Point Blank: The public health case for gun-related injury research
Every two weeks, a family loses a child in a tip-over accident involving a television, piece of furniture, or appliance. That’s about 25 children annually. There are an additional 30 child deaths each year from unintentional poisoning and 90 more from in-home drowning. These are tragedies, to be sure, and the federal government makes a significant effort to prevent them: divisions within the Consumer Product Safety Commission and Centers for Disease Control and Prevention (CDC) conduct research and provide guidance on tip-over accidents, unintentional poisoning, in-home drowning, and other potentially hazardous products or situations.
This effort seems only natural, but it doesn’t extend to every cause of child death. Approximately seven children die each day from gun-related injuries, which accounts for 1 out of every 6 accidental child deaths. Yet there is no agency or division that investigates these incidents.Gun-related injuries kill 100 times as many children as unsecured flat-screen TVs, yet federally funded researchers are only allowed to study the latter. We know that violence of all kinds is closely linked to community and family behaviors and values, yet researchers have been largely unable to study the contexts and causes around the most deadly weapons available.
Even CDC’s Division of Violence Prevention—which includes a suicide prevention sub-division—does not mention the role of firearms in intentional and unintentional injuries and fatalities. This is particularly surprising since suicide is the second leading cause of death among U.S. youth ages 10 to 19, and firearms are their second most common means of suicide.
A Distinctly American Epidemic
In general, firearm injuries are the second leading cause of death among U.S. children. In 2014, there were nearly as many gun-related deaths among 10- to 19-year-olds as there were deaths from motor vehicle accidents. About a quarter of all deaths among 15- to 19-year-olds that year were firearm-related. Black youth are disproportionately affected by these injuries; more than half of all fatal injuries among 15- to 19-year-old black youth were firearm-related. One recent study found that, in 2009, a total of 7,391 children and adolescents were hospitalized due to firearm injuries. That’s an average of about 20 per day and doesn’t include those who died prior to hospitalization. And even for children who never fire or hold a gun themselves, there is a measurable psychological toll to even witnessing violence at an early age.
Gun-related injuries in childhood and adolescence are also substantially higher in the United States than in other developed countries. According to a 2012 statement by the American Academy of Pediatrics, firearm homicide rates for youth ages 15 to 24 are nearly 36 times higher in the United States than in other developed countries. For children ages 5 to 14, firearm suicide rates were eight times higher, and death rates from unintentional firearm injuries were 10 times higher.
A Firewall on Firearms Research
With these numbers in mind, why is there effectively a gag order on federal research into gun injuries? The short answer is a passage in the 1996 Omnibus Consolidated Appropriations Bill known as the “Dickey amendment,” which reads, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” A similar restriction was placed on The National Institutes of Health (NIH) in 2012.
In January of 2013, following the shooting at Sandy Hook Elementary in Newtown, Connecticut, President Obama issued an executive order to reverse the federal ban on firearm research. The order identified gun violence as “a serious public health issue that affects thousands of individuals, families, and communities across the Nation,” and called on the CDC and other scientific agencies to “conduct or sponsor research into the causes of gun violence and the ways to prevent it…by identifying the most pressing research questions with the greatest potential public health impact, and by assessing existing public health interventions being implemented across the Nation to prevent gun violence.” More than three years later, despite an executive order, the CDC is no closer to initiating gun-related injury studies. Congress has twice declined to fund the research.
Research Saves Lives
From what little federally-funded research we do have, we understand that individuals in homes with guns are at nearly five times greater risk of suicide and nearly three times greater risk of homicide. We also know that individuals in possession of firearms are about four and a half times more likely to be shot in an assault than those not in possession. We have learned little since these studies were published, though. Even Jay Dickey himself (the former Congressman who authored the amendment), now believes that research on gun safety is imperative if we intend to reduce the incidence of firearm-related injuries and deaths in the United States.
In a 2012 Washington Post op-ed, he and co-author Mark Rosenberg (a former director of CDC’s National Center for Injury Control and Prevention) wrote that gun safety research is as fundamental as that for motor vehicle safety:
The federal government has invested billions to understand the causes of motor vehicle fatalities and, with that knowledge, has markedly reduced traffic deaths in the United States. Since the mid-1970s, research has inspired such interventions as child restraints, seat belts, frontal air bags, a minimum drinking age and motorcycle helmets…366,000 lives were saved through such efforts from 1975 to 2009…The same evidence-based approach that is saving millions of lives from motor-vehicle crashes, as well as from smoking, cancer and HIV/AIDS, can help reduce the toll of deaths and injuries from gun violence.
Over the last 20 years, public health research has led to significant reductions in fatalities resulting from motor vehicles (31 percent), fires (38 percent), and drowning (52 percent). As noted in The Journal of the American Medical Association, “this progress was achieved without banning automobiles, swimming pools, or matches…it came from translating research findings into effective interventions.” Similar reductions in gun-related injuries and fatalities across the lifespan are absolutely attainable by the same means of public health research and scholarship.
Dickey and Rosenberg co-authored another op-ed in 2015, reiterating that they were once in bitter opposition over this divisive issue, but are now in complete agreement. “Gun violence research can be created, organized and conducted with two objectives,” they wrote. “First, to preserve the rights of law-abiding citizens and legal gun owners, and second, to make our homes and communities safer. We can get there only through research.” Treating gun-related injury as a public health issue (and researching it as such) is one way we can begin to see a reduction in these tragic and unnecessary child and adolescent fatalities.