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Abstract
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It would be easy, perhaps convenient, for a medical society to sidestep a controversial social issue that has vexed the public, politicians, and the legal community for more than 4 decades. But with each new, egregious act of violence perpetrated with a gun, we as health care professionals are confronted with the responsibility of facing up to the realities of the times we live in. The recent events in Buffalo, Uvalde, Tulsa, and Atlanta, as well as daily occurrences on the streets of every city in the United States, have once again focused our collective attention, at least for the moment, on the human suffering that is by definition a public health emergency. Each episode is another call to action that cannot be ignored.
On the surface, and in the eyes of many, medical professional societies would not seem to have "jurisdiction" in this area, which has long been viewed as a social or legal problem. In 2018, following mass shootings in Ohio and Texas, physicians and other clinicians were scolded by the National Rifle Association to "stay in their lane" and to step back from the debate on gun safety and regulation. The overwhelming contrary reaction from the medical community using the hashtag "#ThisIsOurLane" went viral on social media, serving to galvanize clinicians from diverse specialties around the issues of gun safety and mitigation of gun violence.1
An updated policy statement from the American College of Physicians joined by 6 other medical societies representing more than 700,000 physicians soon followed, emphasizing the need to look at the gun issue through the lens of public health.2
A public health model calls for research, education, and advocacy focused on promoting the health and well-being of a population at risk for harm or suffering from a preventable cause. Fundamental to a public health initiative is the need for reliable data. However, the ability to collect accurate and contemporary data regarding gun violence to support such an approach had been limited for more than 20 years through federal legislation passed in 1996 (the "Dickey Amendment") restricting the use of funds allocated to the Centers for Disease Control and the National Institutes of Health to study gun injuries and gun violence.3 In recent years, Congress has appropriated funds for research, including $25 million in FY 2020, but the allotted amount remains very small in comparison to the amount of funding for other deadly illnesses and diseases.
Nonetheless, data collected through privately funded databases and individual states exposed the epidemic nature of gun-related deaths. Each year there are more than 38,000 deaths and over 85,000 injuries related to firearms in the United States.4 In addition, the ratio of guns to population in the United States is >1 to 1, 4 times higher than Canada, the next most heavily armed country, and 1 in 3 U.S. households has 1 or more guns.5 Studies from the early 1990s demonstrated a 3- and 4-fold increased risk of homicide and suicide, respectively, if a gun is present in the home.6
Given the consistent relationship between the number of guns and the gun-related death rate, one would anticipate the number of firearm fatalities to remain epidemic in the United States. Accordingly, gun-related fatalities continue to grow each year, now exceeding the number of automobile-related deaths, which have been declining over the past 40 years.7 Although mass shootings and gun-related murders capture much of the public and media attention, suicide accounts for 60% of all firearm deaths. Gun-related deaths, both from violent acts and suicide, are now the third leading cause of death among children...
Language: en |