicine about my reluctance to advocate for gun safety due to my inexperience, they offered simple advice: “Get over it, and get started.” They suggested that I could read on my own and delve deep into the subject. They suggested I find organizations that would allow me to find like-minded individuals and find advocacy opportunities. They suggested that I fake it until I make it—that small actions in the space would reduce my feelings of inexperience and strengthen my identity as an advocate over time.

My friends were right—over time, advocating for gun violence prevention began to feel more comfortable. My family and I began marching in local protests demanding improved legislation for gun safety. My five-year-old son and some of his preschool classmates carried a sign across the Golden Gate Bridge that read, “Protect Kids Like Me, Not Guns.” I started attending meetings of my local chapter of Moms Demand Action for Gun Sense in America, and I met with some of our California legislators to encourage action on gun safety. I read deeply on the topic in both lay media and medical journals and started giving formal lectures to the pediatric residents at my institution about pediatric gun violence and advocacy. This expanded into teaching sessions about gun violence to pediatric residents from multiple institutions across California through the American Academy of Pediatrics.

Physician advocacy has been defined as an “action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.” Physicians are uniquely positioned to be potential advocates given their deep knowledge and observations of health and its social determinants. Physicians are also trusted voices in communities, regarded as one of the most honest and ethical professions in a general survey.

Even if we physicians are well-positioned to become advocates, I know firsthand how difficult it is to find your voice as a physician-advocate and take the first step into an unfamiliar space. I would offer the same advice that my friends gave me: get over it, and get started. The issues of today—be it mental health access, adequate nutrition, housing insecurity, health inequities, or structural racism, to name a few—need thoughtful, compassionate people to address them. They need you. We need trusted physicians in our community to highlight the issues that affect our health and offer solutions. Even if you are not the leading expert in the field, even if it’s not a subject you see multiple times a day, even if you have not received explicit teaching on the subject—you can still get involved as an advocate. For the sake of our community, I hope you do.

I hope you get over it, and get started. Go find your voice as a physician-advocate.

Vivien Sun, MD MPhil is a pediatric hospitalist in San Francisco. The views expressed here are her own.