On an average day in the U.S., gun violence ends the lives of nearly 100 people. Yet across the country, only about 30 researchers are dedicated full time to studying the public health crisis — and in many ways, they have only begun to scratch the surface.
“This area of research has been so underfunded that while we’ve learned some things, we should know so much more by now,” David Hemenway, PhD, director of the Harvard Injury Control Research Center, told The Nation’s Health. “You need good data that’s consistent and comparable across sites and years and you need money for research, both of which we don’t have. It’s deterring researchers from going into the field.”
Right now, researchers hoping to better understand gun violence and help shape effective interventions face two imposing barriers: a scarcity of detailed data and a near total lack of federal funding support, which would typically play a major role in addressing any other public health crisis similar in size and scope to the nation’s gun violence problem.
According to the Centers for Disease Control and Prevention, firearms were responsible for more than 36,000 deaths in 2015, with the age-adjusted death rate from firearms increasing nearly 8 percent between 2014 and 2015. More than 60 percent of such deaths were from suicide and nearly 36 percent from homicide. CDC researchers estimate there are about 67,000 firearm-related injuries each year. About 1,300 children die and nearly 5,800 are injured by guns annually.
Research on gun violence prevention does occur, despite barriers. For example, researchers are slowly building an evidence base on the effects of state gun policies, and studies show a clear connection between firearm access and fatal suicide attempts. But those in the field are doubtful that the research can ever truly be on par with the scale of the problem without considerable shifts at the federal level.
Daniel Webster, ScD, director of the Johns Hopkins University Center for Gun Policy and Research, said the lag in research and resulting gaps mean prevention workers on the ground have a weaker foundation when trying to build support for gun violence interventions.
“There’s so much we don’t know, and these laws will be challenged both politically and legally,” Webster, an APHA member, told The Nation’s Health. “For these laws to withstand the challenge, you need rigorous research.”
Like fellow gun researchers, Webster said the “most important thing — far and away — is funding. We need the funding.”
The federal Dickey amendment has stunted CDC’s ability to support gun research for decades. Attached to a 1996 spending bill, the language mandated that none of CDC’s injury prevention and control funding “may be used to advocate or promote gun control.” Technically, that language does not prevent CDC from conducting gun violence research, said Linda Degutis, DrPH, MSN, who was director of CDC’s National Center for Injury Prevention and Control from 2010 to 2014. But effectively, the amendment shuttered CDC work on gun violence prevention.
“It’s been over 20 years, and it’s not that there’s been no research on gun violence, but it’s been very limited,” Degutis, an adjunct professor at Emory University Rollins School of Public Health and a former APHA president, told The Nation’s Health. “It means we’ve lost lives that perhaps could have been saved if we knew what worked to prevent gun violence.”
At the time the Dickey amendment passed, Degutis said CDC was putting about $2.6 million toward gun violence research. In 1997, Congress tapped that exact amount and told the agency to redirect it toward traumatic brain injury research. Degutis said the moves sent a clear message to CDC leadership that supporting gun research could threaten CDC’s overall budget. This March, Congress passed a spending bill with accompanying language stating that “CDC has the authority to conduct research on the causes of gun violence,” but no new research funding came with it.
“CDC could have been doing this research all along, but where’s the money that’s needed to do the research?” Degutis said. “That’s the question.”
To help fill that void, some organizations are launching their own research efforts. In April, Kaiser Permanente said it was investing $2 million into gun injury and death research and in March, the American Academy of Pediatrics announced $500,000 for a new Gun Safety and Injury Prevention Research Initiative, which will focus in large part on finding effective ways that pediatricians can provide gun safety education in clinical settings. Scientific journals are taking action too: APHA’s American Journal of Public Health made all of its gun research open access in March and the American Journal of Preventive Medicine later did the same.
Private investment, however, is not likely to make up for the lack of federal support.
“I think the great American research institution really has been funded by our engagement of federal dollars to allow us to address the most important, consequential public health problems of our time,” APHA member Sandro Galea, MD, DrPH, MPH, dean of the Boston University School of Public Health and a gun violence researcher, told The Nation’s Health. “Until that happens, we’ll have much more heat on this issue than light.”
Lack of data major barrier to research
In addition to funding shortfalls, gun research suffers from gaps in data.
For example, CDC’s National Violent Death Reporting System receives data on gun deaths, but not injuries, and not every state participates. Vital statistics data capture numbers of firearm-related deaths, but not details on the circumstances of those deaths. The FBI’s Uniform Crime Reporting System collects numbers on firearm-related crime, but it is also voluntary and offers little detail into the conditions surrounding such crimes. Webster noted that for the most part, the data available to gun researchers is aggregated data.
“There are only a handful of studies published that go to that granular level to where you’re able to say with some precision that the factors a policy was targeting were impacted,” he said.
Getting more granular data is especially challenging for gun researchers, but not entirely impossible. In Maryland, Cassandra Crifasi, PhD, MPH, a core faculty member at the Johns Hopkins Center for Gun Policy and Research, wanted to study the impact of a 2013 state law that requires people to apply for a permit with local law enforcement to buy a handgun, giving law enforcement up to 30 days to do a background check.
But at the federal level, the 2003 Tiahrt amendment prohibits the Bureau of Alcohol, Tobacco, Firearms and Explosives from sharing gun-tracing data with anyone other than law enforcement or prosecutors. However, Crifasi and colleagues were able to obtain local data from the Baltimore Police Department. Their study, published last year in the Russell Sage Foundation Journal of the Social Sciences, found that the 2013 state law was associated with an 82 percent reduction in the risk of a gun being recovered from a criminal possessor who was not the original purchaser. The study also surveyed nearly 200 men on parole or probation who would be prohibited from buying a handgun, 40 percent of whom said the 2013 law made it much harder to get a firearm.
At the Harvard Injury Control Research Center, Hemenway said researchers have authored about 150 books, chapters and peer-reviewed articles on guns and public health. They also often rely on national aggregated data and have conducted at least half a dozen of their own national surveys, but Hemenway said the continuing data gap is a “big barrier.”
Research is slowly growing stronger on certain topics, such as permit-to- purchase laws and the intersections with domestic violence, gun access and a woman’s chance of being killed with a gun. But little is known about many other topics, he said, such as open carry laws, gun theft and gun training.
One area of gun research that is increasingly clear is suicide. According to the Brady Center to Prevent Gun Violence, more than a dozen case-control studies in the U.S. have found an association between gun ownership and suicide. In fact, Robert Kinscherff, PhD, JD, associate professor in the doctoral program in clinical psychology at William James College and science faculty at the Center for Law, Brain and Behavior at Massachusetts General Hospital, said if there is any clear intersection between diagnosable mental health and gun violence, “it’s to be found in suicide.”
However, he said it would be difficult to determine how to address the high suicide rate without knowing a lot more about how people get guns and the impact of policies on gun safety and access.
Gun violence protestors gather in a Brooklyn, New York, park on March 14, a month after the Parkland, Florida, school shootings. Reducing the ongoing toll of gun violence in the U.S. requires more federal funding and better data for research.
Photo by Erik McGregor, courtesy Pacific Press/Lightrocket/Getty Images
“The more we can take a scientifically public health approach to this problem, the better our ultimate results will be and the better we’ll be able to have a reasoned discussion about public safety,” Kinscherff told The Nation’s Health. “If we can’t do that, then we’ll stay polarized and locked in a fruitless debate.”
For more information on gun violence and public health, visit www.apha.org/gun-violence.
- Copyright The Nation’s Health, American Public Health Association
