It’s a leading cause of death, especially among Black Americans, and there is a higher likelihood of death if a member of your household is also affected.
You might think this is another column about Covid-19. But this is about a different public health crisis: gun violence.
The epidemiology of violence, much like the epidemiology of Covid-19, can be documented, predicted — and therefore is preventable.
“Let science lead” has become a mantra promoted often in the context of the pandemic, most notably to try to counter irresponsible language and actions from former President Donald Trump and senior members of his administration. It has applied especially to unproven and often harmful treatments such as hydroxychloroquine.
That mantra should be extended to the issue of gun violence as well. With two mass shootings in less than seven days, America finds itself debating gun control and firearm-related violence without doing what we have done in the case of the pandemic: rigorously scrutinizing the data and allowing science to inform policy.
The epidemiology of gun violence, much like the epidemiology of Covid-19, can be documented and predicted — and therefore is preventable.
So, what does the science tell us? Here are three findings (although there are many others) to consider when it comes to gun violence in the U.S.:
- Keeping a gun in the home is associated with an increased risk of homicide. A landmark study in 1993 looked at over 1,800 homicides. When controlling for other variables, owning a gun and keeping it inside the home almost tripled the risk of death, especially by another member of the household or an intimate partner. The notion that guns can confer protection (an oft-cited reason for advocating for less stringent regulations) was countered in this study, which showed that the risks outweighed the benefits. In a different circumstance such as in medicine, a physician, hospital or government agency would never allow for a treatment that could increase the risk of death by this magnitude to be given to a patient — in any situation.
- Mental health is absolutely a factor in gun violence and is often cited in many situations including the recent mass shootings. But epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in death by suicide. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. One study looked at the populations in two Florida counties, where researchers found that 62 percent of violent gun crime arrests and 28 percent of gun suicides involved individuals not legally permitted to have a gun at the time, illustrating that guns might be easier to access outside of legal channels.
- The same study supports the use of universal or comprehensive background checks (an oft-prescribed policy suggestion, particularly by Democrats) but only in conjunction with permit-to-purchase laws — in other words, they need to be done together. This is likely because the application process required to obtain a permit puts the purchaser directly in contact with law enforcement, which can then hold potential purchasers more accountable and reduce the likelihood of purchases being made on behalf of prohibited persons. The added time to conduct the background check at the local level may also make it easier to identify and screen out prohibited individuals who may be at increased risk of using that firearm to commit a homicide. Additionally, the built-in waiting period as part of the permit application process may prevent impulsive firearms purchases.
The research findings above are just a snapshot pulled from decades of work. But the research has had major roadblocks. Imagine if we halted the Centers for Disease and Control and Prevention data collection or research around Covid-19? That is essentially what happened in 1996 after the Dickey Amendment (led by Rep. Jay Dickey, R-Ark.) was inserted in a federal spending bill and virtually halted federal funding of gun violence/firearm-related epidemiology.
Imagine if a concerted effort to concentrate research, solutions and information could happen at even a fraction of the pace and energy that we put toward Covid-19.
Rays of hope did emerge when a 2018 federal spending bill clarified the Dickey Amendment and allowed CDC funding of prevention research (but kept the amendment in place), resulting in $25 million in federal funding in 2020. But that’s a drop in the bucket: Likely closer to $1.4 billion is needed to begin to curb the epidemic of gun violence in the United States.
There is broad consensus regarding gun control policies among Americans (both gun owners and non-owners alike) around background checks as well as areas for bipartisan support, with growing support for assault-weapon bans, particularly among those who do not own guns. While gun violence knows no boundaries, neighborhoods where poverty is most concentrated bear the largest brunt of gun homicide, crime and associated trauma. Black children and teens are four times more likely than white children and teens of the same age to be killed or wounded with a gun. Especially in light of the two most recent deadly mass shootings, in Georgia and Colorado, solutions and debate are coming fast and furious. And as difficult as it would be, there are ways that firearm advocates and gun violence prevention champions can safely coexist. Imagine if a concerted effort to concentrate research, solutions and information could happen at even a fraction of the pace and energy that we put toward Covid-19. We need to understand more about the patterns of gun violence so we can find an effective approach to prevent it. We need to let the science lead. And to do that, we need the resources to lead the science itself.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
