In a Nutshell:
- Firearms have surpassed motor vehicles as the leading cause of death among youth
- Public health principles have reduced motor vehicle fatalities for decades, and continue to offer ways to make our roadways safer
- Public health offers lessons on the variety of policies that can reduce and prevent gun violence
Punctuated by one shocking and tragic report after another, violence involving firearms has become a seemingly common occurrence in the United States – a continual cadence of carnage that plagues our communities. From Oxford (MI) down to Uvalde (TX), the issue of gun violence (particularly among youth) is ubiquitous, pervasive, and, according to current data, growing.
Mortality data show a 13.5 percent increase in firearm-related deaths from 2019 to 2020. This increase was driven primarily by a 33.4 percent increase in firearm homicides. The crude rate of firearm suicides increased by 1.1 percent during the same period.
Among children and adolescents, firearm-related deaths increased by almost 30 percent (more than double the 13.5 percent increase in the general population). As a result, firearm-related deaths surpassed motor vehicle fatalities, becoming the leading cause of death among young Americans.
Leading Causes of Death among Children and Adolescents in the United States, 1999-2020
Drug overdoses and poisoning also increased, becoming the third most common cause of death among children and adolescents. Certainly, these shifts in mortality are in part associated with the growing youth mental health epidemic. Although policies to advance mental health in Michigan–including those in the recently-passed federal gun safety legislation–are important and long overdue, gun violence is a multifaceted problem that warrants a multidimensional policy response based upon public health principles of risk factor identification, injury prevention, and harm reduction.
As policymakers weigh options to address gun violence, transportation policy may prove to be a valuable source of inspiration.
Public Health and Motor Vehicle Fatalities
The story of firearm-related injury becoming the leading cause of death among American youth is also a story of substantial reduction in motor vehicle fatalities. While tens of thousands are killed (and millions injured) each year by motor vehicle crashes, the rate of motor vehicle fatalities was dramatically reduced in the 20th century by a variety of policy interventions. In fact, improvements in motor vehicle safety are commonly regarded as one of the greatest public health achievements of the 20th century.
Public health works to identify risk (and protective) factors that affect the incidence of disease or injury in a given population or geographic area. By targeting underlying causes of disease and injury, public health works to prevent (or reduce) harm and promote individual and community well-being. Public health researchers and practitioners also work with communities and stakeholders to develop, implement, and evaluate policies and programs to promote and protect health.
The public health approach to transportation safety works in multiple domains: the built environment (e.g., roadway design and lighting), vehicle safety features (e.g., seat belts, airbags, etc.), human behavior (e.g., drivers’ training and licensure and traffic laws), and external factors and attitudes (e.g., impaired or distracted driving).
These domains necessarily have a high degree of interdependence. For instance, campaigns against drunk driving have worked for decades to change societal attitudes and behaviors. Similarly, speed limits and seat belts are only effective if there is driver adherence to traffic laws. When Michigan began working in the early 1980s to implement a fine levied against those who failed to “buckle up,” opponents claimed seat belts were harmful and called them tyrannical threats to personal liberty (rhetoric that will be familiar to anyone who followed public health guidance on face masks during the COVID-19 pandemic). According to the Detroit Free Press, former Michigan Rep. David Hollister, who introduced the bill to require seat belt usage, was likened to Hitler. And yet, opposition gradually waned and changing the law has ultimately saved many thousands of lives.
Seat belt usage is now commonplace – a substantial change from the roughly 14 percent rate of seat belt usage in the early 1980s.
It’s worth noting that, despite public health improvements in traffic safety, many experts argue U.S. traffic laws and road safety efforts don’t go far enough. Some have even argued that “zero traffic deaths” is a reasonable and achievable public health goal. Indeed, the U.S. has lagged other wealthy nations in reducing traffic deaths and injuries in recent decades. Perhaps this global outlier status is yet another way traffic and gun deaths are related in the context of U.S. policy.
A Public Health Approach to Gun Violence Prevention
I’m not the first to suggest a connection between the public health approaches to motor vehicle safety and firearms policy. Indeed, there has been a longstanding and growing movement to treat gun violence as a public health problem (rather than a criminal justice or political issue).
The growing issue of gun violence (and its disproportionate impact on our youth) will not go away without purposeful and targeted public policy efforts and changes. Fortunately for lawmakers, there are not only adjacent issues (like traffic safety) to study, but also numerous international models for firearm policies. There are also domestic centers for firearm injury prevention research at the University of Michigan, Johns Hopkins University, and throughout the nation.
Just as a public health approach to transportation safety requires a multitude of interconnected policies, so too will any efforts to reduce firearm deaths and injuries. Policymakers must consider different circumstances of injury and death (i.e., suicide, assault, accidental death, mass shooting), as well as different aspects of safety and risk (i.e., safety features and firearm modifications, as well as individual behaviors and societal attitudes).
Our societal approach to driving begins with driver’s education and licensure. Evidence suggests that firearm purchaser licensing laws (that may include enhanced background checks, waiting periods, and completion of firearms safety training) reduce homicide and suicide deaths. The cluster of policies surrounding a licensure approach help ensure proper safety training for gun owners and screening procedures that improve the integrity of gun sales.
Firearm purchaser licensing laws might be seen as building off of existing laws in many states governing the concealed carry of firearms. Research suggests that stronger laws governing the public carrying of firearms, whether concealed or open carry, enhance public safety.
Ideally, enhanced firearm safety training will increase individual adherence to safe and secure gun storage practices. While safe and secure storage of firearms is a simple, commonsense way to prevent unauthorized users from accessing guns, more than half of gun owners do not practice safe and secure storage. Better firearms storage–which states can encourage through combinations of education campaigns, laws, and incentives–could reduce adolescent suicide, accidental deaths, and firearm theft and diversion into illegal markets.
Another evidence-based solution to reduce gun-related mortality involves firearm removal policies–namely, the domestic violence protection order (DVPO) and the subsequently-modeled extreme risk protection order (ERPO). The latter is sometimes also known as a “red flag” law. In the simplest terms, an ERPO is a civil order with due process protections issued by a court to temporarily restrict access to firearms when a person is deemed at risk of harming themselves or others. Recently-passed federal legislation–the Bipartisan Safer Communities Act–increases funding opportunities for states to implement ERPOs.
While individual-level laws are essential, a public health approach also works at the community level to identify risk factors and antecedents to gun violence. Policies should directly target community violence interventions that are mindful of factors like trauma and systemic racism. Reducing the overall prevalence of violent crime would also, by extension, likely reduce the prevalence of gun violence. For policymakers, this means investing in place–particularly in high-poverty disinvested neighborhoods–and implementing policies to reduce poverty and inequality.
With increased attention and investment, there is no shortage of viable policy solutions to reduce firearm-related injury and death among our youth—and indeed people of all ages. What remains in short supply are policymakers at all levels of government who are willing to take action on the numerous evidence-based policies to reduce gun deaths.
Despite passage of the federal Bipartisan Safer Communities Act, far more work remains to be done. It isn’t hyperbolic to say that lives depend on it.