More Americans died of gun-related injuries in 2020 than in any other year on record, according to the Centers for Disease Control and Prevention (CDC). The largest percentage of gun deaths were from suicide (54%), followed by murder (43%), and the remaining 3% were from unintentional causes, law enforcement-related causes, or undetermined intent.

With the recent highly publicized mass shooting, it can be difficult to know how to approach gun safety from a medical standpoint. My searching has led me to what appears to be proven public health approaches to tackling this problem.

The CDC is funding leading-edge research into the causes, risk factors, and results of firearm deaths. These are exhibit A of what a medical evidence-based approach to gun violence looks like.

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We need only look to our colleagues in the public health arena to view exhibit B. The Johns Hopkins Center for Gun Violence Solutions published an excellent report titled The Public Health Approach to Gun Violence Prevention. The resource describes how public health differs from health care and offers a clear description of a public health approach to violence, noting these 4 components:

  • Define and monitor the problem through systematic data collection
  • Identify risk factors and protective factors by researching why violence occurs and whom it affects
  • Develop and test prevention strategies; design, implement, and evaluate interventions to see what is effective
  • Ensure widespread adoption of effective strategies

These strategies appear to apply to many areas in the public health arena. The Johns Hopkins Center offers a comparison to car safety efforts, which greatly reduced traffic deaths from 1967 to 2017. The car safety efforts used research, regulation, licensing, and registration to prohibit high-risk people from driving, improve manufacturing standards, require licensing renewal, and provide ongoing monitoring and regulation while holding manufacturers liable for selling dangerous products.

Public health advocates pose this question: if this worked for cars why not for guns?

I think it’s a great question and shows the promise of looking no further than our public health colleagues in trying to better understand what we can do as medical providers to help address the disturbing gun violence epidemic. Conquering our feelings of helplessness and turning to our evidence-based medicine training seems like a logical first step.

In fact, this is something that PAs, nurse practitioners (NPs), physicians, nurses, and other highly trained providers are uniquely qualified to conceptualize. We are trained to manage serious and unsightly injuries. We are charged with going beyond our human responses to apply evidence-based approaches to assessing and addressing suffering. It’s often not pretty, but we do it.

The Freeze on Federally Funded Gun Violence Research

Previously, the CDC was banned from funding research on gun safety until a recent change in the law. How the ban came about is a remarkable story in and of itself. A February 2013 article in the American Psychological Association’s online newsletter Psychological Science Agenda describes the history of what for all purposes was a ban on CDC gun research.

In 1993, Kellerman et al published an article titled “Gun ownership as a risk factor for homicide in the home” in The New England Journal of Medicine that included results of research funded by the CDC. The National Rifle Association responded by campaigning to eliminate the CDC’s National Center for Injury Prevention, which funded the study. In an editorial by Kellerman et al, the authors noted that although the center survived, “the House of Representatives removed $2.6 million from the CDC’s budget—precisely the amount the agency had spent on firearm injury research the previous year” and the following language was added to the final Omnibus Consolidated Appropriations Bill for fiscal year 1997: “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.”  

“Precisely what was or was not permitted under the clause was unclear,” Kellerman et al noted. “But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up.” This language was referred to as the Dickey amendment after its author, former US House Representative Jay Dickey.

After the 2012 Sandy Hook shootings that lead to the deaths of 29 people an effort to revisit this legislation was made. Rep Dickey was a proud supporter of the NRA and called himself the NRA DC “point man.” As reported by The New York Times in a March 27, 2021 article, something extremely unanticipated occurred:

“In an extraordinary turn of events, Mr. Dickey, who died in 2017, befriended the man whose work he had cut off, Dr. Rosenberg. The pair grew so close that Dr. Rosenberg gave the eulogy at Mr. Dickey’s funeral.

In 2019, Dr. Rosenberg and Mr. Dickey’s former wife, Betty, a retired former prosecutor and chief justice of the Arkansas Supreme Court, helped persuade Congress to restore the [CDC] funding; lawmakers appropriated $25 million, split between the CDC and the National Institutes of Health, for firearm injury prevention research.

The agencies are now financing nearly 2 dozen studies, though backers of the research say the money is a pittance compared with the breadth of the problem.”