Gun violence is a fraught topic in our country, with much of the debate framed by ideology, fear and rigidity. But following a string of tragedies, culminating with the recent shooting deaths of 26 people (including 20 children) in Newtown, Conn., national debate has been transformed. A public health framework — the pragmatic, data-based approach that has tackled challenges ranging from influenza to obesity, from polio to heart attacks, from smoking to traffic safety — offers a fresh point of view, important insights, and evidence-based guidelines for action.
What is the magnitude of the problem? Over 30,000 Americans each year — close to 600 each week — lose their lives to guns. The firearm homicide rate in the U.S. is 20 times higher than in other wealthy nations. In 2011, the last year for which statewide data are available, Washington listed 619 firearm deaths, including 492 suicides, 92 homicides, and 9 classified as “accidental.” (Firearms accounted for 50 percent of all suicides and 51 percent of all homicides.) For comparison, motor vehicle traffic crashes accounted for 497 deaths in the state that year, drowning 123, and poisoning (including drug-related deaths) 1,075. In King County, more than 125 people lose their lives to firearms each year, and hundreds more are injured. The burden — in dollars and in human suffering — is enormous.
The impact of gun violence disproportionately impacts communities already struggling with poverty and poor health. In King County, the firearm homicide rate among blacks is seven times higher than among whites. Homicides by firearms are more likely among residents of south and central Seattle (including Beacon/Georgetown/South Park, Southeast Seattle, Delridge and central Seattle) and South King County.
What do we know about firearm risks? A great deal of research data indicates that a gun in the home increases the risk that someone in that home will die of a firearm injury. Much of this data comes from studies conducted, in part, in Seattle. An early 1980s study found that for each case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides and 37 suicides involving firearms. Handguns were used in 70.5% of these deaths. Studies comparing Seattle to Vancouver, B.C., which has very different gun control laws, found that despite similar overall rates of criminal activity and assault, the risk of death from homicide was 63 percent higher in Seattle than in Vancouver. Virtually all of this excess risk was explained by a 4.8-fold higher risk of being murdered with a handgun in Seattle as compared with Vancouver. Similarly, people 15 to 24 years old had a 38 percent higher suicide rate in King County than in the Vancouver area and virtually all the difference was due to an almost 10-fold higher rate of suicide by handguns in King County. Homes that contain guns are associated with a 2.7-fold greater risk of homicide and a 4.8-fold increased risk of suicide.
Does mental illness play a role? When random acts of mass violence such as the Newtown shooting occur, the public perception is often that mental illness must have caused the violence. This perception, sometimes perpetuated by news reports, risks increasing the stigma of mental illness and could keep people from seeking needed treatment. In fact, people with mental illness are much more likely to be the victims of violence, and much more likely to die of suicide by firearms, than to kill someone else using a firearm. The focus on mental illness also ignores potentially larger risk factors that contribute to violence, such as substance abuse, poverty, having a history of abuse and victimization, and social isolation. Early identification of mental illness and broader access to services are an important part of any comprehensive plan to reduce the risk of gun violence, but they are not sufficient.
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