Science as the solution
A conversation with Dr. Rebecca Cunningham about firearm injury prevention
By Madeline Swanson | Photos by Austin Thomason
The story below includes mention of firearm-related injury, death, and suicide that readers may find distressing.
Dr. Rebecca Cunningham (MedRes ’99) is the University of Michigan’s vice president for research and the William G. Barsan Collegiate Professor of Emergency Medicine. She also spent 20 years as an emergency room physician at U-M and Hurley Medical Center in Flint. This summer, Leaders & Best spoke with Dr. Cunningham about how the new Institute for Firearm Injury Prevention, which she helped establish, is working to find innovative solutions to address the nation’s firearm injury crisis and how donors are helping to propel important research around gun violence.
It all started in the emergency room. Before Dr. Rebecca Cunningham would go on to become the University of Michigan’s vice president for research, she worked for more than two decades as an emergency room physician. In these hospitals, she often found herself face to face with victims of gun violence.
“I saw a lot of what I thought were senseless and very preventable deaths by firearm and tragedies that altered families’ lives forever, and I thought that we could do more to prevent those,” Cunningham said. “Part of me always wanted to explore ways to reduce the number of people who were coming in the front door of the emergency department.”
Firearm injury is a public health crisis that leads to more than 100 deaths a day across America. In the United States, nearly 40,000 people died from gun-related injuries in 2019, according to the Centers for Disease Control and Prevention (CDC). And among U.S. children and teens, it’s the No. 2 cause of death, second only to motor vehicle crashes. Yet, there is a dearth of funding to support the study of firearm injuries compared to other leading causes of death.
A spate of recent mass shooting incidents and an announcement from the White House about new federal actions have brought the issue back to the forefront. But the research effort is starting almost from scratch due to a 25-year near-total hiatus on federal research funding for firearm-related studies that was politically motivated. In 1996, Congress created the Dickey Amendment, responding to the political backlash against a study correlating the presence of guns in a home and the risk of a homicide taking place there. The amendment banned the CDC from spending money “to advocate or promote gun control,” essentially blocking CDC studies that investigate firearm violence or how to prevent it.
At U-M, a team of researchers led by Cunningham is addressing the gun violence epidemic head-on, all while respecting the rights of responsible, law-abiding gun owners. Combining their knowledge from disciplines such as social sciences and the arts, to engineering and public health, they work together to formulate and answer critical questions about firearm injury prevention.
In her current role, Cunningham oversees the largest research portfolio of any U.S. public research university. She joined the Office of the Vice President for Research in 2017 as the associate vice president for research – health sciences. In 2019, she was appointed vice president for research, responsible for fostering the excellence and integrity of U-M’s research and scholarship across all three campuses.
And when it comes to firearm injury prevention research, Cunningham is one of the leaders and best doing this work.
From the hospital to the lab
As a former emergency room physician, Cunningham was on the frontlines of this crisis. Seeing gun violence victims of all ages come through the front doors of the emergency department inspired her to help prevent these tragedies altogether. She believed issues around gun-related injuries could be addressed by focusing on injury prevention, utilizing a scientific, holistic approach. By working across the community—with hospitals, schools, and local organizations—firearm-related injuries could be quelled.
“You can see in the time of COVID when we focus all of our energies on solving a really important problem, we actually can make tremendous advances,” Cunningham said. “We have to come to grips with the fact that this is a real public health crisis, and it’s gotten more intense every year for the last several years. That realization really inspires me to help expand this field of research because I know that if we apply the science of injury prevention, we can make an impact.”
In the 1960s, another public health crisis was impacting Americans. There was public outrage over the number of people dying by motor vehicles—outrage that led to the creation of the National Highway Traffic Safety Administration (NHTSA). Federal funding for research around motor vehicle safety increased, resulting in investments in safety measures such as seatbelt mandates and a 76 percent decline in motor vehicle deaths between 1969 and 2017.
Cunningham points to the research that led to these safety advances and believes the same can be achieved to make guns safer.
“That amazing turnaround illustrates that the science of injury prevention continues to inform improvements and decreases the burden of injury,” Cunningham said. “I think we can have that same amount of success over the next 50 years if we apply that same rigor and effort as a nation to make guns more safe. This is a public health success story that was driven by academic research.”
Addressing the problem: science as the solution
In recent years, U-M has ramped up its research around firearm-related injuries and deaths, due, in part, to expanded federal funding. U-M operates the nation’s largest collection of firearm datasets and is now leading a National Institutes of Health-funded consortium of researchers across 12 universities and health systems to study firearm safety among children and teens.
According to Cunningham, U-M is uniquely positioned to address this crisis because its researchers have secured more federal funding to study firearm injury prevention than any other academic institution nationwide.
In 2019, U-M President Mark Schlissel created the Firearm Injury Prevention Initiative, encouraging coordinated research across disciplines to develop new knowledge and data on firearm violence. U-M researchers in fields such as public health, medicine, social sciences, engineering, public policy, and the arts are working to address pressing questions about firearm injury prevention.
“It’s important to create new knowledge and prevention strategies in this space and educate and train our university community—from our students and our faculty, to our postdocs—so that they can be knowledgeable about this topic,” Cunningham said. “This initiative allows us to really leverage the expertise that we have so we can achieve our common goals to decrease firearm injury and death across our communities.”
By June 2021, the initiative was ready to expand. Backed by a five-year, $10 million commitment, the university launched a new Institute for Firearm Injury Prevention to generate knowledge and advance innovative solutions that reduce firearm injury and death. The institute is exploring firearm injuries across the lifespan, including suicide; community and school-based violence; domestic violence; peer violence and police violence; as well as disparities in susceptibility to firearm injuries by race, gender, geographic location, and socioeconomic status.
Cunningham believes this science-based approach to addressing firearm injuries will make communities safer, and researchers across the university are collaborating to do just that.
Marc Zimmerman, the co-director of the Institute for Firearm Injury Prevention, the Marshall H. Becker Collegiate Professor of Public Health, and professor of health behavior and health education, is studying how changing the environment where someone lives affects their experience with gun violence.
Lisa Wexler, a professor of social work, is developing suicide prevention strategies in rural Alaska.
Dr. Patrick Carter (MedRes ’09), co-director of the institute, is studying whether a program in hospitals can reduce risky firearm behavior, violence in urban communities that wind up needing emergency care, and how we can keep kids out of the emergency department.
Cindy Ewell Foster, a clinical child psychologist and associate professor in the Department of Psychiatry at Michigan Medicine and Rackham Graduate School, is partnering with residents in Michigan’s Upper Peninsula to develop a firearm safety education program.
These are just some of the efforts underway at U-M.
“We have such a talented cohort of researchers across the University of Michigan that are working to find solutions for this public health crisis, and they will help train many others who are interested in this with the funding and focus of the new institute,” Cunningham said.
Propelling the work
While funding for this research has increased in recent years, much more is needed to keep the momentum going. At Michigan, donors have been instrumental in advancing this work.
Mount Pleasant, Michigan, native and donor Jack Osborn was raised around guns and has been an avid hunter. Growing up with access to firearms, gun safety was the first thing he learned. But over time, he has seen the landscape of gun ownership and safety change dramatically.
“I don’t understand how over 71 years the perspective in the U.S. could’ve changed so much,” Jack Osborn said. “When we were kids, you never thought of pointing a gun at anybody; you weren’t going to kill a human being. And now we have all these different problems.”
After conversations with President Schlissel and Cunningham about the Institute for Firearm Injury Prevention, Jack and his wife Marilyn (AM ’65, TeachCert ’65) recognized Michigan’s innovative approach to addressing firearm violence through science and academia.
“We were both inspired by this because there have been so many school shootings and recognized that current political commentary on both sides of the aisle didn’t matter—they weren’t getting anything done,” Jack Osborn said. “It just rang a bell that things weren’t happening, and a scholarly approach had to be taken. Since the initiative was launched, we decided to get on board right away.”
The Osborns recently supported the Institute for Firearm Injury Prevention with multiple gifts with the aim of helping to spark important conversations about gun violence that will lead to improved safety measures.
“I think we’re already seeing progress,” Jack Osborn said. “I think our gift helped to get the initiative started, and to us, it’s a modest investment to make a lot of crucial work happen.”
Cunningham hopes more people will be inspired to support this important research as she works with her team to develop science-based solutions to addressing gun violence.
“We will continue to look to donors who have helped us in the past and to those who are potentially interested in this topic in the future,” Cunningham said. “We have to develop a future workforce by educating and training our scholars in this topic and giving them the resources and the mentors that they need to help them find solutions for us in the future.”
The future of firearm injury prevention
With more firearm deaths in America than any other wealthy nation, many ask, “Where do we go from here?” At Michigan, creative solutions are being developed at the institute and beyond.
The institute boasts a research and scholarship core aiming to foster scholarly collaboration across disciplines; seed innovative projects focused on research, scholarship, and creative practice; and prepare teams for external funding opportunities to support future firearm injury prevention research.
The institute will also educate and train the next generation of faculty and students with opportunities that include new firearm-related courses revolving around epidemiology, health disparities and health equity, interventions, and policy analysis.
In addition to the research being conducted by Cunningham and her team, U-M’s School of Public Health now houses a $6 million multidisciplinary, multi-institutional center that will provide schools with training and technical assistance to prevent school violence and serve as a national research and training center on school safety.
And in September, the CDC awarded a $6 million grant to U-M to support researchers so they can partner with communities on innovative projects that ultimately aim to reduce youth firearm violence. The grant will support the Michigan Youth Violence Prevention Center, which is based at U-M and is one of only five National Centers of Excellence in Youth Violence Prevention.
“As researchers, teachers, and members of the community, we really have a fundamental responsibility to use our experience and our expertise to address the important challenges that face our society. This is a giant societal challenge for our time,” Cunningham said.
While Cunningham is aware that the topic of gun violence is polarizing, she believes we can all agree on one thing:
“We need to work toward having less people die by gun violence. We can make a lot of progress in this country by basic injury prevention and safety-focused work.”
To support the Presidential Firearms Injury Prevention Initiative, click here.