Why Addressing Gun Violence as a Health Crisis Is Crucial for Change

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With thousands of lives lost to gun violence every year, a growing number of experts believe we need to reframe how we think about it and begin addressing it as a health crisis. Andrew Lichtenstein/Getty Images
  • In the United States, there are more than 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 that year was particularly deadly — more than 300,000 deaths in the United States occurred as a result.

Since that time, COVID-19 deaths in the U.S. surpassed 1 million people from the start of the pandemic to current 2022 figures today.

As COVID-19 persists there has been another public health threat that has stood out as an enduring crisis that’s only worsened since 2020: gun violence.

While a series of high-profile mass shootings dominated headlines, less-highlighted and smaller scale incidents of gun violence nationwide have continued to make this a central health threat endemic to American daily life.

Healthline spoke with experts about the pressing threat of gun violence in this country, how it’s a public health concern, and ways to raise awareness in order to enact needed change.

Gun violence — a serious problem in America

Gun violence in and of itself certainly isn’t a phenomenon endemic solely to the U.S., 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 more than 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.

A new 2022 report from the Johns Hopkins Center for Gun Violence Solutions takes a deep dive analyzing firearm fatality data from the Centers for Disease Control and Prevention (CDC). The data comes from 2020 and is the most recent currently available.

Johns Hopkins’s analysis revealed that overall 2020 firearm-related deaths totaled 45,222 — an increase of 15 percent from the previous year.

This is the highest reported by the CDC since it started recording these firearm statistics in 1968.

To put that number in perspective, 124 people on average died from gun violence each day. Additionally, firearm homicides saw a 35 percent increase in 2020, which means an increase of 5,000 more of these homicides compared to 2019, according to a Johns Hopkins press release.

A 2022 analysis of the same CDC data published in The New England Journal of Medicine found that gun violence also surpassed car accidents as the leading cause of death among American youth in 2020. The researchers found an increase of 29.5 percent in gun-related deaths among U.S children and adolescents up to the age of 19 from 2019 to 2020.

This was “more than twice as high as the relative increase in the general population,” reads the paper.

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 at the Aspen Institute, 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 early days of the HIV 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.

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.

However, there have been many roadblocks erected to prevent this type of action.

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.

Why viewing gun violence as a health concern is such 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 — 59 percent — of gun deaths are suicides, followed by homicides at 38 percent. Police shootings account for 1.3 percent, unintentional shootings are at 1.2 percent, and 0.9 percent make up “undetermined incidents,” Giffords reports.

Like other public health crises, gun violence exposes fissures and inequities in our society.

Unarmed Black civilians are 5 times more likely to be shot and killed by police than their unarmed white peers.

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.

The report from Johns Hopkins reveals young Black males — who represent just two percent of the total U.S. population — made up 38 percent of total gun homicide deaths in 2020.

These statistics for Black children and adolescents are bleak. Johns Hopkins’s analysis reveals 52 percent of deaths of Black teenagers between 15 and 19 years old were killed as a result of gun violence. The analysis found Black young men from 15 to 34 years old were “over 20 times” more likely to die from a gun compared to their white male peers. From 2019 to 2020, the same data shows a 49 percent increase in gun homicides among Black females.

Domestic violence is also another area where gun violence factors heavily.

Victims of domestic violence are 5 times more likely to be killed if their abuser has a gun, while U.S. women are 21 times more likely to be shot and killed by a gun than their peers in other high-income nations.

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.

Thomas said that organizations like the one she works for are “very committed” to working with medical and public health professionals.

During an early 2021 interview, Thomas expressed optimism at how then President-elect Joe Biden and then-Vice President-elect Kamala Harris would center gun violence as a 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.

Since that time, we have only continued to witness the plight of gun violence sweep America and political inaction to make a change.

On May 14, 2022, a racially motivated, white supremacy-driven shooting at a Tops supermarket in Buffalo, New York, killed 10 people and injured three more. All 10 of those who were killed were Black. In total, 11 of all shot were Black.

After visiting the site of the hate crime and offering words of condolence at a Buffalo community center, President Biden didn’t speak optimistically that gun reform was possible in the current Washington political climate.

“Not much on executive action [that I can enact]. I’ve got to convince the Congress that we should go back to what I passed years ago,” Biden told reporters at Buffalo Niagara International Airport. “It’s going to be very difficult. Very difficult. But I’m not going to give up trying.”

“We have enough laws on the books to deal with what’s going on now,” Biden continued. “We just have to deal with it. Look, part of what the country has to do is look in the mirror and face the reality. We have a problem with domestic terror. It’s real,” Biden said, as reported by NEWS10 ABC out of Albany, NY.

For her part, Thomas added that one of the “sad side effects” of the current era still marked by the ravages of the pandemic and this rolling wave of violence is that we’ve collectively witnessed huge increases in gun purchasing and gun violence that seem to be unabated.

“Communities have also been impacted by more domestic violence and suicide, people are depressed…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 back in 2021.

A wave of hate crimes

One of the most troubling aspects of America’s scourge of gun violence is how so much of it is motivated by hate crimes targeting particularly vulnerable communities.

The recent Buffalo mass shooting was just one of many examples of white supremacist-generated attacks against people of color in the U.S. The shooter at Tops supermarket posted an online manifesto that specifically attributed white supremacy as the influence behind the shootings, according to NEWS10 ABC.

The Brady Plan reports that 56,130 hate crimes were committed in the U.S. “that involved the use of a gun” from the years 2010 to 2016. The wave of mass shootings that have been a horrifying reality for all too many Americans often are tied to hate incidents — whether fueled by racism, misogyny, homophobia, and transphobia, among others.

One prominent example is the 2016 Pulse nightclub shooting in Orlando, Florida, when a gunman shot and killed 49 people and injured 53 others at the LGBTQIA+ space. It is currently considered the deadliest hate crime against LGBTQIA+ people in U.S. history, according to The Brady Plan.

Receiving less press than the mass shooting in Buffalo was a shooting in Dallas, Texas, taking place days before that wounded three Asian women in a hair salon in the city’s Koreatown neighborhood.

A suspect was arrested and his girlfriend told police that he has “delusions that the Asian mob is after him or attempting to harm him,” reports NPR of the alleged racist motivations behind the shooting.

This of course recalled the horrific 2021 mass shooting that resulted in the murder of six Asian women at three spas in the Atlanta metropolitan area over the course of one night.

Antisemitism has also factored into motivations behind American mass shootings. In 2018, the Tree of Life synagogue in Pittsburgh, Penn., became the site of the deadliest antisemitic attack on U.S. soil, when a gunman shot and killed 11 worshippers and wounded six others, according to USA Today.

In all of these examples, different prejudices coupled with America’s still-unchecked gun violence problem resulted in devastating mass shootings targeting specific vulnerable groups.

As hate crimes motivated by racist and anti-LGBTQIA+ sentiments, among others, persist, it makes for something of a perfect storm, with mass shootings hitting groups already vulnerable in American society and prone to negative impacts from other public health crises.

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 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.

However, the same 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.

Why building coalitions is crucial

One way to have these conversations is to try to facilitate dialogue between very disparate groups of policy leaders and medical officials.

Back in December 2020, 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 and attracted 1,300 participants.

Michael Dowling, president and chief executive officer of Northwell Health, told Healthline it’s necessary to hold events like this one that frame 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 were killing more than 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 areas 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 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.”

Reframing gun violence as a health issue

From a policy standpoint, Thomas said it’s been frustrating to see gun control legislation constantly be stymied by Congress. Before the Biden era, she cited how gone control measures would pass successfully through the Democrat-controlled House of Representatives, but then come up short in a Republican-majority Senate.

Likewise, in this current era, a slim Democrat majority in the Senate has failed to result in any positive movement for gun control efforts.

Thomas said the time is now to act, it can’t be something that keeps getting pushed aside.

“It is long overdue for the federal government to be looking at gun violence as a public health crisis, as an epidemic,” Thomas said.

“People are dying, and it is not a problem that can wait,” she added.

She said that she’s “excited” about the prospect of what can happen if there’s support for research that’s based on public health data, and then see that inform new laws that can make a positive impact.

“Firearms might be part of the 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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