Gun violence is a public health issue

As a mother, school shootings tear a hole in my heart, making me fear for a day when my own child doesn’t come home from school. As someone who grew up in a gun-owning family with law enforcement family members, I respect the Second Amendment and believe there are many law-abiding citizens who own guns for legitimate reasons. But as a physician, I ask myself why our country fails to approach gun violence as the public health epidemic that it is.

While the senseless murders of 17 people at a Florida high school earlier this week is staggering, this death toll is dwarfed by the total number of firearmrelated fatalities in the United States annually. The CDC estimates that in 2016, over 38,000 people died and more than 80,000 people were injured by a firearm, whether by homicide or suicide. Guns kill more people than HIV, hypertension and colon cancer. Gunshot wounds cost Americans over $2.8 billion in hospital fees each year. By all measures, gun violence is a public health crisis in this country.

As with any public health epidemic, be it influenza, obesity, opioid addiction or gun violence, prevention is key. How can schools best screen students at risk for gun violence? How can physicians most effectively counsel patients on safe gun storage? What are the most effective safeguards for keeping mentally unstable people from buying guns?

While the questions seem endless, evidence-based answers are scarce. Scientific research on how to prevent gunrelated deaths is absolutely abysmal. Ac- cording to a 2017 study in The Journal of the American Medical Association, gun violence has only1.6 percent of the funding that would be predicted as compared to other leading causes of death in the United States. Based on the mortality burden, deaths from firearms should receive $1.4 billion in research annually, the study found. Instead, it only gets a paltry $22 million.

Because of this, gun violence has only 4.5 percent of the expected volume of publications. In 2014, there were less than 90 scientific articles related to gun violence. That same year, there were over 5,000 articles published on influenza, a disease with a mortality rate on par with guns.

But why such a dearth of research and discrepancy in funding? In 1997, lawmakers added an amendment to the bill that funds the Centers for Disease Control and Prevention that forbade the agency from funding any research that “may be used to advocate or promote gun control.” The amendment was in response to CDCfunded study that demonstrated that having a gun in the home was associated with a higher risk of homicide by a family member or close acquaintance. And while the ban specifically targeted research promoting gun control, it effectively stopped all research on gun violence.

Former Rep. Jay Dickey, an Arkansas Republican and the amendment’s sponsor, has since come out on record against the amendment’s consequences. As he wrote in 2015, “Doing nothing is no longer an acceptable solution.”

We should not be afraid of knowledge. Well-structured research allows us to identify ways to prevent disease. The more research we have, the better. Research has shown us that although more than 70 percent of children under 10 know the storage location of a household gun, almost 40 percent of parents wrongly believe their children are unaware of its location. Research has also shown us that having a gun in the home is associated with a threefold increased homicide risk and a fourfold increased suicide risk within the home, as compared to homes without a gun. Preliminary research also confirms what common sense would lead us to believe: Areas with stricter gun laws, specifically those requiring universal background checks for firearm and ammunition purchase, are associated with lower pediatric mortality from firearms.

This sort of data validates the American Academy of Pediatrics recommendation to add gun-safety screening and education to well-child visits and the American College of Physicians recommendation of routine firearm counseling, especially for highrisk populations. But more data might even lead to more effective change, like mandatory gun-safety education or mental health clearance for every person who buys a gun.

This isn’t a political issue; it’s a public health issue. And yet, public health agencies, physicians and all citizens who want change are left powerless by a twodecades long, misguided ban on research. To study gun death prevention is not anti-gun, it is not anti-Second Amendment. It is pro-truth and pro-safety. It is time to lift the ban on gun research and halt this deadly epidemic.