What do the tragedy of Sandy Hook and the destruction of Hurricane Sandy have in common?

From a public health perspective, which measures the impact of stress on an entire community, the two Sandys have much more in common than one may realize. Both catastrophes were dubbed national disasters. Both incidents captured the nation’s heart and concern, and as such, response to both has been public and swift. The critical difference, of course, is that epidemic gun violence is preventable and storms are not.

In the aftermath of such disasters, images of destroyed buildings, displaced families, inconsolable, crying children stir our inner Good Samaritan and call us to action. The president visits. Fundraisers are organized. Celebrities lend their name. Volunteers and relief organizations swing into action to alleviate the economic, physical and emotional tolls on the affected communities.

Contrast this with the response to communities where gun violence is a constant threat.

In those communities, residents lock doors and suffer in isolation. Notably absent, is the spirited “Good Samaritan.” In New Haven, CT, still recovering from one of its most violent years, one woman poignantly described her experience of hearing gunshots in her apartment complex: “Liv[ing] in this war zone… I hide in our apartment and don’t engage with my neighbors at all.” After a New Haven toddler was shot, caught in the middle of drug war fire, a 6-year-old girl interviewed on local television said matter-of-factly that it is too unsafe to play outside because of the guns. The words of these two residents expose the wounds of a community deeply traumatized by gun violence.

It is time we acknowledge this everyday gun violence as a disaster.

While the definition of disaster, “a sudden event that causes great damage or loss of life” certainly applies, it does not get used. Though community violence differs from natural disasters, the effect of violence on communities is not unlike the trauma that ensues after a disaster. The effects of community trauma can be long lasting, and is experienced even by those not directly affected by the event.

As physicians, we see the far-ranging effects violence has on our patients, many of whom were never directly impacted by violence. Recent research has shown that chronic exposure to violence leads to prolonged activation of stress response systems in the body, called a “toxic stress response.” Early “toxic stress” is associated with disruptions of the developing nervous, cardiovascular, immune and metabolic systems, and impairments in learning, behavior, physical health and mental health. The American Academy of Pediatrics has warned that the harmful effects of  “toxic stress” can last a lifetime. In places where chronic exposure to violence is the norm, entire communities are likely suffering from these adverse effects.

Research has shown that though natural disasters threaten many communities, the response to the challenges of recovery vary greatly and in ways that aren’t explained by the magnitude of the catastrophe. The difference lies in the depth of a community’s resilience.  To this end, building community resilience — the sustained ability of a community to withstand and recover from adversity — has become a key policy issue at local, state and federal levels. Both Homeland Security directives and the National Health Security Strategy recognize the importance of instilling community resilience for both our health and safety.

Communities where gun violence is an everyday occurrence need a similar preparedness and response plan with an emphasis on resilience.

While effective solutions to building community resilience are still emerging, key provisions include delivery of psychological screening and referral, outreach to vulnerable individuals, clear communication, community engagement and building effective partnerships between governmental and community-based organizations. This comprehensive, coordinated response to community violence shifts focus back to the forgotten victim of gun violence – the community.

Using lessons from disaster preparedness to address urban violence may help to build resilience so that when disasters do strike, communities are ready and equipped. Maybe then victims can stop hiding in their apartments, 6-year-olds can again play outside, and communities can start to heal.

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