Katherine Hoops

Background and Objectives: The influence of democracy and democratization on health is difficult to disentangle from a complex web of factors such as population characteristics and social determinants of health. The goal of this study was to begin to characterize the roles of the individual attributes of democracy on a key measure of health, mortality rates among female children under five years of age. Methods: We conducted a retrospective observational cohort study utilizing data over a study period from 1975–2021 with data from 173 countries. We utilized publicly available data from the Global State of Democracy Indices (GSoD) and the United Nations Inter Agency Group for Child Mortality Estimation (UN-IGME) databases. Results: Our data support prior work showing that strength of democracy is associated with improved population health measures. Stronger democracies are associated with improvements in female child mortality, even controlling for within-country variation over time and for income level. This relationship is most pronounced when examining the relationship between protections of civil rights and child mortality. Conclusions: Child mortality increases when democracy declines. With declines in democracy worldwide, it is critical that advocates are concerned with the global democratic experience, especially with policies that compromise fundamental rights.

The city of Baltimore has been ravaged by the epidemic of gun violence for decades and frequently ranks as one of the most violent cities in America. In 2022 alone, 336 people died by firearms in Baltimore and an additional 688 people suffered non-fatal firearm injuries. In 2023, Baltimore experienced the first year in decades with fewer than 300 annual gun violence-related deaths, but 263 lives were still tragically lost in our community. 1 For years, community and faith groups, researchers, clinicians and city and state governments have each worked to reduce violence and the conditions that contribute to it, but often this work occurs in isolated silos. Across the country, there have been evolving initiatives to bring stakeholders together to share information and approaches to develop greater collaboration. In Baltimore, the city government has worked to establish a violence prevention ‘ecosystem’, a comprehensive approach to violence intervention including hospital-based violence intervention programs (HVIPs), victim service organizations, legal advocacy organizations, community violence prevention and intervention programs, school-based programs and other resources through the Mayor’s Office of Neighborhood Safety and Engagement (MONSE).2

This study assesses the feasibility and acceptability of a Firearm Safe Storage Device Distribution Program. The distribution took place at the Break the Cycle of Violence Summit hosted by the Johns Hopkins Medicine, the Break the Cycle Hospital Violence Intervention Program, and the Johns Hopkins Bloomberg School of Public Health Center for Gun Violence Solutions. The findings will guide future efforts to distribute safe storage devices in clinical settings. Attendees of the Break the Cycle of Violence Summit could choose from three types of safe storage devices to provide to their patients within their practice. Those attendees who participated were asked to participate in an electronic survey to assess the feasibility and acceptability of the safe firearm storage device distribution at the Summit. 24 participants received safe storage devices at the Break the Cycle of Violence Summit. Of the 24 participants, 15 participated in our evaluation. 86% of participants distributed most of the devices by the time of the survey and 57% of participants stated that by having safe storage devices to distribute, they were more likely to provide safe gun storage counseling. All participants would like to see continued safe gun storage distribution programs in their community. The provision of free safe storage devices allowed for open conversations about firearms and safe storage with patients and clients. This study can be used as a model to guide future efforts in safe storage device distribution in a hospital or clinic-based setting and showed feasibility, effectiveness, and efficacy.