Gun Violence: A Case for Supporting Research Stacey Pierce-Talsma DO, MS MEdL, FNAOME Health Policy Fellowship 2014-2015

INTRODUCTION HEALTH CARE COSTS ASSOCIATED WITH GUN VIOLENCE INTENDED CONSEQUENCES & SUPPORTING STAKEHOLDERS CONCLUSION American taxpayers pay half a billion a year for gunshot-related Intended consequences of the bill Gun violence continues to be a public safety issue affecting the lives and health of First introduced by Rep. Kelly (D-IL-2) in 2013-2014 (113th Congress) as emergency department visits and hospital admissions according to the Collect data to improve gun safety and decrease gun violence and identify the population as well as directly contributing to health care costs, yet current HR 2456, the Bill “To require the Surgeon General of the Public Health Urban Institute. factors that may be addressed through federal or local initiatives to decrease data about gun violence is lacking. Service to submit to Congress an annual report on the effects of gun the impact of gun violence on society and to improve public safety. 2010 statistics demonstrated hospital costs totaled $669.2 million11 violence on public health” expired at the end of the Congressional 36,341 emergency room visits12 We can look to the example of research and Motor Vehicle Accident (MVA) data session. HR 224 was re-introduced in the 114th Congress (2015-2016) The American College of Physicians 25,024 hospitalizations due to firearm assault injuries12 which led to the implementation of injury prevention initiatives and a subsequent and was referred to the Committee on Energy and Commerce.2 Recommends counselling on guns in the home, universal background Greater than 43% of gunshot victims are males ages 15-2412 decrease in MVA deaths. checks, bans on guns invisible to metal detectors, tracers on guns and • Usually low income HR 224 “Requires the Surgeon General of the Public Health Service to ammunition, and ban of assault and semiautomatic weapons.3 A public health approach is needed that utilizes a scientific approach. “Science • Disproportionately uninsured report annually to Congress on the effects of gun violence on public health defines a problem, conducts research to identify risk and protective factors, and Costs of gun violence include and the status of actions taken to address those effects.”2 The Institute of Medicine use the knowledge about risk and protective factors to develop prevention • Medical 2013 report identified 5 key areas of gun research: the characteristics of gun interventions.”25 • Criminal Justice The intent of the bill is to increase access to data on gun violence and violence, risk and protective factors, prevention, gun safety technology, and identify its causative factors so that federal or local initiatives can be • Government and private costs influence of video games.18 MVA data didn’t lead to the decrease in car sales or use, rather it made them and • Estimated at $6-12 billion per year, could be as high as $80 Billion10 formulated and implemented to decrease the impact of gun violence on their use safer. In order to begin to reduce the impact of gun violence, we need society and improve public safety. The National Institute of Health LEGISLATIVE HISTORY the appropriate data that could be made available by the adoption of HR 224. After the 2013 Presidential memorandum, requested funds for the CDC’s National Violent Death Reporting System (NVDRS) in all 50 states.19 Prior to 1996, the U.S. Centers for Disease Control and Prevention (CDC)

collected data on gun violence (started collecting data in early 1990’s). Various Health Professionals Many medical associations drafted a letter to Congress (7/10/13) urging the 1996 Omnibus Consolidated Appropriations Bill Senate Appropriations Committee to fund gun violence research.20 Backed by the National Rifle Association (NRA) the bill explicitly forbade the agency from research that could be used to “advocate or promote gun The American Academy of Pediatrics 13 control.” $2.6 million dollars were cut from the CDC’s budget, “precisely 2012 policy statement calling for gun safety recommendations, Child Access 3 GUN VIOLENCE BACKGROUND the amount spent on firearm-related research the year before.” In 2012, Prevention (CAP) Laws, and opposing section 2717 in the ACA which only $100,000 of the CDC’s $5.6 billion dollar budget was devoted to gun prevents the collection and housing of information on firearms in the home.21 violence. This has lead to a severe decline in the amount of gun violence Currently there are few federal efforts to identify causative and contributing REFERENCES factors which could provide information on which to base public safety and firearms-related study.13 Law Enforcement Agencies 1. Picture- http://thehill.com/regulation/243425-house-bill-would-require-gun-owners-to-carry-insurance initiatives. The Institute of Justice (among other law enforcement agencies) depends on 2. Congress.gov https://www.congress.gov/bill/114th-congress/house- 2003 Tiahrt Amendments funds to support data collection. bill/224?q=%7B%22search%22%3A%5B%22report+effects+gun+violence%22%5D%7D&resultIndex=2 3. Bernstein, L. Gun violence as a public health issue. April 21, 2014. The Washington Post. Gun violence continues to be a public safety issue due to homicide, •Prevents the use of electronic databases 4. Cornell, D. Gun violence and mass shootings- myths, facts and solutions. 6/11/14. The Washington Post assault, suicide, and mass shootings. The American College of •Restricts the use of trace data Gun Control Organizations 5. Violence Policy Center. Gun deaths outpace motor vehicle deaths in 14 states and the District of Columbia in Many organizations support gun control legislation. 2011. October 23, 2014. Physicians states, “There are about 11,000 homicides, 19,000 suicides •Mandates information on gun purchasers be destroyed within 24 hours 6. Waters, R. Gun violence: how research on an American health crisis has been suppressed. Forbes and more than 2,000 fatal accidents involving guns every year . . . and an •Impact: “prevent(s) academics and policymakers from advancing our 12/17/2012. 3 8 Amnesty International 7. National Institute of Justice. www.nij.gov “preventing gun violence”, “who is most affected by gun violence,” average of 88 gun deaths per day.” According to the Congressional understanding of the criminal gun market.” “gun violence.” Research Service, 78 mass violence incidents have killed 547 people Issued a 2014 letter to President Obama asking for reinstatement of CDC 8. Bureau of Justice Statistics. www.bjs.gov. “Firearm violence 1993-2011”. Planty, Truman. May 7, 2013. between 1982 and 2013. 2012 Consolidated Appropriations Act and NIH research on firearms and requesting removal of ACA legislation 9. Blair, J., Schweit, K. A study of active shooter incidents in the United States between 2000 and 2013. Texas 22 State University and Federal Bureau of Investigation, U.S. Dept. of Justice. Washington D.C. 2014. Prohibited HHS from activities that would be seen as advocating or limiting collection of data on gun violence. 10. Koper, C. Updated assessment of the federal assault weapons ban: impacts on gun markets and gun violence, Gun violence is much higher in the United States than in other promoting gun control. After a study on gun violence was funded by the 1994-2003. Report to the National Institute of Justice, United States Department of Justice. June 2004. UNINTENDED CONSEQUENCES & OPPOSING STAKEHOLDERS 11. Smith, A. Gun violence costs taxpayers $500 Million. CNN Money. September 2, 2014. democratic nations including Australia, Canada, France, Germany, India, National Institute on Alcohol Abuse and Alcoholism, “Congress extended 12. Howell, E., Abraham, P. The hospital costs of firearm assaults. Urban Institute. September 2013. Italy, Japan, South Korea, Spain, Sweden and the United Kingdom.4 13. Access denied: how the gun lobby is depriving police, policy makers, and the public of the data we need to the restrictive language it had previously applied to the CDC to all Health Opponents of HR 224 are concerned the bill would lead to information that prevent gun violence. A Report by Mayors Against Illegal Guns. January 2013. Other gun violence facts and Human Services agencies, including the National Institutes of would restrict or violate freedom granted by the Second Amendment of 14. Kellermann, A., Rivara, F. Silencing the science on gun research. JAMA. Feb 13, 2013 Vol 309, No.6. Health.”14 15. Now is the time: the president’s plan to protect our children and our communities by reducing gun violence. •More than 298,000 people were killed by gunshots between 2000-2009 6 the U.S. Constitution: The Right to Bear Arms. WH.GOV/Now-is-the-time. January 6, 2013. • Almost 30,000 people per year6 16. Frankel., T. Why the CDC still isn’t researching gun violence, despite the ban being lifted to years ago. The 2013 Presidential Executive Order Washington Post. January 14, 2015. • Second leading cause of death (excluding natural causes), Gun Manufacturers 17. Picture http://www.naplespremiumcollisioncenter.com/car-safety-features/ 6 Following the mass shooting at Sandy Hook Elementary in Newtown, CT, Gun and ammunition sales are a large business with annual estimated 18. IOM and NRC (National Research Council). 2013. Priorities for research to reduce the threat of firearm-related automobiles being first violence. Washington, DC: The National Academies Press. 5 President Obama created a plan to address gun violence including re- 23 • 2011 gun deaths exceeded MVA deaths in 14 states and in DC revenues of $6 billion. There are approximately 209,750 jobs related to the 19. Beckett, L. Republicans say no to CDC gun violence research. PROPUBLICA. April 2014. 15 •467,321 victims of a crime committed with a firearm in 20117 instating gun violence research. firearm industry and there was a 30% increase in employment between 2008 20. Letter to Senate Appropriations Committee. 7/10/13 http://www.aap.org/en-us/advocacy- 23 andpolicy/federaladvocacy/Documents/MedicalGroupsCDCgunviolencepreventionresearchfunding_July2013.p •Firearms used in and 2011. Research may lead to gun limitations affecting business and df • 68% of murders7 As of 2015, the CDC still avoids gun-violence research due to limited jobs. 21. American Academy of Pediatrics Gun Violence Recommendations http://www.aap.org/en-us/advocacy-and- 16 policy/federal-advocacy/Documents/AAPGunViolencePreventionPolicyRecommendations_Jan2013.pdf 7 resources and funding. Congress has continued to block funding The National Rifle Association and Other Gun Advocacy Groups • 41% of robberies 22. Amnesty International. Open Letter to the President. April 4, 2014 http://blog.amnestyusa.org/wp- 16 21% of aggravated assaults7 despite introduction of several bills to support it. Opposing groups cite that previous limitations placed on guns did not content/uploads/2014/06/AIUSA-Board-Letter-to-Obama-Gun-Violence-040414.pdf • 10 23. Sanburn, J. America’s gun economy, by the numbers. TIME Magazine. December 18, 2012. 3 demonstrate a strong benefit. Gun advocacy groups have a strong •Firearms contribute to approximately 81,300 nonfatal injuries every year 24. Center for Responsive Politics. Gun rights: lobbying, 2014. lobbying presence spending $9,287,720 in 2014. (In 2008 gun advocacy •119,079 children and teens died from gun violence between 1979-2010.9 www.opensecrets.org/industries./lobbying.php?cycle=2014&ind=Q13 groups spent $3.9 million lobbying vs $115,000 spent by opponents).24 25. American Psychological Association. Resolution on firearm violence research and prevention. ND. http://www.apa.org/about/policy/firearms.aspx