A night out for the midnight premiere of the summer blockbuster “Batman: The Dark Knight Rises” turned deadly. Twelve people are dead and at least 59 were wounded. The victims will be mourned, the suspect studied, and the incident relegated to our criminal justice system. In my circle, however, we see gun violence a public health problem. It affects people, it causes death, injury and disability, and it can be addressed with environmental, legal, and behavioral interventions. A classic paper examining violence in a public health frame was published in a 1993 issue of the journal Health Affairs. J.A. Mercy and colleagues described the methods and models used in public health, including our heavy emphasis on interdisciplinary leadership. More recently, David Hemenway, PhD, a professor of health policy at Harvard School of Public Health published Private Guns, Public Health in which he makes the compelling case that gun violence can be prevented, just like we’ve tackled other public health challenges.
Gun violence is uniquely an American problem compared to other industrialized countries. The rate of gun-related deaths per 100,000 individuals in Australia, Canada and the United Kingdom is 0.1, 0.5, and 0.03, respectively. In the U.S., the overall rate is 2.98. And that overall rate doesn’t tell the full story. In some cities, the rates are five to ten times that number. The fatality rate in Los Angeles is 9.2, in Miami it’s 23.7 and in my hometown of Detroit, Michigan the rate is a staggering 35.9 deaths per 100,000 residents. According to data assembled by the National Center for Injury Prevention and Control (NCIJP), about 85 people in the U.S. are killed everyday in firearm-related incidents. The most recent available NCIJP data (2007) identified more than 31,000 firearm-related deaths in the U.S., including 17,000 from suicide and 13,000 from homicide/police involvement.
The number of deaths are striking enough, but even more so when compared to the firearm-related fatality rates in other countries. I used data from the University of Sydney School of Public Health’s gun policy program to create the following table. It shows gun-related fatality rates for the Group of Twelve countries. The U.S. is a striking outlier on both the rate of homicides by guns and rate of unintentional gun fatalities.
If a cohort made up of 13 advanced industrialized countries that cooperate on monetary policy doesn’t seem like the proper group to draw comparisons, look at Table 2. It compares the gun-related fatality rates among the top-ten countries ranked by number of college graduates.
If you have a better comparison group, use the University of Sydney School of Public Health’s gun facts by country to make your own comparisons. I bet the results won’t make you swell with pride.
Beginning in the 1970’s, the American Public Health Association (APHA) has adopted numerous policy statements to support educational and legislative initiatives to address the factors that contribute to firearm-related injury and death. The most recent statement adopted in 2009 describes the need for youth violence prevention efforts, and complements APHA’s opposition to civilian access to assault weapons. The Association also has a policy statement on the books concerning handgun-injury prevention and one adopted in 2001 supporting curricula in firearm-related violence prevention.
Some of the smartest individuals who can help us understand and articulate the link between gun violence and public health are Matthew Miller, MD, MPH, ScD and, as mentioned above, David Hemenway, PhD. Both are with the Harvard Injury Control Research Center and are also members of APHA’s Injury Control and Emergency Health Services Section. Here’s what they said in the wake of the deadly gun violence in Aurora, Colorado:
“The US has more guns in civilian hands than any other developed country and more firearm related death as a result: more frequent massacres like the horrific shooting in Colorado, and day after day, more accidental firearm deaths, more domestic homicides, more homicides in the streets, and more firearm suicides. …Other countries have much more sensible gun control policies than does the US and, ironically, more people in the US favor sensible firearm control legislation than has been enacted. The toll of firearm death is not, however, inevitable. Indeed, we know that rates of suicide and homicide are lower, all else equal, in areas of the US where there are fewer privately owned guns and where more sensible gun control is the norm. Violence is a public health problem, and firearm violence is recognized as a uniquely American public health problem (at least in comparison to other high income countries). Most scientific studies on firearms now come from the public health community.”
In the 72 hours since the shootings in Aurora, I’ve heard quite a few political commentators say that with the November election looming, most Members of Congress will keep their lips sealed with conversations about gun control. They also predict that neither Mr. Obama nor Mr. Romney will speak on the campaign trail about gun-control policies. Should either candidate or leaders on Capitol Hill decide gun violence in the U.S. deserves national attention, they’d do the country a service by inviting public health experts to sit at the head of the table.