GUN VIOLENCE IS A PUBLIC HEALTH CRISIS IN AMERICA. IT’S TIME TO FIND A SOLUTION.
Every year, nearly 38,000 people are killed with guns in the United States and many more are shot and injured.Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. A yearly average was developed using five years of most recent available data: 2014 to 2018. America’s gun death rate is 11 times higher than that of other high-income countries.Grinshteyn E, Hemenway D. Violent death rates in the US compared to those of the other high-income countries. Preventive Medicine. 2019;123: 20-26. In a recent national poll, 58 percent of American adults reported that they or someone they care for has experienced gun violence in their lifetime.SurveyUSA Market Research Study. Data collected from December 7, 2018 to December 11, 2018. https://bit.ly/2ExxpyZ. See question 39. Despite this uniquely American epidemic, for decades Congress knowingly restricted gun violence research, putting lives at risk. Last year, Congress finally took action and appropriated $25 million for this research,Hellman J. Congress reaches deal to fund gun violence research for first time in decades. The Hill. December 16, 2019. https://bit.ly/2QOz6wb. but more is still needed to support a robust research agenda to study the causes and impacts of gun violence.
In 1996, Congress approved a budget restriction, known as the Dickey Amendment, that dramatically curtailed the ability of the Centers for Disease Control and Prevention (CDC) to conduct firearms research. This restriction prevented the agency from spending funds to “advocate or promote gun control” and effectively zeroed out the $2.6 million the CDC had previously used for firearms research.Omnibus Consolidated Appropriations Act, Public Law 104-208 (1996). In 2011, exactly one year before the tragedy at Sandy Hook, Congress moved to extend these funding prohibitions to the National Institutes of Health (NIH).Consolidated Appropriations Act, 2012, Public Law 112-74 (2011). Although these amendments did not explicitly change existing law,Federal agencies do not traditionally advocate for legislation and research into gun violence and its causes does not constitute advocacy. they had a profoundly chilling effect on federal efforts to develop research on guns and gun violence.In 2013, President Barack Obama issued an executive order calling for the NIH to support research on firearm violence, which resulted in increased funding in the three years to follow. The funding program has since lapsed.
Both the CDC and NIH budget restrictions were deliberate efforts by the gun lobby to suppress gun research.
Both the CDC and NIH budget restrictions were deliberate efforts by the gun lobby to suppress gun research following landmark studies examining the impact of firearms on public health and safety.Jamieson C. American Psychological Association Science Directorate. Gun violence research: history of the federal funding freeze. Psychological Science Agenda. February 2013. https://bit.ly/2SDVXxB. In the spring of 2018, Congress took an important step by clarifying that the CDC has the authority to examine gun violence.Greenfieldboyce N. Spending bill lets CDC study gun violence; but researchers are skeptical it will help. National Public Radio. March 23, 2018. https://n.pr/2GkoIsc. However, the spending bill that accompanied that action lacked funding for any research.Ibid In 2019, for the first time in decades, Congress passed an omnibus funding bill that explicitly appropriated $25 million for gun violence researchHellman J. Congress reaches deal to fund gun violence research for first time in decades. The Hill. December 16, 2019. https://bit.ly/2QOz6wb. —but there is still much more to be done.
Since the passage of the Dickey Amendment, the CDC and NIH have severely underfunded gun violence research.National Institute of Justice, Awards Funded by NIJ: Gun Violence, https://bit.ly/2GzPUnb; Funding from the National Institute of Justice (NIJ) has been similarly impacted, with less than 1 percent of research over the past decade committed to studying gun violence or technologies to make firearms safer. From FY 2004 to FY 2017, the NIJ funded a total of 6,278 projects related to criminal justice research, totaling over $2.9 billion in awards. Out of those projects, only 42 addressed guns, receiving only $21.1 million in total.
- The Centers for Disease Control and Prevention: CDC funding for gun injury prevention fell by 92 percent between 1996 and 2019. Everytown for Gun Safety original analysis. Data obtained directly from the Centers for Disease Control and Prevention, Firearm Injury Prevention Activities at the National Center for Injury Prevention and Control, Budget Expenditures: Fiscal years 1992-2019. Between fiscal years 1996 and 2019, the amount of funding dedicated to firearm injury prevention fell from $3,211,557 to $269,398. Funding amounts in previous years are controlled for inflation by adjusting to their worth in 2019 dollars using the CPI Inflation Calculator at https://bit.ly/2xkC84w. In 2019, out of a budget of $7.3 billion, the CDC devoted merely $269,000 to firearm-related research and projects.Everytown for Gun Safety original analysis. Data obtained directly from Centers for Disease Control and Prevention, Firearm Injury Prevention Activities at the National Center for Injury Prevention and Control, Budget Expenditures: Fiscal Years 1992-2019.
CDC FUNDING FOR FIREARM INJURY PREVENTION 1996-2019
- The National Institutes of Health: For nearly two decades, NIH funding for gun violence research has remained below 1 percent of its total budget for research grants. Everytown for Gun Safety original analysis. Funding data were accessed through NIH RePORT (Research Portfolio Online Reporting Tools) for the years 2001 to 2018. NIH RePORT database was queried for projects awarded by the NIH (including institutes under the NIH, e.g. National Institute on Alcohol Abuse and Alcoholism) containing project titles and abstracts with the keywords ”gun,” ”firearm,” ”gunshot,” and ”rifle.” https://bit.ly/2hvlSAM. In 2018, out of approximately $21 billion in support for research grants,While the total NIH budget for FY 2018 was $36.4 billion, more than half of the total agency budget is directed towards research grant projects (approximately $20.9 billion). Total NIH Budget Authority: FY 2018 Operating Plan. National Institutes of Health. https://bit.ly/2tI6WXX. the NIH awarded less than $9 million—approximately 0.04 percent of the total—to projects addressing gun violence.Everytown for Gun Safety original analysis. Funding data were accessed through NIH RePORT (Research Portfolio Online Reporting Tools) fiscal year 2018. NIH RePORT database was queried for projects awarded by the NIH (including institutes under the NIH, e.g. National Institute on Alcohol Abuse and Alcoholism) containing project titles and abstracts with the keywords ”gun,” ”firearm,” ”gunshot,” and “rifle.” In 2018, research grants for gun violence funded by the NIH amounted to approximately $8,531,117. https://bit.ly/2hvlSAM.
The CDC and NIH grant less funding for gun violence research than for nearly every other leading cause of death in America.
- Gun violence is the leading cause of death among children and teens and the 13th leading cause of death among all ages. Yet, research funding for gun violence prevention ranks 33rd among other leading causes of death.Everytown for Gun Safety original analysis. Funding data were accessed through FedREPORTER for the years 2009 to 2018. Mortality data for the 35 leading causes of death were accessed through Centers for Disease Control and Prevention, Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death reports for the years 2009 to 2018. For each cause of death, FedREPORTER was queried for the total funding awarded by the CDC and NIH to projects containing project terms corresponding to MeSH terms, including descendant MeSH terms. Methodology derived in large part from: Stark DE, Shah NH. Funding and publication of research on gun violence and other leading causes of death. Journal of the American Medical Association. 2017;317(1): 84–85.
- From 2009 to 2018, gun violence killed over 350,000 people in the US but received only $46 per life lost in federal research funding. Ibid. This figure is an approximation and is derived from a search of FedREPORTER for projects with “firearm” or “gunshot wound” listed among the project terms. Also note that gun violence may have received funding from other agencies included in FedREPORTER that were not reported here.
- By contrast, motor vehicle accidents kill roughly the same number of people as gun violence, but receive almost four times the amount of funding per life lost.Ibid. Motor vehicle accidents received approximately $162 per life lost between 2009 and 2018. This figure is an approximation and is derived from a search of FedREPORTER for projects with “motor vehicle” or “traffic accident” listed among the project terms. Also note that motor vehicle accident research may have received funding from other agencies included in FedREPORTER that were not reported here.
RESEARCH FUNDING PER LIFE LOST FOR SELECT LEADING CAUSES OF DEATH 2009-2018Ibid.
Unlike with the issue of gun violence, sustained government investments in research on motor vehicle accidents led to scientific innovations and policies that have saved countless lives.
- Advocates for motor vehicle safety persuaded Congress to enact new legislative standards to support research, despite opposition from the automobile industry.Mashsaw JL, Harfst DL. The struggle for auto safety. Harvard Journal of Law & Technology. 1991;4(1): 307-312. As a result, for nearly 60 years, the US Department of Transportation (DOT) has invested significantly in highway and vehicle safety research.
- Each year, the DOT directs approximately $289 million to studying road safety,U.S. Department of Transportation. Budget estimates Fiscal Year 2018: National Highway Traffic Safety Administration. https://bit.ly/2wGAcmX; U.S. Department of Transportation. Budget estimates Fiscal Year 2017: National Highway Traffic Safety Administration. https://bit.ly/2GAS2uS. U.S. Department of Transportation. National Highway Traffic Safety Administration Fiscal year 2016 budget overview. https://bit.ly/2WUEEZQ. A yearly average was developed using five years of most recent available data: FY 2014 (actual),FY 2015 (actual), FY 2016 (actual), FY 2017 (enacted), and FY 2018 (requested). and it has tracked all motor vehicle deaths since 1975 through the Fatality Analysis Reporting System (FARS).National Highway Traffic Safety Administration. Fatality Analysis Reporting Systems (FARS). https://bit.ly/2V5EzOY. This research led to new motor vehicle technologies, such as safer highways equipped with guardrails and barriers,United States Department of Transportation Federal Highway Administration. Roadway Safety. https://bit.ly/2Sw9MsM. August 2018. and laws requiring seat belts and criminalizing unsafe driving.Canis B. Congressional Research Service. Issues with federal motor vehicle safety standards. CRS Report. https://bit.ly/2NhQEhx. March 24, 2017; Department of Transportation. Understanding the National Highway Traffic Safety Administration (NHTSA). https://bit.ly/2Xf7XUJ. January 31, 2017.
- Together, these measures helped reduce the fatality rate of motor vehicle accidents by 78 percent from 1968 to 2018.National Highway Traffic Safety Administration. Traffic safety facts annual report tables: motor vehicle traffic fatalities and fatality rates, 1899-2017. https://bit.ly/2WLVCtF; Department of Transportation. 2018 fatal motor vehicle crashes: overview. Traffic Safety Facts: Research Note. https://bit.ly/2URLBIT. October 2019. In 2017, firearms killed more people in the US than motor vehicles for the first time in modern history—this trend continued in 2018. Centers for Disease Control and Prevention. National Center for Health Statistics. Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death. Data include gun deaths and motor vehicle deaths from 1968 to 2018.
GUN DEATHS VS. MOTOR VEHICLE ACCIDENT DEATHS SINCE 1999
Following years of inaction, government investments in data collection and subsequent research dramatically shifted the trajectory of the HIV/AIDS epidemic in the US.
- The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) epidemic first emerged in the US in the late 1970s and early 1980s. Despite the devastating impact of the disease, particularly among the LGBTQ community, the government refused to acknowledge the issue for many years.Curran JW, Jaffe HW. Centers for Disease Control and Prevention. AIDS: the early years and CDC's response. Morbidity and Mortality Weekly Report. 2011;60(04): 64-69. It wasn’t until thousands of lives were lost that the US Department of Health and Human Services received congressional support in 1983 for funding to study the epidemic.Institute of Medicine (US) Committee to Study the AIDS Research Program of the National Institutes of Health. The AIDS Research Program of the National Institutes of Health, Section 4. 1999.
- Today, the CDC dedicates an average of $758 million to domestic HIV/AIDS prevention each year, including nearly $120 million for surveillance data tracking the transmission of HIV.Centers for Disease Control and Prevention. Congressional Justification. https://bit.ly/2SVSYAC. A yearly average was developed using five years of most recent available data: FY 2014 to FY 2018.
- Today, more Americans living with HIV are able to manage the condition, Centers for Disease Control and Prevention. HIV in the United States: At A Glance. https://bit.ly/2WP463e. Accessed March 2020. and the death rate has decreased by 91 percent since the height of the epidemic in 1995.Centers for Disease Control and Prevention. National Center for Health Statistics. Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death. Age-standardized rates from Detailed Mortality File 1999 to 2018 and Compressed Mortality File 1979 to 1998. Note that this may be an undercount as AIDS-related illnesses may not have been identified as the cause of death.
Underfunded and censored federal data collection systems leave considerable gaps in our ability to study gun violence. Good research requires good data, but unlike the database of motor vehicle fatalities or the surveillance system for HIV, the systems tracking firearm casualties are incomplete. As a result, researchers lack much of the data necessary to rigorously measure the causes and effects of gun violence, including the following:
- Nonfatal firearm injuries: The CDC derives the estimates of nonfatal firearm injuries treated in hospitals from a survey of hospitals known as the National Electronic Injury Surveillance System (NEISS).Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Data Sources. https://bit.ly/2EBNxOI. NEISS collects data about all types and external causes of non-fatal injuries and poisonings treated in US hospital emergency departments. According to the CDC, these estimates, particularly at a granular level, are unreliable and limit the data for greater specificity by geography and demographics.Centers for Disease Control and Prevention. Definitions for Nonfatal Injury Reports: Advanced Statistics. https://bit.ly/2IpG7li.
- Shootings by law enforcement and unintentional shootings: The CDC’s counts of two fatal injury intents—shootings by law enforcement and unintentional shootings—are believed to be greatly underreported due to missing information on death certificates resulting in misclassification of intent.Foley RJ. New CDC data understate accidental shooting deaths of kids. USA Today. December 9, 2016. https://bit.ly/2tkVHTN; Loftin C, Wiersema B, McDowall D, Dobrin A. Underreporting of justifiable homicides committed by police officers in the United States, 1976-1998. American Journal of Public Health. 2003;93(7): 1117-1121; Barber C, Azrael D, Cohen A, et al. Homicides by police: comparing counts from the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports. American Journal of Public Health. 2016;106(5): 922-927. According to the widely cited Washington Post database, approximately 1,000 civilians are fatally shot by police in an average year—twice as many as recorded by the CDC.Fatal Force. Washington Post. https://wapo.st/policeshootings?tid=ss_tw. Data reflect a five-year average (2015 to 2019) of fatal shootings by law enforcement.
- Gun ownership: In 2001, 2002, and 2004, the CDC measured the prevalence of gun ownership through its anonymized Behavioral Risk Factor Surveillance System (BRFSS) surveys. The CDC removed questions on gun ownership following the 2004 survey.Siegel M, Ross CS, King C. The relationship between gun ownership and firearm homicide rates in the United States, 1981–2010. American Journal of Public Health. 2013;103(11): 2098–2105.
With insufficient federal funding, state governments have stepped in with financial support for research.
- Recent years have seen a growth in public-private partnerships between state governments and universities, such as a $5 million package from the State of California to establish the Violence Prevention Research Program (VPRP) at the University of California, DavisUniversity of California, Davis Health. UC firearm prevention research center launched at UC Davis. UC Davis Health Newsroom. July 24, 2017. https://bit.ly/2BNMOrQ. and $2 million from the State of New Jersey to fund the New Jersey Center on Gun Violence Research at Rutgers University.Stainton L. New Jersey looks to California for gun violence research model. NJ Spotlight. April 3, 2018. https://bit.ly/2BYbjmn. In January 2019, the New York state legislature put forth a bill to fund a similar research center on gun violence.NY Senate Bill S1083. An act to amend the education law and the state finance law, in relation to creating a firearm violence research institute; and making an appropriation therefor. The New York State Senate, January 25, 2019. https://bit.ly/2BNAwj4.
Gun violence is a public health crisis in America, and there is a demonstrated need for additional research to guide policy-making. Research and data are integral to prevention, but without adequate resources, researchers are prevented from thoroughly examining gun violence and gun policies. Appropriating $25 million in federal funding for the CDC and NIH to perform research in 2019 was a critical first step, but significantly more funding and resources are still needed. There are several steps that can be taken to fill these gaps:
Government-funded research will help address gun violence by:
- Supporting a broad range of research topics
- Improving data collection and sharing
- Facilitating multistate consortiums
Federal and state governments can provide additional funding to researchers to conduct a broad range of gun violence research projects.
- To improve understanding of gun violence and gun violence prevention, funding can support research examining the effects of gun policies and prevention strategies on a broad range of outcomes, including, but not limited to, suicide and self-harm, homicide and nonfatal assaults, unintentional shootings, shootings by law enforcement, firearm theft and trafficking, and domestic violence.
- States can support research by dedicating funding to violence prevention centers aimed at studying these issues, following the model of the centers at the University of California, Davis and Rutgers University.
Federal and state governments can support the infrastructure of research on gun violence by improving and expanding data collection.
- Improve the collection and reporting on gun deaths and nonfatal injuries, including the rigorous examination of deaths and injuries disaggregated by different intents.
- Support the expansion of the National Violent Death Reporting System (NVDRS) to all 50 states with additional funding to build that infrastructure.The CDC’s National Violent Death Reporting System (NVDRS), which will vastly improve research on violent injury, only received funding to reach all 50 states in FY 2018 and continued support for reporting infrastructure is necessary. Centers for Disease Control and Prevention. National Violent Death Reporting System. https://bit.ly/2UQRJiZ. NVDRS will provide comprehensive counts of fatal injuries and detailed circumstantial information about these deaths, including deaths resulting from shootings by law enforcement.Conner A, Azrael D, Lyons VH, Barber C, Miller, M. Validating the National Violent Death Reporting System as a source of data on fatal shootings of civilians by law enforcement officers. American Journal of Public Health. 2019; 109(4): 578-584.
- Resume collection of voluntarily provided, anonymized data on gun ownership through federal and state-level health surveys.
States can facilitate the development and maintenance of multistate consortiums to combat firearm violence.
- Funding can support the mission of the Regional Gun Violence ConsortiumHutchins R. 7 governors launch ‘unprecedented’ effort to study gun violence. Politico. April 24, 2018. https://politi.co/2KhnYDg. and similar organizations to inform the public and provide evidence-based recommendations to prevent gun violence.