Gun violence is a public health crisis. According to the American Public Health Association, last year gun violence took the lives of almost 33,000 Americans. Another 85,000 Americans sustained injuries from guns, many of them life-shattering. The price tag for gun violence was $229 billion last year for health care, law enforcement, insurance, employment and other costs.
While mass shootings like Sandy Hook Elementary School, Orlando, Virginia Tech and Fort Hood shake the national consciousness and give rise to calls for gun reform measures, most deaths and injuries from gun violence involve fewer than four victims. It happens in our homes, on street corners, at work and at play.
Gun violence occurs more frequently in the United States than in almost any other nation. A study published in the American Journal of Medicine found that the gun homicide rate in the U.S. is 25 times (that is 2500 percent) higher than in other high income countries. Unintentional firearm deaths in the U.S. are 6.2 times higher. Perhaps most surprising is that about 60 percent of all firearm deaths in the U.S. are suicides, with the use of firearms highest among white males. Our analysis, based on data provided by the Centers for Disease Control for 2015, found that more than one million years of life are lost each year to gun violence, assuming that the victim would otherwise live to age 75. This makes firearm violence a leading cause of foreshortened life, behind only cancer, heart disease and unintentional injury.
Gun violence is a sensitive political issue. Calls for “commonsense gun reforms” – typically more comprehensive background checks for gun purchases – peak after each mass shooting. Gun rights advocates respond that this would infringe on their Second Amendment rights. They believe the focus should be on mental health screenings and interventions.
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Given the current political landscape, it is unlikely that additional gun control measures will be adopted in Washington. In fact, the opposite may occur. The new Congress just voted to repeal the Social Security disability gun rule. This rule limits access to guns for individuals with mental disabilities who are unable to manage their day-to-day affairs. According to the Washington Post, the rule would have prevented about 75,000 individuals with mental health issues from purchasing firearms.
Other gun rights measures that may be considered by Congress and the Trump administration include lifting the ban on suppressors/silencers, eliminating gun-free zones near schools and on military bases and streamlining the background check process.
These proposals are difficult to understand if as Americans we share a common desire to reduce preventable deaths and trauma from gun injuries, both intentional and accidental.
At the state and local levels, the politics of guns is more fluid, reflecting different cultural norms across the country. In November 2016, for example, voters in California, Nevada and Washington adopted new gun control measures, while voters in Maine narrowly rejected one. And in Florida, a federal appeals court just struck down on a state law that barred doctors from discussing gun ownership with their patients.
How can we find common ground? One way is to call this problem what it is, an epidemic of critical proportions. The APHA, which is 25,000 members strong all devoted to improving the health of the public, has issued a call to address gun violence as a public health crisis. In a similar manner to how public health officials investigate a communicable disease threat, APHA emphasizes that we need to understand the underlying causes of this epidemic, how the problem is transmitted and identify existing and other potential remedies.
The strategy includes better surveillance data, more research, expanded access to mental health services, school and community-based prevention, gun safety technology and commonsense gun policies.
So what do we need to do to reduce the epidemic of firearm violence?
1. Nationwide surveillance data to understand the scope of the gun violence problem.
The National Violent Death Reporting System, managed by the CDC, currently collects data from only 32 states. It should be expanded to include all 50 states and the District of Columbia. In the era of big data, we need more, not less data.
2. Better research on which approaches to reducing gun violence work and which don’t.
It is hard to rationalize the almost 20-year-old congressional restrictions on gun violence research by the Centers for Disease Control and Prevention. As a result, the APHA notes that: “We have almost no credible evidence on whether the right- to- carry laws increase or decrease violent crime.” And we have little evidence on the connection between firearms policy and suicidal behavior. The restrictions have resulted in a dearth of research on the causes or the spread of gun violence. Claims by gun control and gun rights advocates about the harm or benefit specific policies are based more on anecdote and intuition than empirical research. Congress should lift or significantly amend current restrictions on CDC gun violence research.
3. Additional resources for mental health services and school- and community-based prevention services.
This is the front line in stopping some of the most horrific incidents of gun violence. Incidents at Virginia Tech, Sandy Hook Elementary School and Emanuel African Methodist Episcopal Church in Charleston have been linked back to the shooters’ mental health. And there is broad agreement among gun control and gun rights advocates that stronger mental health programs are needed to prevent gun violence, including suicide.
4. Better use of existing safety technology.
The technology exists to prevent unauthorized access to guns in homes and businesses and unintentional shootings. Too frequently we read about a young boy or girl who accidentally shoots their sibling or playmate with a parent’s gun, tragedies that simple safety measures can prevent.
5. Commonsense gun policies.
In a nation with an estimated 300+ million firearms, it is hard to believe we don’t have comprehensive criminal background checks and that Congress has repealed the federal assault weapons ban. And do we really want our college students carrying concealed weapons on campus?
The APHA’s call for better understanding of the preconditions and causes of gun violence and for additional resources for mental health services in the community and in schools are initiatives everyone should support. By focusing on the frequency, causes and prevention of violent behavior, a public health approach can help save lives.
National Rifle Association spokesperson Lars Dalseide told National Public Radio that “the National Rifle Association is not and never has been opposed to research that promoted the safe and responsible use of firearms and [it works] to reduce gun-related deaths.” A public health approach can also help us find common ground and work to reduce gun violence and gun-related deaths.
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