A well-known, right-wing personality was shot and killed Sept. 11 in front of a crowd of college students. That same day, a student shot up his Colorado high school, injuring two classmates before killing himself. In St. Louis that day, two men were shot in separate incidents. But those are just a smattering of the typical daily number of shootings in the U.S.; nationwide, an estimated 300 people become victims of gun violence every day. 

“There’s been a real emphasis on assessing individual-level risk factors when it comes to gun violence, but it’s not an individual-level problem; it’s a societal or community-level problem,” said Julia Fleckman, MPH, PhD, an associate professor at the School of Public Health at Washington University in St. Louis. “My interest is in understanding more of the community-level or the social-level factors that influence gun violence and how those might play a role in the way that we think about prevention and intervention.”

Fleckman uses community-centered research and evaluation approaches to study the social and structural determinants of violence, and to evaluate the implementation of public health strategies that reduce risk for gun and family violence. She joined WashU Public Health on Sept. 1, a transplant from Tulane University, where she served as director of research and evaluation at the Tulane University Violence Prevention Institute and senior director of the Tulane Gun Violence Policy Lab. 

“There are differences, of course, between St. Louis and New Orleans, but there are a lot of similarities, too,” Fleckman said. “It’s actually really interesting and important to think about how we tailor and adapt interventions from one place to another. The players that should be at the table, the types of interventions that matter, or rather the ecosystem of interventions we should be rolling out, the outcomes we should be focused on — those are all things that are much the same no matter where you are.”

Here, she talks about how she got into the field, the roots of gun violence, and what she has learned about how to develop and evaluate effective violence-prevention programs.

Q: Why did you start studying gun violence?

“My interest in public health started early. I had my own personal experiences with social determinants growing up, so I was always interested in public health, but more on the social side of it. In my master’s program at the University of Texas, I had some really great mentors who helped me recognize that my interests lie in understanding and addressing social-structural determinants of violence and trauma. I started in the child maltreatment-prevention space, and most of my dissertation work is in that area. Child maltreatment is still a very big issue that I am passionate about, but I started to see this really big connection with gun violence. It was just clearly such a pressing, personal, community-oriented issue that I just kind of got pushed into that space.”

Q: What are the causes of gun violence?

“I think many people have this concept that gun violence is driven by premeditated incidents or gangs. And that just isn’t true. The majority of everyday incidents are arguments that have escalated where people have access to guns and don’t know how to control things. This is something we all need to understand better.

“Firearm violence is influenced by many of the same risk and protective factors as so many other health outcomes. We could talk about structural racism, or poverty, but we don’t. We haven’t talked about violence in the same way we talk about chronic disease.”

Q: A recent survey found that St. Louisans consider gun violence the most important health problem in the region. There are many individuals and organizations working on this issue, but it remains a challenge. How do you see yourself contributing to the discussion?

“My general approach is I don’t like to rush into it. I get the urgency and the need, I really do. I need to know more about the context of the players and the relationships, because that’s primarily how this kind of work is driven. I’m not going to be the one rolling out these interventions and testing them and building a model. 

“A lot of what I do is evaluation of community-driven and cross-sector-stakeholder-driven interventions. The goal is to really understand, process-wise, how we create and sustain a lasting coalition of stakeholders who inform the development, implementation and evaluation of programs. We need to show not only that these programs work but how and why they work. It helps us ensure that these programs last even if political winds change.”

Q: Speaking of politics, the national discussion on gun control seems deadlocked. How can we make progress on gun violence in this climate?

“I still believe in my heart of hearts that more people are on the same page than not when it comes to gun safety and preventing gun violence. I’m saying this as a pretty progressive person with some conservative family and friends who I maintain relationships with. So I don’t really have a great answer besides trying to figure out common ground there, finding solutions we can all agree on.

“You don’t need to agree on politics to take action on the local level. We need people working on all aspects of the problem. We need a hospital violence-intervention program with a community arm, so once people leave the hospital, they still have folks to go to. We need people to be in the community at the front end to prevent violence by de-escalating situations and teaching others to de-escalate. We need to work with schools on restorative programs. We need built environment interventions. All of these kinds of interventions have shown great promise in the work to prevent and reduce violence.”

Q: What gives you hope regarding this field?

“I’m presenting research next month at the National Firearms Research Conference. The first year of that conference, it was small. Just a couple hundred researchers, from universities with large firearm violence programs like Johns Hopkins, the University of Michigan, and Columbia. This year, they received around 400 submissions, and I’m sure it will be even bigger attendance-wise this year. And that gives me a lot of hope that we will figure this out.”

Writer

Tamara Schneider, MPH, PhD, is the senior science writer and assistant director of communications for WashU School of Public Health. She holds a bachelor’s degree in molecular biophysics & biochemistry and in sociology from Yale University, a master’s in public health from the University of California, Berkeley, and a PhD in biomedical science from the University of California, San Diego.