Two mass shootings, two countries, two futures.

In response to tragedy, Australia is already moving to act. In the US, the data show firearm mortality isn’t inevitable—but only where policy keeps up with reality.

Getty Images photographs of Australia’s Prime Minister Anthony Albanese and Rhode Island Governor Dan McKee.

“Mass shootings in America have become ritualized. News channels show aerial views of ambulances and police vehicles stationed outside a hastily drawn perimeter. Fresh footage airs loops for an hour, quickly becoming stale. Those images are replaced by interviews with victims and television pundits repeating what have, shockingly, becoming the tired platitudes of our time.

Meanwhile, away from the cameras, physicians begin receiving casualties in local hospitals, saving as many souls as possible. Our colleagues, from Las Vegas to Charleston, Pittsburgh to Parkland, have performed admirably in horrific circumstances, continuing their work even as impromptu vigils and memorial services have begun, and often long after the latest well-meaning hashtag has faded away. Emergency and trauma doctors are frequently the unsung heroes of America’s gun violence.

But for too long, we have been reactive. Our hospitals receive “notification” of an incident in progress, and we activate our emergency contingency plans.

Given the deplorable frequency of these incidents, that posture no longer suffices. After a period of relative inaction and observation from the sidelines, doctors are speaking out en masse, declaring it time for the ritual to end. The time has come for physicians to be proactive.”

These are words I wrote in The New York Daily News, words that I stand by today. The problem is that I wrote them in 2018. Precious little has changed.

But change is possible. This week, we were reminded of that. Two mass shootings, one in America and one in Australia, reveal exactly how societal choices matter.

Two tragedies, two responses.

First, in the wake of a terrible mass shooting in Australia in 1996, that nation decided to act. The results speak for themselves. After enacting firearm ownership reforms, mass shootings in Australia were virtually eliminated, and firearm mortality decreased in general. For anyone pointing to last week’s horrific mass shooting at Bondi Beach near Sydney as evidence that the policies failed, consider this: that event is an exceptional one. It is the biggest news story in Australia, and will be for some time. Rather than platitudes (“thoughts and prayers”) alone, this tragedy has already galvanized action. Leaders announced that they will seek to improve on existing laws to make such attacks less likely, and act to reduce antisemitism. While I have only visited Australia, it does not, to me, seem to have descended into tyranny due to its tightened laws around firearm ownership since 1996.

By way of contrast, we have the Second Amendment but also ICE, and an executive branch whose audacious cronyism and alarming appetite for leveraging of the judicial system to tighten its grip on power—attempting to prosecute its enemies and removing accountability to a craven and diverse cadre of criminals who support them—makes me wonder whether those who have argued that the individual right to bear arms is there to protect against government tyranny may not have authentically held such views after all.

Meanwhile, the murders at Brown University are just another mass shooting in this country. The shooting is on the CNN homepage now, but it’s not even the major story. There’s no realistic expectation that this tragedy will inspire systemic, sensible reforms. Quite the opposite, in fact. My friend and colleague Dr. Dara Kass wrote this terrific piece, terrific in both senses, advising parents on what they should (and should not do) when their children find themselves in lockdown during an active shooter situation. That is: we need to stop hoping these events won’t happen, and prepare for how best to deal with them in real time. How depressing is that?

Indeed, another friend and colleague Dr. Megan Ranney wrote in The Atlantic that what the students experienced is now an “American rite of passage.” While Dr. Ranney, as always, identifies practical data-driven actions we must take, I can’t help but feel a growing sense of defeat here. (Megan is a good friend. I’ve read virtually every word she has published with admiration. So I’ve not only read iterations of many of these words before, in some configuration; I’ve written variations on some of them myself.)

Change is possible, even in America.

What does this say about us? The answer is something—less depressing than it sounds, thankfully.

Today, I am traveling to Dallas to deliver a Grand Rounds lecture at the University of Texas. A theme of my lecture is that humanity has entered a unique phase in which our policy choices strongly influence how and when we die. Our ancestors, even as recently as a century ago, did not enjoy such power. They, for example, could decide to reduce deaths by certain infections by 99%. Now, with vaccines, we can. But under HHS Secretary Robert F. Kennedy’s anti-vaccine policies, we are choosing not to. Similarly, in many places in America, firearm ownership policies have not kept up with the danger that these weapons pose to law-abiding citizens.

Note the bolded, italicized word. As I told The Boston Globe, on this question, two Americas are emerging, one where policies enhance safety, and one which spurns such endeavors. The mortality disparities that already reflect this will almost certainly widen in the coming years.

Depressing as that sounds, that is precisely from where the hope comes. Measles outbreaks will happen in many places—but more frequently and severely in places that integrate Secretary Kennedy’s views on vaccines into their policies. Firearm deaths will not vanish in places that enact lawful reforms—but will continue to be highest in places that do not (to say nothing of those that act to make weapons of war more common in public spaces)).

We have seen this. Vaccine rates among kindergartners in the US are at their all-time lows in states President Trump won, but not those that Former Vice President Harris won. As my team showed, most states that enacted sensible firearm safety laws after McDonald v. Chicago (2010) did not see an increase in pediatric firearm mortality, and several saw decreases. Meanwhile, states that loosened firearm ownership and carry laws saw large increases.

Also, while we may feel that mass shootings do lead to reforms, that is actually not true. These events can encourage change, even in America. While Florida, by our count, enacted seven firearm laws from 2011-2023, my team noticed that the only one that enhanced firearm safety there was enacted in 2018. It’s called the “Marjory Stoneman Douglas High School Public Safety Act.” Similarly, while Connecticut has long been considered a state with relatively safe firearm laws (that is, the NRA gives it low grades, while the Giffords Center gives it good ones), it did not add any new laws after 2010 until the Sandy Hook tragedy. The first related law it passed after was the “Gun Violence Prevention and Children’s Safety” act. (Connecticut has done well since.)

Voting with our ballots and our feet.

As a citizen and a parent, I think about these issues a lot. While we can’t control every law that is or is not enacted, we can push for change, either at the ballot box or through advocacy.

But the reality is that it’s far easier to control where we live, isn’t it? Increasingly, the “two Americas” mortality divide I have spoken about will only make these choices starker in the decades to come. While we are not perfectly safe in Massachusetts, I know we are safer than we would be elsewhere. Therefore, I would visit Texas, as I do today, but I would not live here.

If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.