Rural proofing the public health approach to preventing firearm-related suicide deaths
References
1. Gomez D, Saunders N, Greene B, Santiago R, Ahmed N, Baxter NN. Firearm-related injuries and deaths in Ontario, Canada, 2002–2016: a population-based study. CMAJ 2020;192(42):E1253-E63.
2. Pollock NJ, Healey GK, Jong M, Valcour JE, Mulay S. Tracking progress in suicide prevention in Indigenous communities: a challenge for public health surveillance in Canada. BMC Public Health 2018;18(1):1320.
3. Block R. Firearms in Canada and Eight Other Western Countries: Selected Findings of the 1996 International Crime (Victim) Survey. Canadian Firearms Centre, Department of Justice; 1998.
4. Miller M, Salhi C, Barber C, Azrael D, Beatriz E, Berrigan J, Brandspigel S, Betz ME, Runyan C. Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Departmen
5. Grossman DC, Stafford HA, Koepsell TD, Hill R, Retzer KD, Jones W. Improving firearm storage in Alaska Native villages: a randomized trial of household gun cabinets. American Journal of Public Health 2012;102(S2):S291-S97.
In their recent paper, Dr Gomez and colleagues have offered much needed insight about the geographic patterns of firearm injuries in Ontario.(1) They found that assault-related injuries were concentrated in cities and rates of self harm-related injuries were highest in rural areas. We support the authors’ call for context-specific public health interventions, and wish to offer an additional perspective on rural suicide prevention and the role of guns in rural communities.
Although the authors did not evaluate race-based differences, the north-south disparities in self-harm may reflect differences in suicide rates between Indigenous and non-Indigenous populations. Compared to southern areas, northern regions in Canada have proportionately larger Indigenous populations, and suicide rates in many northern areas tend to be higher, including in Ontario.(2) Assessing possible differences in patterns of self-harm between Indigenous and non-Indigenous peoples in rural and northern areas may help further tailor interventions.
The limited data about household firearm ownership in Canada shows that the prevalence is higher in rural areas, and in the territories and Atlantic provinces in particular.(3) While we recognize the relationship between firearm access and suicide, it is worth noting that the majority of firearms in rural households are rifles and shotguns,(3) and that hunting is the main reason many rural families in Canada own a gun.(3) Given the high rates of food insecurity in rural and Indigenous communities, it is important to understand that firearms support household access to country foods such as birds, moose, caribou, and seal. As a matter of equity, this context needs to be part of discussions about the role of firearm policy in suicide prevention.
Local interventions that support the safe storage of firearms may offer practical opportunities for suicide prevention in rural and northern areas. This could include counselling for means safety when people who are suicidal visit the emergency department,(4) providing households with gun cabinets,(5) setting up community firearm storage lockers, or creating voluntary, out-of-home firearm storage plans with retailers or law enforcement agencies for people who are at acute risk of self-harm. In Nunavut, for example, the territorial government established a firearm safety program which involved distributing free trigger locks through hunting associations, wildlife offices, and police detachments.
From a public health perspective, it is important to avoid viewing rurality as a homogeneous context. A key direction for suicide prevention research in Canada is to assess the effectiveness of firearm safety interventions in diverse rural settings. We hope the study from Ontario(1) will support efforts to prevent firearm-related suicide with a process that is not only ‘rural proofed,’ but also designed by the families and stakeholders who have the most to gain from rural suicide prevention.