Gun Violence and Public Health: The Need for Federal Research Funding

By: Gali Katznelson

In the wake of yet another school massacre, ‘thoughts and prayers’ are not enough. But if we don’t get more laws and regulations soon, we should at least get more facts and figures.

Though approximately 30,000 people die of gun related violence each year in America, a 2017 study found that gun violence is the least studied of the top 30 causes of death in America. To put this into perspective, gun violence kills as many people in America as sepsis, yet gun violence research has just 0.7% of the funding that sepsis does, and only 4% of its publication volume.

Bioethicists have been criticized for staying out of the gun violence debate. So here’s my bioethical opinion: withholding government funding for lifesaving research as children are massacred across the country is unethical.

Allow me to explain. Today, car accidents claim about as many lives as gun violence, but the number of fatalities continues to fall. We can thank a public health approach to road safety for that. What is a “public health approach”, you ask? Two leading public health gun violence researchers, David Hemenway and Matthew Miller, describe public health in terms of five components. This approach: is population based rather than individual-based; focuses on upstream prevention strategies; uses a systems approach in which it becomes difficult to act inappropriately; is interdisciplinary; and emphasizes collective responsibility.

This strategy has been successful in decreasing motor vehicle deaths, Hemenway and Miller explain. It focuses on upstream system changes rather than on individual drivers, by creating a system in which mistakes are avoided and harm is reduced. Consider seat belts. Different disciplines worked together to ensure that cars were manufactured with seat belts, that neglecting to wear seatbelts was seen as socially unacceptable, and that laws were enacted to enforce seat belt use. Road signs, speed bumps, drinking restrictions, driver education programs and licensing – these are all interventions that have contributed to a 31% decrease in motor vehicle fatalities between 2000 and 2013.

Taking a similar approach to combating gun violence is not a novel idea. As the “nation’s health protection agency, working 24/7 to protect America from health and safety threats,” the Center for Disease Control and Prevention (CDC) used to fund research into gun violence just as it funds road safety. Gun violence is, after all, a serious health and a safety threat. That is until one of its funded studies, published in 1993, found that guns in homes were associated with higher risk of homicide. Enter the National Rifle Association’s (NRA) lobbying efforts, and a 1996 appropriation amendment stating, “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.” Though this was not an explicit ban on gun violence research, the accompanying House of Representatives’ reallocation of the amount of money ($2.6 million) used in the previous year on firearm injury research, sent a clear message to researchers. Firearm injury research through the CDC screeched to a halt. It’s been 22 years.

Limited federal funding research leaves simple questions unanswered. With no national gun registration system, data about gun ownership is scant. Who owns firearms, how many, and where? How are they stored? Is training effective? Which specific factors lead to gun violence? The only data collected by the CDC is in the National Violent Death Reporting System, a database that is not specific to firearm injuries and that does not report data from every state.

The research that we do have has been extremely helpful in thinking about prevention. Take this national randomized control trial, which found that a conversation with a primary care doctor about safe firearm storage lead to families reporting an increase in the use of cable locks six months after the intervention. This evidence can urge us to think about the role physicians can play in preventing gun-related violence and to prevent the enactment of unproductive laws, like the Florida law prohibiting physicians from speaking about firearms to patients. Thankfully, it has been struck down.

Ideally, public health research could help implement effective laws and policies. President Trump’s recent twitter proposal suggests that teachers should be armed and trained with guns. Is this the most effective way to decrease gun violence? Probably not. But the reality is, we don’t actually know. Let’s do the research and figure it out. What might the psychological effects on children and teachers be with firearms in the classroom? What are the safest ways of storing guns to keep them out of reach of children? Will potential benefits outweigh the costs?

But even if more research fails to influence law, the public health enterprise has been incredibly effective in changing social norms. Remember when smoking and drunk driving used to be cool? Me neither. But I do remember the TV advertisements and the school educational programs against smoking and drinking and driving. Public health can change social norms in the area of gun violence too. I spoke to Dr. Hemenway, Director of the Harvard Injury Control Research Center at the Harvard T.H. Chan School of Public Health who explained that public health interventions can be leveraged to change social norms such that we could live in a society in which “whatever the law says, everyone would know that it is unconscionable to sell a gun to a stranger without a background check.”

The American Public Health Association and the American Medical Association both acknowledge gun violence as a “public health crisis.” But tracking down and analyzing data is an expensive operation that needs support. The dozen or so researchers in America currently investigating gun violence are doing commendable work (even while under death threats), but they need more researchers to join the movement and they need funding to come from a federal source. As of now, gun control advocacy groups fund most of their work. This of course, tends to raise questions about the partiality of the research.

Along with an increase in federal gun violence research funding, the Dickey amendment needs to go. Even Representative Jay Dickey (R-AR, 1993-2001), the lifetime NRA member who proposed the 1996 amendment came around to support gun violence research in an op-ed for the Washington Post in 2012. Gun advocacy groups need not worry. It’s removal will not transform the CDC into a gun control advocacy group, because it is not within the CDC’s mandate to “advocate or promote” anything  without a rigorous scientific basis. It will however, send a clear message to researchers from all sides, encouraging them to answer important questions about a country in which there are more guns than people. Or are there?

Though gun ownership is a deeply divisive and emotionally charged topic in this nation, taking measures to reduce preventable violence is something we should all agree on. A core mission of public health is to balance individual autonomy with the public good. There is a severe imbalance between these two ideals when a 17-year-old can walk into a school with a legally purchased assault rifle murdering 17 and injuring 17 people. Public health can help craft a system in which both goods are maximized; it just needs the space and support to carry out this goal. How many more preventable deaths must it take to repeal the Dickey amendment and to allocate federal funding to study gun violence as the public health crisis that it is?


Gali Katznelson

During her fellowship year, Gali Katznelson was an MBE candidate at the Center for Bioethics at Harvard Medical School. Before her master's degree, she completed a bachelor’s degree in Arts & Science at McMaster University in Canada. Her fellowship project focused on clinicians' perceptions of the uses and regulations of smartphone mental health apps.

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