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Gun Violence as a Public Health Issue

August 11, 2022

A group of protestors holding anti-gun-violence signs.

Gun violence takes a devastating toll in the United States. On May 24, 2022, an 18-year-old opened fire in Robb Elementary School in Uvalde, Texas, killing 19 children and two adults and injuring 17 people. Events like this are tragic and yet increasingly common. Every year, an average of 100 Americans a day die from gun violence, according to Giffords Law Center. To address this enormous cost, experts are calling for resources to study and combat firearm violence as a public health epidemic.

According to emergency physician Megan L. Ranney in Time, not treating gun violence as a public health issue but rather as a political issue to be debated has resulted in a failure to contain gun deaths. Gun-related tragedies continue to surge, from suicides to public mass homicides.

Societal Costs of Gun Violence

Every gun injury or death, whether intentional or unintentional, sows destruction in its wake. Societal costs of gun violence include:

Employer costs
Decreased quality of life
Insurance claims processing
Post-traumatic stress and mental health counseling
Medical/healthcare costs, including emergency transportation
Social contagion (the spread of attitudes or behavior patterns in a group through imitation)
Wage loss
Death

Gun Violence Statistics

A quick glance at gun violence statistics in the United States reveals why gun violence is a problem we cannot afford to ignore:

The Robb Elementary School shooting in Uvalde, Texas in 2022 is the 9th deadliest mass shooting in US history.
2020 saw the highest gun-inflicted death toll in 20 years, according to the Gun Violence Archive (GVA). This website collects and verifies gun violence and crime data in the U.S. from 6,500 sources.
Time magazine reported 2020 was one of the most violent years in recent U.S. history. The number of mass shootings — which are classified as an incident in which four or more people are shot and injured or killed — has drastically risen. The number of mass shootings in 2020 was over 600, the most in the past five years and representing a nearly 50 percent increase from 2019’s total.
Gun violence disproportionately affects people of color, especially Black Americans. According to Everytown for Gun Safety, a nonprofit organization that advocates for stricter gun laws, Black Americans make up 68% of homicide victims in cities, many of which are victims of gun violence.
Gun violence costs the U.S. $280 billion each year, according to the American Public Health Association. This includes money paid by individual victims of gun violence, the healthcare system, and mental health services.

School Gun Violence Statistics

Guns are the leading cause of death among U.S. children and teens, according to the Sandy Hook Promise, a nonprofit organization dedicated to preventing gun violence at schools. One out of every 10 gun deaths in the United States are of people age 19 or younger (including suicides).
At least 114 incidents of gunfire on U.S. school grounds caused at least 23 deaths and 60 injuries in 2021, according to Everytown research.
Statista reports that, as of September 2021, 170 school shootings had occurred in the United States so far this year — the highest number of school shootings since 1970.
The National Center for Education Statistics reported a total of 75 school shootings in the 2019–20 school year, of which 27 resulted in deaths. The majority of school shootings occurred at high schools.

Barriers to Gun Violence Research from a Public Health Perspective

Is gun violence a public health issue? For years, public health experts have been hamstrung when it comes to studying gun violence. Here is why.

In 1996, the Dickey Amendment banned the use of government funds to advocate for gun control. As a result, commentators for Time argue that the public health approach to gun violence has been 50 to 100 times smaller, in terms of research dollars spent, compared to similarly lethal diseases and sources of injury.

In addition, reliable data on gun injuries and gun-related deaths is still insufficient, according to some public health experts.

But that is changing. In 2016, The Guardian reported that over 140 medical organizations called on Congress to “end the dramatic chilling effect of the current rider language restricting gun violence research and to fund this critical work.”

The movement to fund gun violence research continues today. Recently, the American Medical Association and the American Public Health Association unequivocally describe gun violence as a public health issue, putting pressure on federal legislators to put more public health funding toward gun violence prevention research.

Framing Gun Violence as a Public Health Issue

Why is a public health approach vital to preventing the damage gun violence inflicts on communities? The answer boils down to understanding the social and structural factors that predict gun violence.

Dr. Maeve Wallace, assistant professor at Tulane University’s School of Public Health and Tropical Medicine, describes a public health approach to gun violence as “the ability to see [gun violence] as a result of societal oppression and all these larger forces at play, and not just the result of someone who has criminal behavior.”

Rather, Dr. Wallace emphasizes that thinking of gun violence as senseless, random, or too painful to talk about hinders a proper understanding of the issue’s deeper causes.

“[Gun violence is] due to structural racism, classism, sexism,” says Dr. Wallace, “all these societal hierarchies that dictate who gets access to high-paying jobs, who gets access to college education, who gets to live in an environment that has safe houses and stable neighborhood opportunities.”

In a phrase, says Dr. Wallace, “social determinants matter.”

Fund Evidence-Based Policy

Thinking about a public health framing of gun violence — considering its deeper social and structural causes — allows for a grounded, evidence-based public health approach to gun violence prevention.

“How we shape structures, I think, is by policy,” says Dr. Wallace. Equitable, research-backed policies can “create better health-promoting opportunities for everybody.”

For example, Everytown for Gun Safety is a nonprofit organization that advocates for gun policy changes to close the “boyfriend loophole.” Everytown reports that nearly 4.5 million women have been threatened with a gun by an intimate partner. Of these, 1 million women have reported being shot at, or shot by, a partner.

The “boyfriend loophole” allows abusers to purchase and possess guns — even after they have been convicted of abuse, or are actively under a restraining order for abusing a partner. Everytown argues that policy changes could make it harder for convicted abusers to wield a firearm.

In sum, public policy requires research on the root causes of gun violence and what prevents gun violence. With proper funding, public health researchers can mobilize to study these causes and make evidence-based recommendations.

Steps to Approaching Gun Violence as a Public Health Issue

To address gun violence, more research is needed to understand its underlying causes and to assess policy responses to this ongoing crisis.

Steps to approaching gun violence as a public health issue include the following:

1. Gather Accurate Data

Historically, few public health researchers have been able to study gun violence from a public health perspective. With increased pressure on politicians from public health experts, medical doctors, nonprofit organizations, and grassroots movements, lawmakers may be more likely to treat gun violence as a public health issue that can be studied and confronted using public health dollars.

Public health experts who study gun violence can help to collect and analyze more accurate data about how and why gun violence occurs, and which policies are effective at preventing injury and death due to firearms.

2. Support Increased Funding for Gun Violence Research

Research costs money. Public health experts understand that to gain a big-picture understanding of complex issues, they need resources.

Federal government officials only allocated $25 million to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) for firearm injury prevention in 2020. This unfortunately does not yet make up for the decades in which little to no funding was available to public health researchers to study this deadly phenomena.

For public health researchers to effectively apply their unique skill sets to gun violence prevention, federal and state funding would need to increase, they say.

3. Scale Effective Programs

To address the enormous costs and meet the challenge of preventing gun violence, experts are calling for resources to study and combat firearm violence not in the context of gun rights or control, but as a public health epidemic.

Individuals interested in learning about promising research into gun violence as a public health issue can read about a variety of approaches here:

Lock to Live is a suicide prevention program that enables emergency room doctors to counsel suicidal patients on safe gun storage and improve safe storage among the military.
Advance Peace is a violence interruption program that has effectively decreased gun homicides in California.
Center for Youth Equity is a collaboration between New Orleans area community organizations and Tulane University aimed at preventing youth exposure to violence and supporting victims of gun violence trauma.
Beautifying spaces matters. Transforming vacant city lots into gardens in high-risk neighborhoods has been shown to decrease crime, stress, and gunshot wounds in surrounding areas.
Family doctors can help. Studies show that teens and parents who were counseled by physicians on safe firearm storage were less likely to experience firearm violence.
Tulane University’s Violence Prevention Institute is led by an interdisciplinary group of professors working to research violence prevention measures.

So long as there are guns, the specter of gun violence looms. But research shows that gun violence can be predictable and preventable when lawmakers, communities, and researchers join forces to apply a public health approach to understanding gun violence and halting it.