Gun Violence and Public Health
Each year in the U.S., there are an overwhelming number of deaths by gun violence. One way to address this crisis is to treat gun violence as a health problem and to treat guns the same way we treat other consumer products—limiting access to them, holding their manufacturers accountable for harm they cause, and requiring safety mechanisms and other means of protecting public health and safety. Firearms are the only consumer product manufactured in the U.S. not subject to federal health and safety regulations.
The United States has the highest firearms-related mortality rate among all industrialized nations. Gun violence is one of the leading causes of premature death in the U.S. (Butkus, Doherty, and Daniel). The U.S. also has an extremely high rate of non-fatal injury by firearms (CDC WISQARS 2013). These statistics correlate strongly with another: the United States ranks first by a large margin among developed countries in the number of privately owned guns (Small Arms Survey).
Motivated by these facts, as well as by the large numbers of mass shootings in recent years, dozens of U.S. organizations devoted to medicine, public health, and professionals in those fields have declared that in the United States, gun violence is a health crisis of epidemic proportions. As such, gun violence should be dealt with as our country has dealt with other threats to public health. Motor vehicles are a prime example: regulations that require safety features and that limit access have reduced motor vehicle deaths dramatically over the years. Yet firearms manufacturers, distributors, dealers, and their trade associations are immune from civil liability in most gun violence deaths, and access to and the manufacture of firearms remain unregulated.
Physicians Declare a Crisis
The largest U.S. professional physicians’ group, the American Medical Association, announced in June of 2016 that it sees U.S. gun violence not merely as a crime problem but as a public health crisis. In doing so, the AMA joined the American College of Physicians, an organization of specialists in internal medicine and the largest medical-specialty society in the world, which has been calling gun violence in the U.S. an epidemic health problem for more than 20 years, beginning in 1995 (Leonard).
In February of 2018, the AMA and the American College of Physicians were among 75 medical, health, public health, and research organizations that joined together to urge Congress to “address gun violence as the significant public health threat that it is.” The organizations called for legislation that treats “gun violence with the same dedication applied to other successful public health initiatives over the past 25 years, such as immunizations, public sanitation, and motor vehicle safety” (APHA).
In a 2013 survey of U.S. physicians specializing in internal medicine, 63% of respondents reported having patients who were injured or killed by a gun (Butkus, Doherty, and Daniel).
Details Bring Crisis into Focus
Other statistics illuminate the issue further. Each year, more than 32 000 persons are killed in the United States by firearms. These deaths include homicides, suicides, and unintentional fatalities and amount to 88 deaths per day (APHA; see also Butkus, Doherty, and Daniel; Leonard).
Moreover, deaths by gun violence are rising. CDC preliminary reports show that in 2016, there were more than 38,000 gun-related deaths in the U.S. and about 34,000 in 2015 (Rhodan).
Firearms are now the third leading cause of death overall among U.S. children. Every year in the U.S., nearly 1300 children die by gun violence, and nearly 5800 children receive emergency-room treatment for firearms-related injuries (Bort). From 2001 to 2010, children ages 15–19 were eighty-two times more likely to die from gun homicide in the U.S. than in other developed countries (Thakrar, et al.).
Firearms also injure many. In 2013, for instance, over 84,000 non-fatal firearms injuries occurred in the United States (CDC WISQARS 2013).
Firearms Increase Risk
Access to firearms has been shown repeatedly to increase a person’s risk of death. Owning a gun has been associated with a net increase in the risk for death by firearm compared with the risk for those who don’t own guns (Cummings and Koepsell). An analysis of data on homicides that occurred in the home in three metropolitan counties showed that keeping a gun in the home increases the risk for homicide in the home independent of other factors (Kellermann, et al.). A study published in 2004 in the American Journal of Epidemiology found that families that had purchased a handgun had an elevated risk of both homicide and suicide (Wahowiak). Results of a study published in 2014 show that merely having access to firearms in the home correlates with an increased risk for both suicide and homicide (Anglemyer, Horvath, and Rutherford).
In the U.S., firearm ownership is more prevalent than in any other country (Anglemyer, Horvath, and Rutherford; see also Small Arms Survey), and the U.S. rate of death by gun violence is the highest in the developed world. Authors of a 2013 study concluded that the number of guns per capita in a country was a strong and independent predictor of firearms-related death, proving that gun ownership does not make a country or its inhabitants safer (Bangalore and Messerli).
Congress Blocks Solutions
Despite the data that make overwhelmingly clear that in the U.S., gun violence is a serious problem, Congress has refused to limit gun ownership; has made it difficult to do research on gun violence; has shielded the gun industry from accountability; and has also barred any safety regulation of firearms.
Studies have shown that state restrictions of firearm ownership correlate with decreases in firearms-related suicides and homicides (Anglemyer, Horvath, and Rutherford). Yet Congress has failed to pass meaningful legislation to restrict gun ownership. It has also passed legislation preventing the CDC or other organizations from using public funding to conduct any gun-violence research that might be interpreted as advocating gun control (Leonard).
Unlike other industries, manufacturers and dealers of firearms are shielded from accountability for the harm they cause. The Protection of Lawful Commerce in Arms Act (PLCAA), which Congress passed in 2005, generally shields licensed manufacturers, dealers, and sellers of firearms or ammunition, as well as trade associations, from any civil action “resulting from the criminal or unlawful misuse” of a firearm or ammunition (Congressional Research Service). The PLCAA thus removes incentives for the gun industry to act responsibly and with concern for public safety. Gun manufacturers have no incentive to include certain safety features on their products. Sellers of guns also enjoy immunity and therefore have no incentive to provide training to their employees or adopt rigorous procedures to help keep guns out of the hands of dangerous individuals.
Congress has failed to pass legislation subjecting gun manufacturers to health and safety regulations. The Violence Policy Center contrasts deaths by firearms in the U.S. with deaths by motor vehicles, which are subject to licensing laws that limit access and regulations that require the motor vehicle industry’s attention to public health and safety: “While motor vehicle-related deaths are on the decline as the result of a successful decades-long public health-based injury prevention strategy, firearm deaths continue unabated—the direct result of the failure of policymakers to acknowledge and act on this ubiquitous and too often ignored public health problem.” Even though more than 90 percent of American households own a car but fewer than a third of American households contain a gun, and even though Americans spend far more time driving than they do using guns, “deaths nationwide from these two consumer products are on a trajectory to intersect.” The Violence Policy Center concludes, “The health and safety regulation of motor vehicles stands as a public health success story, yet firearms remain the last consumer product manufactured in the United States that is not subject to federal health and safety regulation.”
In the United States, gun violence has long since reached crisis levels. One way to address this crisis is to treat gun violence as a health problem and to treat guns as we have most other consumer products. This would include limiting access to guns as we limit access to motor vehicles, through licensing laws and other legal restrictions. It would include holding gun manufacturers accountable for the harm their products cause and regulating their manufacture to require safety mechanisms, child-proof locks, and other means of protecting public health and safety—as we have done in many other cases, ranging from lead in paint to poison in pesticides to danger in baby’s cribs and children’s toys Creating a public health initiative to respond to gun violence would help save many lives each year.
Sources
Anglemyer, Andrew, Tara Horvath, and George Rutherford. “The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-analysis.” Annals of Internal Medicine 21 January 2014. Accessed at http://annals.org/aim/fullarticle/1814426/accessibility-firearms-risk-suicide-homicide-victimization-among-household-members-systematic on 21 May 2018.
APHA (American Public Health Association). “Topics and Issues: Gun Violence.” (https://www.apha.org/-/media/files/pdf/advocacy/letters/2018/180222_health_gvp_house.ashx?la=en&hash=76FD7504E245D2559300E25AA4. Accessed 21 May 2018
Bangalore, Sripal, and Franz Messerli. “Gun Ownership and Firearm-related Deaths.” The American Journal of Medicine 126.10 (October 2013): 873-76. Accessed at https://www.amjmed.com/article/S0002-9343(13)00444-0/abstract on 21 May 2018.
Bort, Ryan. “Kids and Guns: Shootings Now Third Leading Cause of Death for U.S. Children.” Newsweek 19 June 2017. Accessed at http://www.newsweek.com/guns-kids-third-leading-cause-death-627209 on 21 May 2018.
Butkus, Renee, Robert Doherty, and Hilary Daniel. “Reducing Firearm-Related Injuries and Deaths in the United States: Executive Summary of a Policy Position Paper From the American College of Physicians Annals of Internal Medicine.” www.annals.org, 10 April 2014 http://annals.org/aim/fullarticle/1860325/reducing-firearm-related-injuries-deaths-united-states-executive-summary-policy. Accessed 1 May 2018.
CDC WISQARS 2013. “Nonfatal Injury Reports, 2001 – 2013.” Web-based Injury Statistics Query and Reporting System / CDC WISQARS. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Accessed 21 May 2018.
Congressional Research Service. “The Protection of Lawful Commerce in Arms Act: An Overview of Limiting Tort Liability of Gun Manufacturers.” 20 Dec. 2012. Accessed at https://fas.org/sgp/crs/misc/R42871.pdf on 21 May 2018
Cummings, Peter, and Thomas D. Koepsell. “Does Owning a Firearm Increase or Decrease the Risk of Death?” Journal of the American Medical Association 280.5 (1998): 471-73.
Leonard, Kimberly. “American Medical Association Calls Gun Violence A National Health Crisis,” U.S. News and World Report, 14 June 2016. https://www.usnews.com/news/articles/2016-06-14/ama-calls-gun-violence-a-public-health-crisis. Accessed 1 May 2018.
Kellermann, A. L., et al. “Gun Ownership as a Risk Factor for Homicide in the Home.” New England Journal of Medicine 329 (1993): 1084-1091.
Rhodan, Maya. “Gun-Related Deaths in America Keep Going Up.” Time, 6 November 2016. http://time.com/5011599/gun-deaths-rate-america-cdc-data/. Accessed 21 May 2018.
Small Arms Survey. “Research Notes.” No. 9, September 2011. http://www.smallarmssurvey.org/fileadmin/docs/H-Research Notes/SAS-Research-Note-9.pdf . Accessed 21 May 2018.
Thakrar, Ashish, et al. “Child Mortality in the US and 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis.” Health Affairs 37.1 (January 2018). 140-49. Accessed at http://www.projecthope.org/assets/documents/Child-Mortality-in-the-US-and-19-OECD.pdf on 24 May 2018,
Violence Policy Center. “Gun Deaths Outpace Motor Vehicle Deaths in 10 States in 2009.” Accessed at https://www.apha.org/-/media/files/pdf/factsheets/gundeathsoutpacecardeaths.ashx on 21 May 2018.
Wahowiak, Lindsey. “Public Health Taking Stronger Approach to Gun Violence: APHA, Brady Team Up on Prevention.” The Nation’s Health 45.10 (January 2016): 1-10. Accessed at http://thenationshealth.aphapublications.org/content/45/10/1.3.full on 21 May 2018.