In 2019, after another of the horrific mass shooting events that most Americans have become numb to but are far less common in other developed countries, I was asked to participate in a panel presentation on "Gun Violence as a Public Health Issue" at the Family Medicine Education Consortium's annual meeting. I worked hard to make my presentation as non-ideological as possible, mustering slide after slide of statistics showing the rise in firearm-related injuries and deaths since the turn of the century from many peer-reviewed studies. I acknowledged, though, that as with many other public health issues, no number of facts and figures would be completely persuasive. Gun violence is an issue where emotions matter more than evidence. For many, firearm ownership ensures freedom from tyranny, and government restrictions on purchasing guns, however reasonable, represent threats to personal liberty.
The following year, homicides and suicides from firearms surpassed motor vehicle accidents as the leading cause of death in children and adolescents for the first time, and an updated analysis found that the firearm-related death rate in this group increased by 3.9% from 2020 to 2023. For perspective, in 2023, guns killed 4455 children, while Covid-19 infections accounted for 125 children's deaths in 2023 and 547 deaths at the pandemic's peak in 2021. This is why it is as essential for physicians to provide counseling on firearm injury prevention during well-child visits as counseling regarding Covid-19 and other recommended vaccines.
A recent cross-sectional study in JAMA Network Open examined associations between state firearm laws and firearm-related suicides from 1976 to 2024. The investigators focused on 6 types of laws involving handgun permits, waiting periods for firearm purchases, concealed carry licenses, minimum age requirements, extreme risk protection orders, and permits for gun dealers. They found that states that required handgun permits, waiting periods, and/or concealed carry licenses had lower firearm suicide rates, and states with all 3 laws had 25% lower rates than states with none.
Compared to these legislative interventions, individual clinicians have less to offer. The U.S. Preventive Services Task Force found insufficient evidence that screening adults for suicide risk prevents suicides, and it isn't certain that counseling gun owners about safe storage practices (using trigger locks, gun safes, storing ammunition separately) makes a difference, either.
As for gun homicides, public health interventions aimed at resolving conflicts without resorting to violence have shown positive results in Baltimore, Maryland, where gun violence is treated as a contagious disease and "violence interrupters" work diligently to defuse small disputes before they involve firearms. Critically, preventing violence also involves recognizing and addressing its structural causes:
Baltimore’s first comprehensive violence prevention plan takes public safety beyond police, prosecution, and prison by working closely with community groups to focus on prevention and support for those most affected by the violence. ... Community organizations, some partially funded by the Mayor’s Office, connect people to education and life coaching. They help get documents like IDs, birth certificates, and Social Security cards, and they help expunge criminal records, making it easier to get jobs. They pay energy bills and fill gas tanks; they offer emergency relocation, financial stipends, transitional employment support, drug treatment—even helping people to reconnect with their families.
