Restoration Magazine

Health justice is a framework that addresses health inequities by centering community based perspectives and efforts grounded in the interest of human rights.

Healthcare practices are efficient when local communities are involved, as they understand the nuances of the issues by contextualizing the problems with lived experience and culturallyspecific knowledge (Wiley et al., 2022). Historical, geographic, economic, community power dynamics, and other contexts can be applied to analyses and create a cohesive response to health injustice. As such, advocates with ties to the people they support are the leading sources for local solutions.

Firearm violence is a national public health and safety crisis. Access to firearms can mean the difference between life and death for victims of domestic violence (DV), increasing the risk of homicide in a DV incident by 500% (Campbell et al., 2003). Furthermore, when there is a firearm in the home, the risk of homicide committed by an intimate partner or relative is increased by eight times compared to a household without a firearm (“Domestic Violence and Women’s Homicides,” n.d.). When previous incidents of DV exist, the risk of homicide is 20 times greater with a firearm present. The intersection of DV and firearms also has a direct connection to mass shootings and stranger violence (Tobin-Tyler, 2023). According to a Johns Hopkins article (n.d.), “Researchers found that in 68.2% of mass shootings from 2014-2019, the perpetrator either killed family or intimate partners or the shooter had a history of DV.” Protections against gun violence and DV are necessary for communities to thrive.

The presence and misuse of firearms as it relates to the injury and death of Native women is a critical health inequity in Indian Country. Although there are plenty of statistics conveying the reality of gun violence as it intersects with intimate partner violence (IPV) and DV, the information for American Indian, Alaska Native, and Native Hawaiian women is not as abundant nor as accessible as for non-Native counterparts. However, one study by the Centers for Disease Control and Prevention (CDC) shows that 38.8% of American Indian and Alaska Native (AI/ AN) women who are murdered by an intimate partner are killed with a firearm (Petrosky et al., 2017).

Addressing the intersection of firearm violence and DV in Indian Country from a health justice perspective requires an understanding of the barriers to justice and safety AI/AN people face, such as distrust of law enforcement and healthcare systems, lack of safe shelter and housing, and underfunding of Native resources and programs. Increased Tribal access to the National Crime Information Center, funding the Tribal Access Program, and effective multi-jurisdictional coordination between law enforcement to enforce Tribal orders of protection are recommendations worth considering (Turner, 2021). There are models and possible solutions to address this crisis:

• Quality Data Collection - Data collection has been lacking in quantity and quality; AI/AN women are often left out of data collection, or the results are insufficient when it comes to inclusion. Oftentimes, the data on death/death certificates misrepresents the ethnicity of a victim (“Domestic violence and firearms,” n.d.). However, research may be expanding. In 2019, the freeze on federal funding for firearms research was lifted after 30 years. The CDC and the National Institutes of Health (NIH) have $24 million in firearms research funding (Weir, 2021). The inclusion of more comprehensible data collection could be a reality in the future.
• Community-based Violence Intervention - A key component of the health justice framework is considering the solutions within the community. There have been focused efforts on creating specific responses, such as the communitybased violence intervention model (CVI), which uses a violence interruption model to disrupt gun violence in targeted communities (Vera, 2021). This model engages and collaborates with community members, stakeholders, and law enforcement to de-escalate gun violence (Julien, 2023). A community-based response collaborates with community members at the initial planning and considers the perspective of those same community members throughout the implementation. It has been modeled in a few states.
  • A program in California that has utilized the CVI model has seen a reduction in gun-related injury and homicide by 43% (Julien, 2023). The Washington State Office of Firearm Safety and Violence Prevention has called on Tribal-led organizations and Tribal leaders to address prevention and intervention firearms safety needs, using “evidence-informed approaches that are culturally relevant and community-led” (Berg, 2024).
• Community Response Plans - The Department of Justice (DOJ) has created resources to help communities build Community Response Plans (Tribal Community Response Plans, 2023). Although these guides are targeted for Missing and Murdered Indigenous People, the model could be used as a template for focusing on other concerns. The DOJ coordinated and collaborated with Tribal law enforcement, Tribal leaders, and Tribal community members to create these guides. The guides are for different areas of concern, such as developing community outreach response guidelines and victim services response guidelines. Creating guides that are focused on firearms safety and prevention could be useful for those affected by firearms violence.

Firearms-related injury and death is a crisis nationally; however, as with most health injustices, it affects Native women and children at alarmingly high rates. There are considerations when it comes to Native women’s health that are unique and deserve focused interventions and prevention strategies. Health justice frameworks encourage that the answer lies within the community. Health justice matters because, at the root of it, it is a way that Native people have addressed community issues. It centers a problem with community knowledge and efforts. It is a collective answer from within rather than outsider observation. Health justice solutions matter in Indian Country because the solutions are creative, tailored to the environment, and sustainable because the people addressing the issue live in the impacted places. Resources such as funding research are integral in finding solutions; however, the most important aspect is listening and understanding the experiences and knowledge of the Native women who are victimized by firearms and interpersonal violence and including those perspectives in the strategies.

References

Altman, D. G. (2009). Challenges in Sustaining Public Health Interventions. Health Education & Behavior, 36(1), 24–28. http://www.jstor.org/stable/45056413

Berg, B. (2024, April 16). OFSVP solicits proposals for community-led Firearm Violence Prevention. Washington State Department of Commerce. https://www.commerce.wa.gov/contracting-with-commerce/ofsvp-solicitsproposals-for-community-led-firearm-violence-prevention/

Campbell, J. C., et al. (2003). Risk factors for femicide in abusive relationships: Results from a multisite case control study. American journal of public health, 93(7), 1089-1097.

Domestic violence and firearms. Center for Gun Violence Solutions. (n.d.). https://publichealth.jhu.edu/center-forgun-violence-solutions/solutions/domestic-violence-and-firearms

Domestic Violence and Women’s Homicides - NNEDV. (n.d.). https://nnedv.org/wp-content/uploads/2019/07/ Library_Policy_Firearms-Factsheet.pdf

Julien, J. St. (2023, September 15). Communitybased violence interruption programs can reduce gun violence. Center for American Progress. https://www.americanprogress.org/article/community-based-violenceinterruption-programs-can-reduce-gun-violence/

Petrosky, E., et al. (2017). Racial and ethnic differences in homicides of adult women and the role of intimate partner violence — United States, 2003–2014. MMWR. Morbidity and Mortality Weekly Report, 66(28), 741–746. https://doi.org/10.15585/mmwr.mm6628a1

Tobin-Tyler, E. (2023). Intimate partner violence, firearm injuries and homicides: A Health Justice approach to two intersecting public health crises. Journal of Law, Medicine & Ethics, 51(1), 64–76. https://doi.org/10.1017/jme.2023.41

Tribal Community response plans. Tribal Justice and Safety. (2023, March 31). https://www.justice.gov/tribal/mmip/tribal-community-response-plans

Turner, K. (2021, June). The risk firearms pose to indigenous women. Restoration Magazine, 18(2).

Vera. (September 2021). Community Violence Intervention Programs, Explained. vera.org. https:// www.vera.org/inline-downloads/community-violenceintervention-programs-explained-report.pdf

Weir, K. (2021, April 1). A thaw in the freeze on federal funding for gun violence and injury prevention research. Monitor on Psychology, 52(3). https://www.apa.org/monitor/2021/04/news-funding-gun-research

Wiley, L. F., et al. (2022). Introduction: What is Health Justice? The Journal of law, medicine & ethics: a journal of the American Society of Law, Medicine & Ethics, 50(4), 636–640. https://doi.org/10.1017/jme.2023.2