The Public Health Approach to Prevent Gun Violence

Why is Gun Violence a Public Health Epidemic?

Gun violence is a public health epidemic that affects the well-being and public safety of all Americans. In 2021, nearly 49,000 Americans were killed by gun violence, more than the number of Americans killed in car crashes.⁴ An additional 76,000 Americans suffer nonfatal firearm injuries, and millions of Americans face the trauma of losing a loved one or living in fear of being shot.⁵ The impacts of gun violence, both direct and indirect, inflict an enormous burden on American society. When a child is shot and killed, they lose decades of potential: the potential to grow up, have a family, contribute to society, and pursue their passions in life. When compared to other communicable and infectious diseases, gun violence often poses a larger burden on society in terms of potential years of life lost. In 2020, firearm deaths accounted for 1,131,105 years of potential life lost before the age of 65—more than diabetes, stroke, and liver disease combined.⁶ 

Scope of Gun Violence 

Americans are impacted by various forms of gun violence – including suicide, homicide, and unintentional deaths, as well as nonfatal gunshot injuries, threats, and exposure to gun violence in communities and society.  

Firearm Suicide: 

• Each year, nearly 25,000 Americans die by firearm suicide.⁷ 

• Half of all suicide deaths are by firearm.⁸  

• Suicide attempts by firearm are almost always deadly — 9 out of 10 firearm suicide attempts result in death.⁹ 

• Access to a firearm in the home increases the odds of suicide more than three-fold.¹⁰ 

Firearm Homicide:  

• Each year 18,000 Americans die by firearm homicide.¹¹ 

• Eight out of ten (79%) of homicides are committed with a firearm.¹² 

• Access to firearms — such as the presence of a gun in the home — doubles the risk for homicide victimization.^_13,14  

• The firearm homicide rate in the United States is 25.2 times higher than other industrialized countries.¹⁵  

Domestic Violence:  

• More than half of female intimate partner homicides are committed with a gun.¹⁶ 

• There are about 4.5 million women in America who have been threatened with a gun and nearly 1 million women who have been shot or shot at by an intimate partner.¹⁷ 

• A woman is five times more likely to be murdered when her abuser has access to a gun.¹⁸  

Police-Involved Shootings: 

• 1,000 Americans are shot and killed by police every year.¹⁹ 

• Black Americans are disproportionately impacted by police-involved shootings and are killed at more than twice the rate as White Americans.²⁰ 

• An estimated 800 of people are wounded by police shootings each year.²¹ 

Unintentional Shootings: 

• Each year, more than 520 people die from unintentional firearm injuries — an average of one death every 17 hours.²² 

• More than 140 children and teens (0-19) die each year due to unintentional gun injuries.²³ 

• Americans are four times more likely to die from an unintentional gun injury than people living in other high-income countries.²⁴ 

Mass Shootings:  

• Each year, there are an estimated 600 mass shootings with four or more people shot and/or killed in a single event — more than 500 people are killed and 2,000 are injured.²⁵ 

• From 2019 to 2021, there were an average of 27 incidents annually where four or more people were killed at a single event  —in total more than 130 people were killed.²⁶  

• From 2013 to 2022, the number of mass shootings (shootings where four or more people were shot and/or killed) have doubled; so too has the number of people killed and injured from the shootings.²⁷ 

• States with more permissive gun laws and greater gun ownership had higher rates of mass shootings.²⁸ 

Nonfatal Firearm Injuries: 

• For every person in the United States who dies by firearm, two people are treated at  hospitals for nonfatal gunshot wounds.²⁹ 

• Each year there are over 76,000 nonfatal gunshot injuries, costing hospitals an estimated $2.8 billion annually.^30,31 

• Gun assaults and unintentional injuries make up the vast majority of nonfatal gun injuries; gun suicide attempts accounted for aproximetaly 5% of nonfatal gun injuries.³² 

Exposure to Gun Violence: 

• More than half of all adults in the U.S. report that they, or a family member have been involved in a gun violence-related incident.³³ 

• One in five adults say they have had a family member killed by a gun.  

• One in five adults report being personally threated or intimated with a gun.³⁴ 

• One-third of US adults report that fear of a mass shooting has prevented them from attending certain places or events.³⁵

Health Impact Pyramid

The goal of public health is to maximize the overall health and well-being of populations. Public health practitioners do this by developing a wide-range of interventions. These interventions address risk and protective factors ranging from factors at the individual level to the societal level. The public health pyramid helps researchers conceptualize the many different levels of intervention needed to address a public health problem like gun violence.⁴³

At the top of the pyramid are narrowly tailored interventions that work with individuals at risk for gun violence. These interventions, like lethal means safety counseling and violence intervention programs, can have tremendous impact in reducing gun violence. Yet, they also require individual action. These programs provide the tools and support to change behavior, but the individuals themselves must be willing to take action and change behavior.

The middle of the pyramid includes interventions that require less individual action. They are often laws and policies that change the environments within communities to mitigate risk factors. One such policy is universal background checks and firearm purchaser licensing. Research shows that when individuals are required to undergo a background check and obtain a license to purchase a firearm, far fewer firearms are diverted into illegal markets and used to perpetrate violence.

At the bottom of the public health pyramid are the conditions within society that lead to poor health outcomes like gun violence. These factors are often referred to as the root causes or social determinants of health. Socioeconomic factors, such as racial disparities, inequality, poverty, inadequate housing and education, are all risk factors for interpersonal gun violence. Policies that address these root causes have enormous potential to reduce gun violence and improve health. These policies, while requiring a broad collective effort to achieve, require minimal individual effort to be effective at reducing gun violence.

How Do We Address Gun Violence Through the Public Health Approach?

The public health approach is multifaceted and comprehensive and brings together institutions and experts across disciplines in a common effort to develop a variety of evidence-based interventions.⁴⁵ This comprehensive approach to tackling public health crises in America has been used over the last century to eradicate diseases like polio, reduce smoking deaths, and make cars safer. This public health approach has saved millions of lives. We can learn from the public health successes -- like car safety -- and apply these lessons to preventing gun violence.  

Applying the public health successes of car safety to prevent gun violence 

One of the greatest American public health successes is our nation’s work to make cars safer.

By using a comprehensive public health approach to car safety, the United States reduced per-mile driving deaths by nearly 80% from 1967 to 2017.⁴⁶ This public health approach to car safety prevented more than 3.5 million deaths over these fifty years.⁴⁷ In the years since 2017 car crashes have begun to increase. This recent increase illustrates how threats to public health constantly evolve, and the work of public health practitioners is never complete. They must continue to monitor the problem, identify emerging risks, and develop new solutions. While the work in U.S. auto safety is far from complete, the comparisons illustrates the steps needed to address the epidemic of gun violence. To reduce gun violence, we should apply this same time-tested public health approach.

Applying the Public Health Successes of Auto Safety to Gun Violence Prevention 

Recommendations

Apply the public health approach for effective gun violence prevention. 

Public health is the science of reducing and preventing injury, disease, and death and promoting the health and well-being of populations through the use of data, research, and effective policies and practices. The public health approach has been successfully applied to tackle a wide variety of complex health problems at the population level. Gun violence is a public health epidemic that requires a public health solution. We recommend the following: 

Better Data Collection

Federal, state, and local governments should collect more comprehensive gun violence data for fatal and non-fatal firearm injuries, shootings that may not involve physical injuries, and firearm-involved crimes where no shots were fired, including domestic violence-related threats. Federal, state, and local governments should make data publicly available where possible and particularly to researchers studying gun violence and its prevention. 

Research Funding

Enhanced research funding is key for advancing knowledge and improving public health interventions and outcomes. Federal, state, and local governments, in addition to foundations and universities, should dedicate funding to research gun violence prevention.

Evidence-based Policies and Practices

Gun violence is a muliticated problem that takes many forms and requires a multitude of data-driven solutions. Gun violence prevention policies and practices should be evidence-based. 

• Firearm Purchaser Licensing or permit-to-purchase laws require all prospective gun purchasers to obtain license prior to buying a gun from a dealer or a private seller. These laws enhance universal background checks by establishing a licensing application process as well as considering additional components such as fingerpinting, a more through vetting process, and a built-in waiting period to prevent individuals with a history of violence, those at risk for future interpersonal violence or suicide, and gun traffickers from obtaining firearms.
• Extreme Risk Protection Order (ERPO) is a civil process allowing law enforcement, family members, and, in some states, medical professionals and other parties to petition a court to temporarily restrict access to guns from individuals determined to be at elevated risk of harming themselves or others. ERPO laws are associated with lower rates of firearm suicide and have been successfully used in mass shooting threats.⁴⁸
• Community Violence Intervention (CVI) programs aim to identify and support the small number of people at risk for violence by providing them with wraparound mental health and social supports. Investing in CVI programs provides a public health approach to gun violence prevention, interrupting cycles of violence, and addressing the unique needs of the community where systemic racism, disinvestment, and trauma occur.
• Safe and secure gun storage practices, such as Child Access Prevention (CAP) laws, require households with a child or teen to keep firearms unloaded and locked when unattended. These practices promote responsible firearm storage practices protecting children and teenagers from various forms of gun violence, including unintentional shootings and gun suicides. CAP laws are linked to sizable reductions in child and teen gun deaths, including reductions in youth suicide, accidental shootings, and homicides.^49,50
• Public carry of firearms poses a serious threat to safety. Permissive public carry and “stand your ground” laws increase violence by allowing people with violent histories to carry their firearms in public, providing more opportunities for armed intimidation and shootings in response to hostile interactions, and increasing criminals’ access to guns. States should regulate the carrying of guns in public by prohibiting open carry of firearms particularly in sensitive places, passing strong concealed carry permitting laws, and repealing “stand your ground” laws.  

Implementation and Evaluation

It is essential to pass evidence-based policies that address gun violence, but that is not enough. Gun violence takes many forms and impacts a variety of groups, requiring ongoing surveillance and evaluation to ensure effective implementation of policies and practices. Federal, state, and local governments should dedicate resources to ensure proper implementation, education and ongoing evaluation of gun violence prevention policies.