COVID-19 has taught us many deadly lessons, including how dangerous it is to approach a health problem as a political problem. We have lost lives, jobs, hope, and an imagined future because political scoring points have become more important than following science. This is not the first time Americans have made this mistake of conflating politics and health. For decades, we have made the same error about firearm injuries. We have not approached gun deaths as an issue of public health. As a result, we have not just failed to contain gun injuries and deaths. We have seen them increase substantially in number and horror.
For most Americans, “gun violence” surfaces only when a mass shooting occurs. The fact is, gun-related injuries are far more common than we think. From 2014 to 2017, death rates from gunshot wounds in the United States increased by approximately 20%. In 2020, preliminary reports suggest that the overall rate of gun homicide and suicide increased by 10%. More than 100 people died, and more than 200 were injured by firearms daily in 2020. Most of these deaths, as in every other year, were gun suicides.
In March, the two public mass shootings in the spas in Atlanta, Georgia, and at the supermarket in Boulder, Colorado—were horrific. But gun violence in America is just the tip of the iceberg. Each firearm-related injury and death leaves a trail of destruction, contagion, post-traumatic stress, future damage, and lost wages behind. We must meet this challenge by approaching firearm injury as a public health epidemic rather than a debate about gun rights or control. This is what we’ve done for COVID-19—we’ve tested, identified that being a frontline worker puts you at risk, proven that masks and vaccines make a difference, and now we’re (finally) spreading these small miracles across the country. We’re on the road to ending that pandemic.
History provides us with many other examples. For instance, in the 1970s, car crashes were considered inevitable. Since then, death rates have decreased by more than two-thirds—although more and faster cars on the road and millions of more miles traveled—thanks to the public health approach. Instead of trying to ban cars, we used good public health techniques. We improved car safety through engineering (installing airbags and 3-point seatbelts). We educated parents about the importance of child car seats. We passed laws about drunk driving. And we funded research on how to make us safer. We knew that policy was necessary but not sufficient.
Now compare that to our approach to firearm injury. In 1996, the now infamous Dickey Amendment was passed. It ostensibly banned the use of government funds to advocate for gun control (which, by the way, was already illegal). But after its passage, all money that our country’s research institutions had received for firearm injury prevention dried up. As a result, government-funded research on the public health approach to firearm injury prevention has been 50-100 times smaller in dollars spent than for diseases and injuries that kill a similar number of people. And that means we have had no reliable data on gun injuries and minimal data on deaths.
We have been relying on the goodness of philanthropy and non-profits to develop new ways to stem the tide. We have also been stuck in tired arguments between banning guns and arming everyone, thinking that policy debates alone were sufficient instead of doing the hard work to reduce risk and improve safety. Considering the number of firearms in private hands in America, we’re kidding ourselves if we think that laws alone will fix this problem. Moving forward requires that wefinally use a basic, four-step public health approach.
First, we need accurate data. Americans deserve to know who is hurt, where, and why. We deserve to know what makes some firearm owners safe and others not. We deserve to know which policies are effective and which aren’t.
Second, this approach requires non-partisan money to create answers and drive change. Although $25 million was appropriated to the NIH and CDC in 2020 for firearm injury prevention, this is a drop in the bucket compared to the decades this issue was sidelined. As we learned with COVID-19 vaccines, there can be no progress without funding—whether for Operation Warp Speed or the logistics behind its distribution. The solutions may involve effective policies but may also include changes in how guns are engineered, differences in beliefs about risk, or changes in economic incentives for safety. We need the best and brightest minds working on this problem in the country.
Third, we must scale it up once we know what works. A few examples among many: Violence interruption programs like Advance Peace have effectively decreased gun homicides in cities in California; Innovative suicide prevention programs like Lock2Live.org can help ER doctors to counsel suicidal patients on safer storage of guns and improve secure storage among the military; Turning vacant lots into gardens in high-risk neighborhoods decreases crime, stress, and gunshot wounds in surrounding blocks; Physician counseling of parents and teens results in improved safe storage of firearms and reduces future violence. These programs, and others, deserve investment. And with proper research funding, there will be many more to come.
Finally, a successful public health approach to firearm injury requires we stop pointing fingers and instead work together. Some of the most promising approaches to firearm injury prevention (such as the work of AFFIRM Research, a non-profit that I’m affiliated with) are true partnerships between experts in firearms and those who are health experts.
It’s time to flip the narrative. Because, honestly, both sides of the debate are right. Yes, we would have zero gun deaths if we had zero guns. But a gun does not go off independently; there is always a person behind it. Ultimately, too many guns are in the hands of people whose risk changes instantly. The public health approach requires discussing both the object and the person. These mass shootings, and the 1000s of daily tragedies behind them, are not inevitable. We can reduce gun deaths, just like we did for cars, by acknowledging that firearm injury is, at its root, a health problem—and that solutions are within reach.
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