This episode focuses on the impact of gun violence featuring Dr. Najma Ahmed, a trauma surgeon at St. Michael’s Hospital and professor of surgery at the University of Toronto. Dr. Ahmed is also a physician leader with Canadian Doctors for Protection from Guns.
This episode focuses on the impact of gun violence featuring Dr. Najma Ahmed, a trauma surgeon at St. Michael’s Hospital and professor of surgery at the University of Toronto. Dr. Ahmed is also a physician leader with Canadian Doctors for Protection from Guns.
OMA Podcast Episode 19: Gun Violence and medicine with Dr. Najma Ahmed
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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan, and I'm the Director of Media Relations and Social Media for the Ontario Medical Association.
Dr. Najhma Ahmed: And my name is Najhma Ahmed. I'm a trauma surgeon in Toronto and Professor of Surgery at the University of Toronto.
Flanagan: We're here today to talk about advocacy to prevent gun violence.
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Flanagan: Dr. Ahmed, how did you become involved in advocating against gun violence?
Dr. Ahmed: I have worked as a trauma surgeon in Toronto for about 20 years now. And over the last many years, probably the last five or six years, we as a trauma community—not just myself, but many emerge doc's and pediatricians, psychiatrists, rehab specialists, nurses, paramedics, police—have noticed an uptick in gun violence, and not just the numbers of gun violence, but the types of weapons that are being used.
Often there are multiple victims where it used to be one person was brought in who had been shot, now there are multiple. The violence lasts for days sometimes. And also when we look at the literature, we found that there's a real increase in femicide and domestic homicide related to guns.
So we as a community, as a trauma community, had been noticing this for some time. And then, I think in the summer of 2018, with the shooting on the Danforth, this issue became sort of alive for the country again. And now the public is focused on it again after the horrible shooting in Nova Scotia.
But I think, for me, I have been thinking about it for some time. And we as a medical community started talking about what we could do and how we must say something and do something. And so we organized ourselves as an advocacy organization called Canadian Doctors for Protection from Guns. We really figured out what our objectives would be, what our strategy would be, and how we were going to approach this and implement ways to reduce harm, injury, and death from the proliferation and presence of firearms in our homes and communities.
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Flanagan: Why do you believe a ban on handguns and assault weapons is a public health issue, and why do doctors have an important role to play there?
Dr. Ahmed: Physicians have had a long history of advocating for social change, where that social change intersects with public health, and improving the health of populations. For instance, efforts for clean water, widespread vaccinations, the nicotine packaging, all those things have been public health issues that the medical community have helped to inform and shape health and public policy around.
The American Medical Association and the World Health Organization have both framed gun violence as a public health issue that requires a public health approach. But we've been somewhat sheltered in Canada, at least until recent days, from these terrible things.
Prevention, actually, is what keeps us healthy. It's much more effective and much less expensive than treatment. Other countries have banned semi-automatic weapons, and they have reaped the rewards by decreasing gun deaths in their countries.
So Canada, you know, although we compare ourselves to the U.S. and think we do really well, in fact we don't do so well when we compare ourselves to our peer nations. It is true that in Canada our gun fatality rate is six times less than the U.S., but compared to 23 other peer nations, we rank fifth for gun deaths around the world.
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Flanagan: I'm going to assume that, as a surgeon, you have seen certain patients, you've had folks on your table, that have really made an impact.
Dr. Ahmed: I will share the story of a young man who was shot. He was a bystander. He's been a patient in my practice now for about seven or eight years. In those seven or eight years, he had spent more time in hospital than out of hospital, as a young man in his early 20s.
And that's because of all the operations and re-operations, time in the ICU—he's had probably 11 operations to initially resuscitate and treat him, and then reconstructive operations.
Almost a decade of someone's life. And I know that he'll never be the same person. This has really defined him. He was a university student when this happened, he had to stop his university career. So he's just now almost 30. I think about the toll this has taken on him, and the toll this has taken on his family and his community; the emotional trauma.
And when he tells his story to people, there is a stigma. There's a social stigma that goes with that. "So what were you doing that you got shot?"
There are so many stories. I could tell you so many, but that is just one story. He popped into my mind, but there are so many stories like that.
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Flanagan: COVID impacts people from different backgrounds differently. It doesn't affect everyone equally—there's gender, there's race, there's socioeconomic—in how people are impacted by that disease. Do you see the same situation when it comes to gun violence?
Dr. Ahmed: For sure. Women and children are disproportionately affected by gun violence.
Killing by gun was the most frequent method of killing of women in 2018 and 2019. And the most frequent perpetrator was a partner or ex-partner, or a male relative.
Women of younger age were more susceptible, and rural women were more at risk for death from guns, as well as indigenous women.
We also know that people of lower socioeconomic status and people with mental illness have a higher incidence of gun deaths in urban centres. But interestingly, in rural centres it's older white men who are susceptible.
Many people don't realize but the most frequent cause of gun deaths in Canada, and in all industrialized countries, is suicide. The most at risk death for suicide by gun is older men, often in rural settings.
Suicide by gun is an important topic because mental health experts understand that this is a preventable event. 90% of suicide attempts by gun result in death. Whereas, if less lethal means are used, often patients will survive and can be helped by a mental health intervention.
Certain groups are at risk for certain kinds of injuries, for certain kinds of circumstances. And then there's the phenomenon of mass shootings, which makes us all at risk, regardless of where you are, or who you are, or where you might live.
And that's why the proliferation of guns makes us all less safe.
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Flanagan: Those numbers are a bit shocking.
Dr. Ahmed: There's a lot of discussion about crime-related gun deaths in the urban setting, but the per capita death rate from guns is actually higher in rural settings. That per capita ownership of guns is higher in rural settings, and their presence in homes and communities makes those homes and communities less safe.
The presence of a firearm in a home makes it five times more likely that a woman will end up dead in a domestic abuse situation than if a gun was not present.
Those are statistics that shock people and often we don't think about, and then of course, the issue of suicide is often a very private matter, and it's not publicized in the media, etc.—and it's not just a matter of urban crime, as some people like to frame it.
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Flanagan: There's quite a strong gun lobby, even in this country. So how do you deal with that? How do you remain strong when you've been publicly and personally targeted by gun lobby groups?
Dr. Ahmed: When I started off on this, I thought this is going to be easy.
Canada is a country of reasonable people, where we dialogue and debate the issues and public policy comes to bear. And everyone I know thinks this is a great idea. “Of course we should ban highly lethal weapons, it only makes sense; what can we do to make our community safer?” And as a physician, people that I talked to are interested in the health and safety of our community. That's our... that's our job, that's what we do.
The medical evidence is so strong that I thought this is going to be a pretty easy win.
And I was really quite taken aback by the vociferous and aggressive outcry and targeting by the Canadian gun lobby, to tear us down, to discredit myself, and the others and our group, and the others that we work with. Over 80 complaints to the CMPA alleging that I was being unprofessional, somehow; I was abusing my title as a physician to advocate for gun safety.
The history of physician advocacy is that we've always advocated for what is right, and good, and best for our communities, and our patients, and our societies. Many social changes have been spurred forward by physicians—and particularly women physicians, I will note.
I think that I was quite taken aback and surprised. First of all, you have to situate yourself, and check yourself, and make sure that what you're advocating for is really the right and good thing. And the medical evidence convinces me more and more every day.
It's important to note that our position statement is supported by 15 national medical societies, two national nursing organizations, and two women's groups. The majority of the medical community in Canada, the vast majority of the medical community, agrees with our position.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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