12/04/2015

Understanding The Epidemic Of Gun Violence

12:10 minutes

In December 2015, a mass shooting in San Bernardino, California left 14 people dead, making it one of the deadliest in modern American history. In fact, there have been more mass shootings than there have been days in 2015 so far. Of course, gun violence in the United States isn’t restricted to mass shootings—firearm homicides and suicides far outpace the number of mass-shooting fatalities. Taken together, an estimated 32,000 people die as a result of gun violence in the United States annually, and an additional 180,000 to 190,000 people are injured, says Sandro Galea. He’s the dean of Boston University’s School of Public Health and one of a number of researchers calling for firearm deaths to be treated as a public health issue. Another is Garen Wintemute, of the UC Davis School of Medicine, who has done extensive research on the effects of access to guns. Wintemute and Galea join Ira to discuss why they see gun violence as a public health issue and what research must be done and steps taken to address the problem.

[What we do (and mostly don’t) know about guns.]


Interview Highlights

On why the Centers for Disease Control and Prevention has conducted little research on the effects of gun violence in the past.
Garen Wintemute: To put it very simply, they don’t have any money. 20 years ago, Congress took from CDC the funds that they were spending for research on firearm violence. They gave them that money allocated for another purpose and wrote some language into CDC’s budget that has been interpreted as a ban on CDC conducting or funding research. As a point of fact, there simply is no money for research from CDC. It’s not that they’re banned from doing it.

Sandro Galea: There [has been] 20 years of effort to actively discourage—if not legally prohibit—CDC from studying gun violence. In the past couple of years [since 2015], the Obama administration has reversed that. But at the same time there has also been no extra money given to CDC to do this. So you have a disease which we understand there’s a pathogen for, but we have very little data on because our premiere public health organization has been hamstrung for decades. So we know far less about what we can do to curb gun violence than we would if we had the same number of 32,000 people dying from an infectious agent, for example.

[Boosting vaccination rates, one conversation at a time.]

On how gun violence increases psychological and long-term effects on health.
Garen Wintemute: Some research has been done, including on mass shootings. And perhaps not surprisingly, we learned that long-term emotional scars, if you will, or psychological scars are common. They’re more common with increasing intensity of exposure to the violence. Relatively little work has been done on this, because as we’ve just discussed, there’s been no support for it. But to the extent that we do know, the evidence suggests that firearm violence is different even from other forms of violence. So for example, the Bureau of Justice Statistics last year published a major report on the long-term social and psychological sequelae of violence. And if that violence involved a firearm, the odds that there would be such long-term effects more than doubled. That was an effect that was far greater than if some other weapon were involved. There is something unique about firearm violence.

On how researchers view gun-related incidents and injuries as an epidemic.
Sandro Galea: There are about 30,000 people who die from firearms a year, but there are about 180,000 who are injured. So although there’s no direct evidence about this, we can extrapolate from other data… and we can guess that about 30 percent of people who are injured, they have been shot, will go on to have long-term emotional sequelae. So that’s another 60,000 people a year who go on to have long term mental illness, psychological distress.

Then you have the family members of those who died. And probably 10 to 20 percent of them will also go on to have long-term emotional sequelae. So very, very quickly, you have hundreds and hundreds of thousands of people who are affected by this epidemic. And there is no other way of characterizing this than it is an epidemic and it is a preventable epidemic.

[How one hospital is coping with a national IV bag shortage.]

On the high firearm mortality rates.
Garen Wintemute: We have repeatedly, consciously, and deliberately turned our back on this epidemic, the result being that these days, there’s a neck and neck race between firearms and motor vehicles to see which will kill more people each year. You are absolutely right that we hear these same numbers year after year. Firearm mortality rates have not budged since the year 2000. It’s because we’re not doing anything about the problem.

This interview has been edited for space and clarity.


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Segment Guests

Sandro Galea

Sandro Galea is the Dean of the School of Public Health and a professor of epidemiology at Boston University in Boston, Massachusetts.

Garen Wintemute

Garen Wintemute is the Susan P. Baker and Stephen P. Teret Chair in Violence Prevention, a professor of  emergency medicine, and the Director of the Violence Prevention Research Program at the UC Davis School of Medicine in Sacramento, California.

Segment Transcript

IRA FLATOW: This is Science Friday. I’m Ira Flatow. We are all still trying to come to grips with the killings in San Bernardino, California. 14 people were killed, making it the sixth most deadly mass shooting in the United States since 1949. And with less than a month left in 2015, some sources which define a mass shooting as “four or more victims killed or injured” estimate that there have been more of those kinds of shootings than days in this year. But gun violence isn’t just limited to mass shootings grabbing headlines. Every day, firearm homicides and suicides vastly outpace mass murder. And taken altogether, some researchers see guns, which have claimed more lives in America than AIDS, illegal drug overdoses, wars, and terrorism combined between 2001 and 2013– these researchers see it as a threat to public health.

So if you wanted to curb shootings in this country, why not treat gun deaths as a public health issue the same way you would treat deaths that kill tens of thousands of people struck down by disease? One of the obstacles to treating gun deaths as a disease is that the Centers for Disease Control and Prevention is hamstrung from collecting data about gun deaths as it would collect data about disease deaths. Well why? Joining me to discuss the question is Sandro Galea. He’s the Dean of Boston University School of Public Health, and he joins us today from Zambia by phone– welcome.

SANDRO GALEA: Thank you for having me.

IRA FLATOW: Also joining me is Garen Wintemute. He’s a Professor of Emergency Medicine and Director of the Violence Prevention Research Program at the UC Davis School of Medicine in Sacramento, California. Welcome to the program.

GAREN WINTEMUTE: Thank you for having me.

IRA FLATOW: Garen, why have the CDC’s hands been tied when it comes to funding research that looks at the effects of gun violence?

GAREN WINTEMUTE: To put it very simply, they don’t have any money. 20 years ago, Congress took from CDC the funds that they were spending for research on firearm violence. They gave them that money allocated for another purpose and wrote some language into CDC’s budget that has been interpreted as a ban on CDC conducting or funding research. As a point of fact, there simply is no money for research from CDC. It’s not that they’re banned from doing it.

IRA FLATOW: Is there any effort to try to get that money back in there to study it that way?

GAREN WINTEMUTE: Yes, the Obama administration, since 2013 has been pushing for such funding to be available. Congress has refused to provide it. An interesting side story. Congressman Jay Dickey, who led the successful effort to strip CDC of its research funding back in the mid 1990s, has since recanted. And recently, including today, he has been in public saying that was a mistake and saying that CDC should be allowed to conduct and fund research. Other federal agencies do– the National Institutes of Health for the first time in its history is funding research specifically on firearm violence. The National Institute of Justice has been doing it pretty much all along.

IRA FLATOW: Sandro, if we’re talking about a disease that kills tens of thousands of people each year in the US, do you think the CDC would investigate it, if it could?

SANDRO GALEA: Well, I think the CDC would and should. And I suspect that many in the CDC want to. I think Dr. Wintemute is entirely correct. There is 20 years of effort to actively discourage– if not legally prohibit– CDC from studying gun violence. In the past couple of years, the Obama administration has reversed that. But at the same time there has also been no extra money given to CDC to do this. So you have a disease which we understand there’s a pathogen for, but we have very little data on because our premiere public health organization has been hamstrung for decades. So we know far less about what we can do to curb gun violence than we would if we had the same number of 32,000 people dying from an infectious agent, for example.

IRA FLATOW: Is there any centralized database of people who have been affected by gun violence?

SANDRO GALEA: There is no registry of people who have been affected by gun violence. There are individual research efforts. We have done some. Dr. Wintemute has done even more. But there is no registry of victims of gun violence in the same way as there is, for example, a registry of survivors of 9/11 or registries of survivors of any number of large scale events that has taken a lot of life in this country.

IRA FLATOW: Dr. Wintemute, do we know how people react after being affected by gun violence? Is it seeing it, being part of a family, or being injured themselves?

GAREN WINTEMUTE: Some research has been done, including on mass shootings. And perhaps not surprisingly, we learned that long-term emotional scars, if you will, or psychological scars are common. They’re are more common with increasing intensity of exposure to the violence. Relatively little work has been done on this, because as we’ve just discussed, there’s been no support for it.

But to the extent that we do know, the evidence suggests that firearm violence is different even from other forms of violence. So for example, the Bureau of Justice Statistics last year published a major report on the long-term social and psychological sequelae of violence. And if that violence involved a firearm, the odds that there would be such long-term effects more than doubled. That was an effect that was far greater than if some other weapon were involved. There is something unique about firearm violence.

SANDRO GALEA: Let me just add to that for a second, Ira. We tend to forget in our public discussions that there are about 30,000 people who die from firearms a year. But there are about 180,000 who are injured. So although there’s no direct evidence about this, we can extrapolate from other data, like the one Dr. Wintemute just mentioned.

And we can guess that about 30% of people who are injured, they have been shot, will go on to have long-term emotional sequelae. So that’s another 60,000 people a year who go on to have long term mental illness, psychological distress. And that, of course, is not counting their family members or the family members of the loved ones who died unexpectedly, which is in and of itself a traumatic event. So you have– I’m sorry, go ahead.

IRA FLATOW: No, go ahead. I’ll let you finish. It’s important.

SANDRO GALEA: So if you were to really tally the consequences, we all talk and the media has been very good in the past few weeks of pointing out 32,000 people dying a year. Now you have 180,000 people who are actually injured. From those, let’s say 60,000, 70,000 go on to have post-traumatic stress disorder or depression.

Then you have the family members of those who died. And probably 10% to 20% of them will also go on to have long-term emotional sequelae. So very, very quickly, you have hundreds and hundreds of thousands of people who are affected by this epidemic. And there is no other way of characterizing this than it is an epidemic and it is a preventable epidemic.

IRA FLATOW: And that number is repeated every year.

SANDRO GALEA: That number is every year. So in terms of the long-term psychological sequelae, let’s say post-traumatic stress disorder, we know that once you have chronic post-traumatic stress, it lasts for years and years. So if you take my conservative estimate of 60,000 people, then you’re building on that year after year.

IRA FLATOW: And we have no apparatus for following these people, because involved in a shooting is not considered to be a disease, like you following people who had the measles and following them up.

[INTERPOSING VOICES]

IRA FLATOW: Go ahead, please jump in.

GAREN WINTEMUTE: If I could generalize, we have no apparatus for following these people for the same reasons that we have very little research on firearm violence generally. And an instructive contrast is to motor vehicle injuries, where faced with an epidemic 50 years ago, we did what America does best. We mobilized.

We put smart people on the case. We gave them funding to do research. Policymakers were interested in translating the results of that research into policy, with the end result today being that the motor vehicle related death rate is more than 50% lower than it was back then. We would be dealing with maybe 150,000 motor vehicle related deaths a year, rather than the much smaller number we have today.

We have repeatedly, consciously, and deliberately turned our back on this epidemic, the result being that these days, there’s a neck and neck race between firearms and motor vehicles to see which will kill more people each year. You are absolutely right that we hear these same numbers year after year. Firearm mortality rates have not budged since the year 2000. It’s because we’re not doing anything about the problem.

SANDRO GALEA: Let me add to what Dr. Wintemute just said. What is remarkable about the motor vehicle example is while the number of motor vehicle deaths has gone down about five-fold, the number of vehicle miles driven in this country has gone up about five-fold. So essentially, we have succeeded over the past 50 years in lowering what you might expect as a motor vehicle fatality by about a 25-fold factor.

And that is, as Dr. Wintemute correctly said, a testament to the fact that we set our minds to it, that we started collecting data. And we started implementing policies to try to see what works and doing so nationally. The fact is, on the issue of firearms, we are not trying. We are not really doing very much at all. We have a patchwork of laws in different states, and some of that is being evaluated.

Of course, we know that state borders are porous and that guns cross state lines. So we have neither data nor a concerted national effort to deal with it, which would work. We know it works, because motor vehicles are but one of many examples where we have shown we can do it and we can save lives if we set our mind to it.

IRA FLATOW: I’ve got about a minute to go. Is there any possibility that something will happen?

GAREN WINTEMUTE: Yes. Yes. I think the tide is shifting. People understand– primarily because of mass shootings, which are affecting our entire society, not just the people who were shot or witnessed– realizing we all have a stake in this. We all need to make a commitment. At a minimum, I think that will shake loose funding for more research.

IRA FLATOW: All right. We’ll follow this. We’ve run out of time. Sandro Galea is Dean of Boston University’s School of Public Health. Garen Wintemute is a professor of emergency medicine, director of the Violence Prevention Research Program, UC Davis School of Medicine.

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