This was posted on the American College of Surgeon’s Bulletin.
In light of the pervasiveness of gun violence and increasing frequency of mass casualty shootings, the Resident and Associate Society of the American College of Surgeons (RAS-ACS) Advocacy and Issues Committee endeavors to explore the issues of gun violence and firearm policy in the U.S. As surgeons and surgical trainees, we are confronted with the consequences of gun violence in our hospitals daily. This article discusses the history and current landscape of national firearm policy.
Epidemiology of gun violence in the U.S.
Firearm violence accounted for 36,252 U.S. deaths in 2015 and continues to be a leading cause of death for individuals 10–24 years old, constituting a public health crisis.1 The age-adjusted death rate due to firearm injury by all intents, after remaining stable for several years, increased by 7.8 percent in 2015.1 The U.S. Centers for Disease Control and Prevention (CDC) data reveal that deaths from firearm injury accounted for almost 17 percent of all injury-related deaths in 2014.2 Of these mortalities, suicides remain relatively unchanged at 63 percent of all firearm-related deaths, and homicides comprise approximately 37 percent of firearm deaths.
The 2014 Annual Review of Public Health found that the increase in the mortality rate from firearm violence had greatly differed from other etiologies. Notably, while significant progress has been made in reducing the incidence of death from other injuries through public health interventions and federal policies, similar trends have not been observed in mortality rates due to firearm injuries, leaving room for interventional strategies in this area.3
Compared with other member nations in the Organisation for Economic Co-operation and Development, the U.S. is an outlier in mortality rates from firearm violence, with exceptionally high rates of firearm-related homicide and suicide.4 A number of studies demonstrate that access to a firearm greatly increases the risk of injury. In a 2014 meta-analysis conducted at the University of California, San Francisco, researchers assessed 16 observational studies on firearm-related death and found that access to firearms is associated with increased likelihood of both completed suicide and of being the victim of homicide.5
In addition to the public health costs, firearm-related injuries add significant financial burdens to the U.S. health care system and result in reduced productivity of U.S. workers. According to the National Violent Death Reporting System (NVDRS), in 2010 the medical costs for the approximately 30,000 people killed by firearms were an average of $5,891 per person and nearly $186.6 million overall.4 The 38,500 injured individuals who survived firearm-related injuries but required hospitalization accrued nearly an additional $852.9 million and more than $3 billion in lost wages.4 Another group of patients whose injuries were less severe and were discharged without inpatient admission had medical and lost wages expenses totaling an additional $200 million.4
Gun violence legislation: A brief history
Federal research funding
The CDC’s National Center for Injury Prevention and Control has a history of studying gun violence as it relates to public health. However, for the past two decades, federal firearm injury prevention research has stalled due to the 1996 Omnibus Consolidated Appropriations Act.6 In 1996, the National Rifle Association—in reaction to CDC-funded studies demonstrating that firearm ownership was a risk factor for homicide in the home—lobbied Congress to eliminate $2.6 million from the CDC budget, the exact amount the CDC had allocated to gun violence research the previous year.7 As a result, the 1996 appropriations bill included a rider proposed by Rep. Jay Dickey (R-AR) that stated “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.”8
Congress subsequently reallocated the funds for firearm injury research to the prevention of traumatic brain injuries, and the CDC ultimately ceased all firearm-related research. In a study of scientific publications related to firearms from 1991 to 2010, the number of firearm studies was significantly fewer than other major causes of death, highlighting a detrimental result of the funding ban.9 The CDC provision was then expanded in 2012 to include other agencies in the U.S. Department of Health and Human Services (HHS), further limiting research related to this topic.
However, in January 2013 President Barack Obama encouraged Congress to invest several million dollars to expand the NVDRS to all 50 states to facilitate a better understanding of the role of firearms in violent deaths.
In addition, the Gun Violence Research Act, introduced in November 2015, amended the Public Health Service Act to include gun violence-related injury as an acceptable area of research for the CDC. The Gun Violence Research Act failed to pass but was reintroduced in March 2017 and sought to repeal the prohibition of the HHS from researching gun-related violence. The National Institutes of Health also responded to the presidential directive and funded nine proposals aimed at researching firearm violence and its prevention; however, this program has since been suspended.6