Abstract
Firearm injury and mortality is on the rise and represents a complex and challenging public health crisis in our country. 1 In 2020, firearms became the leading cause of death in the United States for children and adolescents for the first time. 1,2 As clinicians and researchers like us grapple with the fact that firearm injuries kill more children than sepsis, childhood cancers, heart disease, and cerebrovascular disease combined, it is imperative that we act now to curb this public health issue. 3
To effectuate true change, reframing gun violence as a public health issue rather than a political one is essential. But while we rigorously research potential public health solutions, such as firearm safe storage education and violence intervention resources, we must not forget the importance of policy. Evidence informed policy is an essential element of public health, and is by no means in itself political. 3 It is simply part of good public health. And we must thread the needle carefully to shift the paradigm and move public health policy back into the apolitical nonpartisan lane where it belongs.
Firearm injury prevention policy is arguably one of the most understudied yet potentially impactful areas. Policy is what will ultimately drive forward the adoption and implementation of broad societal mechanisms that seek to address root causes while enhancing the health and safety of our communities, such as seat belts for motor vehicle safety, age limits for tobacco purchasing, and regulations for drugs such as opioids.
Although some view firearm injury prevention policy as a polarizing topic of discussion within the health care community, we believe this narrative must change. As health care researchers, we often shy away from including policy research as a mainstay of our academic portfolio. 3 This thinking must shift. It is not uncommon for us to hear “stay in your lane” or “stay away from discussing gun safety policies” such as background checks, assault weapon bans, age limits for purchasing, licensing, or child access prevention (CAP) laws. Yet, if we are truly going to take a comprehensive public health approach to firearm injury prevention, policies such as these and the evidence behind them must be front and center.
Policy is particularly important in implementing preventative strategies. Policy has served as a crucial element to several successful US public health campaigns. For instance, from 2001 to 2020, the national fatality rate secondary to automobile-related injuries fell by ∼21%. 2 This significant reduction in automobile-related injuries is largely attributed to a public health approach to this issue. 2,4 Specifically, policies related to enforcement of seat belt laws, child restraint laws, safety standards, and impaired driving restrictions contributed to improved automobile safety. 4 Similarly, policy was an essential element of other successful public health campaigns against vaccine-preventable diseases, tobacco use, and childhood lead poisoning. A reframing of firearm injury prevention policies as a public health tool is necessary.
Effective policy solutions and the dialogue surrounding them also require an understanding of the intricacies of different types of firearm injury, whether it be firearm suicide, unintentional injury, or intentional injury (assaults and mass shootings), and acknowledgment that a comprehensive strategy with multiple policies is required to address the true root causes of each. For example, extreme risk protection orders seek to temporarily restrict access to firearms for individuals experiencing a mental health crisis, with evidence indicating that these policies can prevent both mass shooting incidents as well as deaths by firearm suicide. 5 CAP laws limit a child's access to weapons by promoting secure storage practices and impose criminal liability on adults who negligently allow access to a firearm. 6 Federal laws such as the 1994 Violence Against Act and the 1996 Lautenberg Amendment limits firearm purchasing and possessions from persons who are under certain domestic violence restraining orders. 7
As a result of the complexities of each type of firearm injury and their respective potential solutions, paired with the simplicity in which the lay media speaks about this topic, it is not uncommon to hear folks say banning assault weapons will not help because such a ban will not stop day-to-day interpersonal violence, or that policies that target legal gun owners will not make a difference. Unfortunately, this misses the point, as 1 policy solution is not meant to tackle all types of gun injury. It is our responsibility to dispel these myths by focusing on the evidence, ensuring we do not conflate the impact of 1 policy to broader gun injuries and violence in general unless warranted, and communicating this appropriately to the public. Given the magnitude of our gun violence epidemic, implementation of policy in the face of imperfect science is necessary and urgent.
To develop and evaluate effective policies that will work, more research is sorely needed. As a result of so little research in the gun violence space and limited ability to capture comprehensive data on gun injuries nationally, 8 evidence for or against several gun prevention policies is often lacking. 9 The paucity of research for the past several decades has been in part due to flawed framing of gun violence as a political issue and the passing of the Dickey Amendment by Congress in 1996 that stymied firearm injury prevention funding from the Centers for Disease Control. However, in 2020 Congress introduced a spending bill that designated 25 million US dollars to the Centers for Disease Control and Prevention and the National Institutes of Health for firearm injury research. This funding has been an important first step and has already led to a significant uptick in the number of gun violence prevention publications.
Firearm injury and mortality is a complex and multifaceted issue that requires a multipronged interdisciplinary approach going forward. Firearm policy driven by sound scientific evidence will play a key role in tackling this public health crisis. There is new momentum in recent years in considering gun violence a public health issue, along with much needed funding for research and program implementation through federal and state agencies, and legislation such as the Bipartisan Safer Communities Act. Although research and implementation priorities include data infrastructure for firearm injury surveillance and better evaluative frameworks for community engaged research, policy is equally as important. 8 It is up to us to reframe the narrative and ensure that evidence informed public health policies are viewed as what they are—life saving measures that promote the health and safety of our communities—and not political talking points.