Age
Male
Female
15–34
1.0
0.5
0.0
35–54 55–74 75 +
Firearm Death Rates in the U.S. by Gender and Age, 1990–2015
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SEPTEMBER/OCTOBER 2019
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DISCOVER 35
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packaging. Accidental baby aspirin poisonings of
children younger than 5 dropped by an astonishing
70 percent three years after the change.
The public health approach can even save lives by
analyzing data and identifying injury reductions that
come about by happenstance. For instance, before
England and Wales shifted utilities from domestic
coal gas to natural gas in the 1960s and ’70s — an
economic decision that by chance eliminated deadly
carbon monoxide — inhaling oven fumes was the
method of choice for 41 percent of all suicides in 1963.
After the switch, it became nearly impossible. The
overall suicide rate in the two countries dropped by
30 percent and never rebounded. Preventing suicide
was an unintended consequence, revealed after the
fact through public health data, but it showed what
can happen when individuals contemplating the act
lose an easy-access method.
Something similar may be possible when it comes
to reducing gun violence.
For instance, public health researchers agree that
suicide is typically an impulsive act, often aborted
before completion — and that the majority of people
who survive an initial suicide attempt never make a
second try. As shown in England and Wales, when
an immediately accessible, highly effective means of
suicide is no longer available, the overall suicide rate
may drop.
In the U.S., the limited data available suggests that
only about 13 percent of all suicide attempts succeed.
However, up to nearly 90 percent of attempts using
firearms result in death.
The link between gun availability and suicide has
already been studied in other countries. In the early
2000s, Swiss army reforms halved the number of
soldiers, which also reduced the number of firearms
kept in homes. Before the reduction, the suicide rate
among 18- to 43-year-old men had already been
falling. But researchers observed the rate dip sharply
immediately after the reform, and then continue its
gradual downward trend.
Around the same time, a similar phenomenon
happened in Israel, which began requiring soldiers
and so can the broader community. A neighborhood
or city where gun violence is epidemic may also see
lower property values, reduced tourism and less com-
munity engagement, says David Hemenway, director
of the Harvard Injury Control Research Center. For
the most part, we don’t know the details — because
they haven’t been studied.
A MATTER OF PUBLIC HEALTH
The key to tackling firearm violence, Hemenway and
peers say, is taking a science-driven public health
approach. The method, as laid out by the CDC, is
straightforward: define problems, identify risk and
protective factors, develop and test prevention strate-
gies, and assure their widespread adoption.
Hemenway explains the public health model in
simpler terms: “Make it really hard to get sick and
injured, and really easy to get healthy.”
There’s already a long history of using the tools
of public health research to reduce injury, perhaps
most dramatically with car safety. Since the 1950s,
the per-mile fatality rate in the U.S. has fallen by 80
percent. The reduction is rooted in myriad sources,
such as increased seat belt use, stricter penalties for
drunken driving and new regulations for licensing.
But robust data collection, overseen by the National
Highway Traffic Safety Administration, is particularly
important. NHTSA tracks everything from vehicular
accidents involving fatalities to recalls and crash test
results, all down to the smallest detail. Researchers
analyze this data to discover common patterns, while
lawmakers use it to measure the effect of legislation.
Graduated driver licensing — a multistage process
for young drivers to become fully licensed — is a clas-
sic example. Researchers discovered that 16-year-olds
had 10 times the risk of getting into a crash as older
drivers; those accidents happened most often at night
and while driving unsupervised with other teens. So
states implemented a simple solution: Initially restrict
newly licensed, young drivers from driving at night
or alone with their peers. By 1997, all 50 states had
implemented some form of graduated licensing,
and results were often dramatic. In Michigan, for
example, the crash risk for 16-year-old drivers fell
almost 30 percent.
Such an impressive reduction in deaths thanks
to the public health approach is not an outlier. For
example, in the mid-1960s, more than 11,000 young
children were poisoned by baby aspirin each year.
Doctors, researchers and drug manufacturers took
a multidisciplinary, public health approach, address-
ing drug flavoring and marketing, parent education,
and dosing. The effort culminated in the Poison
Prevention Packaging Act of 1970, when the U.S.
mandated the medicine be sold in child-resistant
Over a 15-year period,
across four age groups,
females were at
significantly lower risk
of firearm-related death
than males in the U.S.
Source: “Geospatial, racial, and educational variation in firearm mortality in the
USA, Mexico, Brazil, and Colombia, 1990–2015,” The Lancet Public Health, 2019
Steps to a
Science-driven
Public Health
Approach
- Define problems
- Identify risk
and protective
factors
- Develop and
test prevention
strategies
- Roll out
strategies and
assure their
widespread
adoption