Firearm-Related Injuries and Deaths

November 3, 2009
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Les Fisher

The U.S. is the most highly armed country in the world. There are 90 guns for every 100 citizens, according to 2007 figures from the Small Arms Survey; in the rest of the world, the rate is ten firearms for every 100 citizens. The U.S. rate of lethal violence is correspondingly higher than other developing countries. A study of crime in the 1990s by the Centers for Disease Control and Prevention (CDC) put the U.S. firearm homicide rate for children at sixteen times that of other developed countries. Moreover, gun-related suicides are the leading cause of gun-related deaths.

Firearm injuries, by virtue of the number of deaths, years of life lost, and cost to society, represent an important and persistent public health problem. Although the total fluctuates from year to year, firearms consistently rank second only to motor vehicle crashes as a cause of fatal injury in the U.S. More than 95 percent of fatal firearm injuries are the result of self-directed or interpersonal violence. The available data demonstrate that firearm injuries continue to be a major cause of mortality in the U.S., producing approximately 30,000 deaths per year. In 2002, more than half of these deaths were suicides, a fact that has been neglected by much of the public health community and largely outside the scope of criminal justice efforts to decrease firearm misuse. Gun injuries have a very high case-fatality ratio, especially self-inflicted gunshot wounds. And there’s a greater chance that a gun injury in the home will harm another family member — not an outside intruder.

The long-term consequences of firearm injury can be substantial. In one study of hospitalized gunshot victims, health status six to twelve months after injury was significantly worse than before the event. In addition to physical disabilities, more than one third of individuals studied reported symptoms of posttraumatic stress disorder.

Another measure of the magnitude of the gun problem and its importance for society are the costs of gun violence, which include not only the costs stemming from gunshot injuries but also the costs of all the efforts to deter shootings or protect against them. For example, it is estimated that the costs of gun violence in the U.S. are approximately $116 billion per year (in 2004 dollars). These costs increase our individual health insurance rates nationwide — what does this mean?

Banning all guns is not suitable nor realistic among public health prevention workers who seek not to blame but rather to prevent, reduce, and ameliorate substantial health risks. Public health prevention strategies (before the injury) that do seem to work to reduce gun-related “accidents,” homicides, and suicides, include hospital and community-based programs (like CeaseFire in Chicago) that work to stop victims from shooting others — the most common form of street gun violence. Effective strategies for reducing gun violence also include using tested school curricula. These strategies would eventually prove economically wise.

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Les Fisher, MPH, is a safety leadership consultant in Delmar, NY. His national public health injury prevention publications are found at among other places.

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