The Need to Replace ‘Ideology, Intuition and Common Sense’ with a Science-Based Public Health Approach to Gun Violence: A Conversation

On an average day in the United States, 320 people are shot with a firearm, and approximately 90 people die from a gunshot wound. Meanwhile, funding for gun research at the nation’s leading public health institute has been “going in the wrong direction,” David Hemenway, PhD—one of the nation’s most influential injury researchers—stated during a PHI Dialogue4Health web forum last month.

“Since I graduated from college [in 1968], there have been more civilians killed by guns in the United States than soldiers have been killed on the battlefield in all of the wars in American history by any means,” said Hemenway, Director of the Harvard Injury Control Research Center and the Harvard Youth Violence Prevention Center, adding that this is a uniquely American problem among high-income countries. When compared to our peers, the rate of gun homicides among children ages 5-14 in the U.S. is 18 times higher than the rate in other high-income nations.

Yet we know incredibly little about such a sweeping public health problem, primarily due to a lack of funding for research.

In 1996, after the Centers for Disease Control and Prevention (CDC) had published studies implying that possession of a gun in the home dramatically increased the risk of murder and suicide, anti-gun-control groups began attacking the agency and its research. They pushed sympathetic lawmakers in Congress to threaten to strip all CDC funding for injury research and to stipulate that, in general, no CDC funding could go toward research that could be used to advocate for gun control. While this was not an explicit ban, it effectively prohibited support for firearm-related research, and the de facto ban has continued and been reinforced by Congress in recent years.

Three other experts joined Hemenway in identifying the need for more research to support a public health approach to gun violence on PHI’s web forum panel, Gun Violence Research and Data Collection: Getting the Facts Straight, moderated by Linda Degutis, DrPH, who from 2010 to 2014 was director of the CDC’s National Center for Injury Prevention and Control—the agency whose funding for gun violence research was stripped by Congress 19 years ago.

Why a Science-Based Public Health Approach

We must address gun violence for what it is: a leading cause of premature death in this country, Susan Polan, PhD, Associate Executive Director of Public Affairs and Advocacy at the American Public Health Association (APHA), told the web forum last month. In light of this, a public health response to gun violence is appropriate.

“Gun violence is preventable, but we know we need to move upstream,” said Polan. “As with all good public health approaches, we need to find the root causes to fully understand the issue.”

Data is crucial in this process, to validate that there is a problem, identify any root causes, and to evaluate the effectiveness of any interventions.

The problem, according to Alan Leshner, PhD, CEO Emeritus of the American Association for the Advancement of Science, is that not only does the U.S. lack a public health strategy for dealing with gun-related violence, but it also has no database from which to develop one.

“All effective public health strategies are typically science-based. Those that we make up in the shower—those that are based on people’s ideology, intuition or common sense—rarely are effective,” Leshner stated. “[The fact] that we don’t have a science base is heavily responsible for keeping us with this problem.”

What’s Missing

What do we need to know more about related to gun violence? Everything, according to Hemenway, who listed off a seemingly endless litany of missing data sources on issues like gun storage, gun training, gun use in self-defense, straw purchasers, assault weapons, guns and alcohol, and the list went on.

Key among the missing data sources are:

• The National Violent Death Reporting System – which lacks a representative sample of data from across the U.S. because several states don’t report.
• The Behavioral Risk Factor Surveillance System – which lacks a current accounting of what percentage of households contain firearms and how guns are stored, by state.
• Trace data from the Bureau of Alcohol, Tobacco, Firearms and Explosives – which means researchers have no way of knowing where guns come from. The data exists, but due to Congressional action, it’s difficult if not impossible for researchers to get the data.
• Private surveys – because even privately funded researchers are unwilling to add questions to surveys related to guns or gun violence, fearing that someone will complain and their funding will be cut off as a result.

While securing funding for research in virtually all fields is difficult in general, the amount of funding for gun violence research is particularly restricted, said Hemenway.

The tragic December 2012 mass shooting at Sandy Hook Elementary School in Connecticut was seen by many as a landmark moment that would reopen public discourse on policies related to gun violence in the U.S. and that would result in meaningful changes, including changes in opening up funding for research. In the weeks that followed, President Obama enacted a series of executive orders related to gun violence, and directed the CDC to resume support of research to identify the causes of gun violence.

During this time, Leshner was appointed chair of a committee with the Institute of Medicine and National Research Council tasked with establishing a public health research agenda on dealing with gun violence. The committee identified key areas in which virtually no data exists and recommended what research questions needed to be answered to move a public health approach forward.

These included the need to:

• Characterize the scope of and motivations for gun acquisition, ownership and use characteristics of gun violence
• Characterize the differences in fatal and nonfatal gun use
• Improve understanding of what constitutes risk for gun violence at the society level, the community level, the situational level, and the individual level
• Evaluate the potential health risks and benefits of having a firearm in the home (e.g. suicide rates, personal protection)
• Improve understanding of the effectiveness of violence prevention interventions, including for instance, actions aimed at restricting gun access for violence-prone individuals and criminals, or programs to alter physical environments in high-crime areas
• Examine different gun safety technological approaches to reducing firearm-related injury and death, along with past consumer experiences with accepting other safety technologies

The committee produced a report with its extensive recommendations, and briefed “all the right people” – Senate and House staff, White House staff, leadership at the CDC – with no obvious backlash or objections to the recommendations. What happened after that? Fundamentally nothing.

“We posed all the right questions, said Leshner, “but sadly, there has been no real funding response.”

Barriers to Overcome

Despite the elevation of the problem of gun violence in the media and public discourse (often prompted by mass shooting instances) and increased attention on the dearth of research on firearms, political barriers continue to stand in the way of funding.

Leshner said nothing has been produced by the CDC since it was instructed to resume support for gun research. The agency did ask in the President’s last two budget requests for Congressional approval of $10 million to study gun violence—a paltry amount—but no funding was approved by Congress. Two Members of Congress also introduced a bill supporting funding for the CDC to do gun research. Again, the Republican-controlled House of Representatives voted it down.

These political barriers to federal funding seem to also extend and have an effect on private foundations and nonprofits, as Hemenway pointed out when discussing the difficulty of getting questions related to guns on private surveys. There is less than a handful of “brave” foundations, he said, that are quietly providing some funding, but many other foundations could do so and are not.

“I think they are afraid they have a board member who might be a member of the National Rifle Association who would say, ‘We don’t want this controversy,’” he said.

The bottom line, Leshner said, is that we know without question that we need a public health strategy to tackle gun violence, and we know that we currently don’t have adequate science upon which to base that strategy, to ensure that it is founded on more than just intuition or a particular belief system.

“We know what research needs to be done, but nobody seems to want to make the investment necessary to approach this set of problems.”

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