5 Questions: Dr. Marian Betz, CU’s Firearm Injury Prevention Director

Another school shooting shook Colorado on Wednesday, Sept. 10. At Evergreen High School, a suspected gunman opened fire on his classmates, injuring two before turning the gun on himself.

Federal agents and local law enforcement swarmed the scene within minutes, but for the students, parents and teachers caught in the chaos, the trauma will last much longer. For many Coloradans, the incident is another painful reminder of a reality that has become all too common. Since Columbine, there have been 13 school shootings in Colorado.

For Dr. Marian “Emmy” Betz, an emergency physician in Denver and professor at the University of Colorado School of Medicine, these headlines are deeply familiar. Week after week, she treats patients whose lives have been upended by firearms. Those experiences drive her mission: preventing firearm injuries before they reach the ER.

Betz is the founding director of CU Anschutz’s Firearm Injury Prevention Initiative, which combines research, education and community engagement to reduce gun-related harm. She has also co-founded the Colorado Firearm Safety Coalition, a rare partnership between public health experts and firearm retailers that works to prevent suicide. Her leadership has earned national recognition, including election to the National Academy of Medicine in 2023.

In this week’s 5 Questions, Betz talks about what prevention looks like in practice: from creating space for dialogue across political divides to developing tools for caregivers of vulnerable populations. She also reflects on the importance of collaboration and offers concrete steps that communities, lawmakers and individuals can take to move toward a future with fewer firearm injuries and deaths.

Why did the University of Colorado School of Medicine believe it was important to have the Firearm Injury Prevention Initiative?

Firearms are now are a leading cause of injury and death across the lifespan, and professionals across the CU SOM are on the front lines of both treatment and prevention. Many of us feel and see the impact of firearm-involved violence professionally, but oftentimes also personally.

Alongside treatment and prevention, the CU SOM is committed to science and education—all which FIPI does as part of our mission to be leaders in evidence-based, community-engaged approaches to firearm injury prevention. The CU SOM saw the need, but also that the work and leadership was already happening on our campus.

What do you witness in a Denver area ER every week with regard to harm from guns, and how does this inform the work your team is doing?  

In the ER, we predominantly see three kinds of firearm-related harm because they are the most common. First, we see youth and young adults injured or killed in shootings related to community violence. Second, we care for victims of intimate partner or domestic violence, or are injured or threatened by a partner with a gun. And third, we help individuals with suicidal thoughts or behaviors, and we talk with them about reducing firearm access until they’re feeling better.

 While mass shootings and accidental shootings in kids get a lot of media attention, they are thankfully relatively rare and not something we see every day. Seeing the human impact and witnessing the lived experiences of the patients that come to the ER is what drives our work and commitment to our mission, vision, and values.

You say a future with zero firearm-related injuries or deaths is only possible through collaboration. Who are these collaborators, and are zero firearm-related injuries even possible? If so, what are the solutions? 

We think having an aspirational goal helps us think differently and question assumptions, even if reaching zero injuries or deaths may ultimately not be feasible. But it’s important to remember that no one wants a friend or family member to be hurt by a firearm. That’s true regardless of whether a person owns a gun or not (and why), who they voted for or their demographics (age, race, sex, geographic area, job, etc.).

Communities are impacted differently by different types of firearm injury and death, and there are different solutions. For example, in urban areas, community violence is a major problem, particularly among youth and young adults of color, and solutions include programs to interrupt cycles of violence and address upstream factors like jobs and housing. In rural areas, firearm suicide, particularly among middle-aged and older white men, is a major problem, and solutions include secure firearm storage and programs to encourage help-seeking behavior. We’re committed to working with impacted communities on solutions that have scientific evidence AND fit the needs and preferences of the community.

Firearms are such a contentious issue. How do you get those who believe unequivocally in the right to bear arms and those who believe there should be limits to even talk to one another, especially when you say over 40% of Coloradans live in a home with a gun?

We start with our core belief: no one wants to see a friend or family member be harmed by a firearm. We keep this shared goal in mind in all our work with communities by striving to understand the views and preferences of community members so that we can help apply evidence-based solutions. For example, in working with firearm owners around suicide prevention, our messages are focused on voluntary, temporary reductions in firearm access for individuals at risk; it’s not about confiscation or legislation, it’s not about the right to bear arms or whether a person should or shouldn’t own firearms.

In our experience, people are ready for these conversations—both to learn from others and to share their own stories and experiences. There seems to be a sigh of relief when we create the space for conversation rather than argument, and instead of pointing fingers, we talk about how to move forward together.

We just had a deadly school shooting in Minneapolis, Minnesota, and another here in Evergreen, Colorado. If you were talking to lawmakers, what advice would you have regarding access to firearms to reduce injuries and deaths?

Equally important to talking to lawmakers is talking to everyone across the country who’s asking themselves, “How do we stop this?” We all have a role in preventing these injuries and deaths—it’s not just the job of legislators or healthcare providers or law enforcement. 

A concerned social worker can start respectfully talking about secure storage options for firearms to make sure little kids cannot access them. A firearm-owning parent can make plans to adjust storage practices if they are concerned about their teen’s moodiness or depression. Hospitals can start programs for victims of firearm injuries to ensure they are connected to all necessary resources after discharge. Schools can provide free firearm locking devices to families. A non-firearm-owning parent can ensure they, and their children, know what to do to if they encounter a firearm. Community groups can fix streetlights to make the walk to the park safer. 

There are so many things that each of us can do—it’s important not to feel helpless. Everyone has a role!