- In the United States, there are over 100 gun deaths each day and about 38,000 each year.
- Despite the number of deaths, lingering health impacts from gunshot wounds, and the psychological impact a gun death or injury can have on a household or community, gun violence is framed as a political or criminal justice issue rather than a health issue.
- Many experts say there’s a great need to begin reframing the impact of gun violence as a medical issue, not a political one.
As 2020 came to a close, it was deemed “the deadliest year in U.S. history,” with early data showing that total deaths climbed above 3 million for the first time.
Understandably, the COVID-19 pandemic captured most headlines for why the past year was particularly deadly — more than 300,000 deaths in the United States occurred as a result.
While the pandemic took a disproportionate toll on American life, there was another devastating, enduring public health crisis that only got worse in 2020: gun violence.
Gun violence — a serious problem in America
Gun violence in and of itself certainly isn’t a phenomenon endemic solely to this country, but the statistics are worrying when compared to the rest of the world.
Globally, an estimated 2,000 people are injured and 500 die each day, while there were a total of 1.4 million deaths tied to firearms between 2012 and 2016, according to Amnesty International.
What about domestically? In the United States, there are over 100 gun deaths each day and about 38,000 each year, according to Giffords, the gun control advocacy and research organization co-founded by former U.S. Representative Gabby Giffords.
Given that issues of mortality, lingering health impacts of a gunshot wound, and the psychological impact a gun death or injury can have on a household or community at large, why isn’t this discussed as a public health crisis on par with the current pandemic impacting our lives nationwide?
It partly has to do with the fact that gun violence is framed as a “political or criminal justice problem,” said Dr. Megan Ranney, MPH, FACEP, associate professor of emergency medicine at Rhode Island Hospital/Alpert Medical School of Brown University, and a director and assistant dean of the Brown Institute for Translational Science.
“The forgotten underlying issue is when someone pulls the trigger, it causes health problems — the pulling of a trigger is no different than someone eating unhealthily or using substances or driving without a seatbelt on,” said Ranney, who’s a practicing emergency room physician as well as health policy researcher.
Ranney, who serves as chief research officer of AFFIRM, a nonprofit that addresses gun violence through a public health approach, told Healthline that this approach involves relying on data, education, and collaborating directly with community stakeholders.
It’s been effective in the past with other health crises.
She pointed to how we’re addressing car crash deaths as a public health problem.
The institution of seatbelt enforcement and public education campaigns around driving while drunk reduced car crash deaths by over 70 percent in this country.
Ranney also zeroed in on the AIDS crisis in the nation and how advances in modern science, improved medications and treatments, and awareness campaigns centered on behavioral interventions decreased deaths from complications tied to HIV at the height of the epidemic in the 1980s and 1990s.
As a nation, Ranney asserted that we need to do the same with firearm use.
We must move the debate from policy and criminal justice, and solely gun rights and gun control discussions, to focus instead on harm reduction, identifying risk factors for gun injury and death, and devising education and clear messaging.
Of course, there’s been roadblocks to that.
It took until December 2020 for gun violence research to receive federal funding — the first time after a 20-year gap.
Ranney said that the long absence of federal support for understanding gun violence in this country made it nearly impossible to create impactful evidence-based programs in the first place.
A complex issue
It’s important to note that the issue of gun violence as a public health concern is complex and multi-faceted.
As with most public health crises — take COVID-19, for example — the umbrella issue of “gun violence” touches on many interlocking facets of our society at large.
The toll of gun violence manifests itself in many different ways.
It’s said that nearly every person in this country will know at least one victim of gun violence over the course of their lifetime, according to Giffords.
The advocacy organization reports that the majority — 61 percent — of gun deaths are suicides, followed by homicides at 35.6 percent.
Like other public health crises, gun violence exposes fissures and inequities in our society.
Unarmed Black civilians are
Gun homicides have a high impact on Black people in this country, with Black men comprising more than half — 52 percent — of all gun homicide victims, Giffords reports.
Domestic violence is also another area where gun violence factors heavily.
Victims of domestic violence are
Robyn Thomas, executive director at the Giffords Law Center, told Healthline that looking at gun violence through a public health lens entails approaching these complicated issues holistically, echoing Ranney that this involves prevention and treatment.
This means handling each of these big issues underneath the umbrella of “gun violence” with sensitivity and nuance.
Dealing with the specific issue of suicide requires its own preventive methods compared to dealing with homicide, for instance.
There isn’t a one-size-fits-all conversation — each of these issues require unique discussions being had between advocacy organizations, doctors, public health officials, lawmakers, and cultural leaders.
Coming from the advocacy side of things, Thomas said that organizations like the one she works for are “very committed” to working with medical and public health professionals.
She also said it’s encouraging that the incoming presidential administration led by President-elect Joe Biden and Vice President-elect Kamala Harris has been on board so far with centering gun violence as a serious national concern.
“I’ve heard them speak very clearly with their commitment to reducing gun violence, and now we’ll have both a Senate and a House [of Representatives] that will support gun violence prevention legislation,” Thomas added.
“Now, it’s important that they all be held accountable to make those changes, ensuring they have the information about these policies and programs and the public support they need to move this forward,” she said.
Thomas added that one of the “sad side effects” of the current pandemic is that we’ve collectively witnessed huge increases in gun purchasing and gun violence during what has been a difficult year.
“Communities have also been impacted by more domestic violence and suicide, people are depressed, people are stuck at home, and it’s more urgent than ever to take steps to address gun violence with this administration and the Congress that sits behind them,” Thomas stressed.
“We know they all have a lot on their plate, but we think this should be one of their absolute priorities,” she added.
Raising awareness can also lead to positive change
Ranney said that when discussing gun violence from a public health perspective, it’s important not to get too mired in the political and policy debate, especially for the media and cultural commentators who bring it to the public consciousness.
She explained that policy is crucial — but it has to be done with care to make sure it doesn’t negatively affect some of the most vulnerable groups in this country.
In many ways it comes down to promoting proper interventions at the micro, community level.
Ranney cited programs that center on interventions with young people who have a history of physical fights, knowing that fights are often a precursor to firearm violence.
When it comes to suicide, she said this is another area where education and prevention are key, especially given that for the majority of people who attempt suicide, a firearm is usually the first option they turn to.
She said there’s a parallel to resistance of COVID-19 prevention when it comes to resistance to having these conversations around guns.
Many Americans might assume they’re unaffected personally by gun violence.
She cited very public events, like the attempted assassination of Giffords in a suburban area just outside Tucson, Arizona 10 years ago, or the school shootings at Sandy Hook Elementary School in Newtown, Connecticut, as moments of awakening for some Americans to the very pressing reality of gun violence.
Of course, the attention hasn’t always been paid to the stark realities of gun violence in Black and brown communities. News cameras and political spotlights aren’t often centered on these communities in a sensitive way.
She pointed out that this can be another blind spot in how we address gun violence as a public health threat.
Building coalitions
One way to have these conversations is to try to facilitate dialogue between very disparate groups of policy leaders and medical officials.
In December, Northwell Health hosted its second annual Gun Violence Prevention Forum, which convened a wide range of experts and leaders to discuss gun violence as a major public health issue.
Due to COVID-19, the event was virtual this year, attracting 1,300 participants.
Michael Dowling, president and chief executive officer of Northwell Health, told Healthline it was necessary to hold this event framing gun violence as a public health crisis because it’s one that still goes woefully under-discussed.
He said that if any other health issue or disease was killing nearly 40,000 Americans each year, there would be nonstop discussion from all medical officials.
“I do believe we have an obligation to treat it as a public health issue,” Dowling said.
He echoed both Ranney and Thomas that politics — and the partisan debates it inspires — tend to take up all the oxygen in the room and prevent gun violence from being framed as the health crisis that it is.
“I think it’s been politicized so much. I’ve talked to some of my friends around the country and know they have the same belief systems as mine, but it’s an issue they’re unwilling to take a public stance on because they live in area where if you say anything about guns, then you are ‘an enemy,’” Dowling explained. “The NRA [National Rifle Association] is very, very powerful.”
He said some of his health administrator peers in parts of the country that might be under more political sway of the NRA than the New York metro area, for instance, are more reluctant to host a forum like this one.
Dowling said the tide might be changing somewhat, just by the nature of political changing of the guard in Washington, D.C., and that the environment might be somewhat less toxic to at least start having these kinds of conversations between public health leaders and policymakers.
Dowling added that one area where the medical community can take cues from politics is building coalitions to have these conversations, brainstorm solutions and create effective preventive measures, and encourage gun safety and health practices.
He not only cited car safety as one example but also smoking, another health issue that faced opposition from special interest groups and political players.
“I’m a big believer that we can have different viewpoints converge, but it requires logical people and logical questions. It’s all about education, you learn for example from others,” Dowling said.
“Most gun owners support what we are talking about here,” he added. “Most people who are gun owners understand it’s a public health issue, it’s not a debate that is always existing on the fringes of the far left and the far right.”
Looking ahead
From a policy standpoint, Thomas said she’s hopeful that a new Congress will revisit and pass some of the measures that in the past have successfully gone through the House of Representatives but then come up short in a Republican-majority Senate.
She cited the idea of universal background check reform, something that successfully passed in the House, but has been stymied afterward by the Senate, as one example.
“It is long overdue for the federal government to be looking at gun violence as a public health crisis, as an epidemic, and I think through comprehensive measures, this administration and this new Congress need to step up and take action,” Thomas said.
“People are dying, and it is not a problem that can wait,” she said.
She added that she’s “excited” about the prospect of what can happen with new support for research that’s based on public health data, and then see that inform new laws that can make a positive impact moving forward.
“Firearms might be part of heritage or your culture. It might be something important to you, so it is necessary to own them in as safe a way as possible. [But also] be aware of risk factors and what those might be for your family members and yourself,” Ranney said, when discussing helpful ways to approach gun safety with gun owners.
“We should take it out of this political debate and reframe it as a health problem,” she added.
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