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Gun Control Issues, Public Health, and Safety

Gunshot wounds impact severely on the criminal justice as well as health care systems. Some basic statistics are important in understanding the magnitude and severity of the social and economic burden to the U.S. The subject remains contentious. (Glantz and Annas, 2009) In 2016 worldwide there were an estimated that 251 000 deaths from firearm injuries, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% of those deaths. 64% of those firearm injury deaths were homicides, while 27% were firearm suicide deaths, and 9% were unintentional firearm deaths. (Naghavi et al, 2018)

Though the U.S. has about 4.5% of the world's population, The U.S. accounts for 45% of all civilian-owned guns worldwide (Wintemute, 2015). In the U.S. in 2018 almost 40,000 persons died from a firearm-related injury, and of these, 61% were suicides and 35% homicides. Males were almost 6 times more likely to die from a firearms injury (CDC, 2021). For comparison, representative statistics from various countries are shown in the table (https://ourworldindata.org/grapher/homicide-rates-from-firearms):
Homicides by firearm per 100,000 population, in 2020
Honduras27.57
Mexico19.88
Colombia16.67
El Salvador14.28
Costa Rica 7.95
Uruguay 6.19
Ecuador 4.57
Dominican Republic 4.47
United States 4.11
Canada 0.73
Sweden 0.48
Bosnia 0.37
Netherlands 0.16
Switzerland 0.10
Australia 0.08

In 2020 the majority of homicides (79%) and suicides (53%) in the United States involved a firearm, and from 2019 to 2020, the overall firearm homicide rate increased from 4.6 to 6.1 per 100,000 persons (34.6%). (Kegler et al, 2022)

Firearms injuries account for a significant number of hospital visits. From 2010-2012 in the U.S., over 67,000 persons per year (21.6/100,000) received emergency medical treatment for a firearm-related injury, and over half of these required hospitalization. (Fowler et al, 2015) In one study the mean charges per person were $5254 U.S. for emergency department patients and $95,887 for inpatients, resulting in the annual financial burden estimated at $2.8 billion. (Iacobucci G, 2017) The rate of nonfatal firearms injuries has declined over the past 2 decades in the U.S. (Kalesan et al, 2013) Between 2010 and 2012, the combined lifetime medical and work loss costs were estimated at $48 billion. (Fowler et al, 2015)

Child safety is an important issue. Firearm-related deaths are the third leading cause of death overall among U.S. children 1 to 17 years of age, surpassing the number of deaths from congenital diseases, heart disease, respiratory infections, and cerebrovascular diseases. Nearly 1300 children die and nearly 5800 are treated for gunshot wounds each year. The highest rates for pediatric homicide are in southern states. Of all firearm deaths in children up to 14 years of age living in high-income countries, 91% occur in the U.S. Childhood suicide risks involve acute crises and life stressors including relationship, school, and crime problems. (Fowler et al, 2017) A study of cases of school shootings and attempted school shootings from 1980 to 2019 showed that the rate of deaths was 2.83 times greater in schools with an armed guard present. (Peterson et al, 2021)

Accidental child shooting deaths are most commonly associated with one or more children playing with a gun they found in the home. (Choi, et al, 1994) The person pulling the trigger is a friend, family member, or the victim. (Harruff, 1992) In the period from 1979 to 2000, accidental firearms deaths involving children declined in the U.S., aided by child access prevention laws and felony prosecution of offenders. (Hepburn et al, 2006)

Approximately 7% of US children live in homes in which at least one firearm is stored loaded and unlocked. (Azrael et al, 2018). Another study showed that two-thirds of accidental firearms injuries occurred in the home, and one-third involved children under 15. 45% were self-inflicted, and 16% occurred when children were playing with guns. (Morrow and Hudson, 1986) A study from 1991-2000 showed that twice as many people died from unintentional firearm injuries in states in the U.S. where firearm owners were more likely to store their firearms loaded. (Miller, et al, 2005)




There is a positive correlation between firearm fatality rates and number of guns in developed nations. (Bangalore and Messerli, 2013) The number of firearms in the hands of private citizens in the U.S. far exceeds that of other countries. Thus, the laws of the U.S. Federal government as well as the states do not as yet severely restrict the manufacture, sale, and use of firearms by ordinary citizens. "Gun control" is a sensitive issue that evokes strong emotions in persons both for and against control. Politicians find it difficult to deal with this issue. There is disagreement as to whether a reduction in access to or numbers of firearms will have a measurable effect upon crime. The Brady Handgun Violence Prevention Act passed in 1994 in the U.S. established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales (but the law does not apply to secondary markets). Laws related to strenthening background checks and permit-to-purchase firearms appear to have decreased firearm homicide rates. (Lee et al, 2017) Attitudes and tolerances may be reflected in the high visibility of firearms and firearms-inflicted injuries that are portrayed in the media. (Price et al, 1992) One thing remains certain, despite laws for or against gun control, a lack of care and concern regarding one's fellow human beings, whether in war or through domestic violence, will continue to promote firearms injuries.

The issue of "home defense" or protection against intruders or assailants may well be misrepresented. A study of 626 shootings in or around a residence in three U.S. cities revealed that, for every time a gun in the home was used in a self-defense or legally justifiable shooting, there were four unintentional shootings, seven criminal assaults or homicides, and 11 attempted or completed suicides (Kellermann et al, 1998). Between 2001 and 2016, the crude national firearm suicide mortality rate increased from 6.8 to 8.0 per 100,000, and household firearm ownership rate remained relatively stable, at around 40%. (Martínez-Alés et al, 2021) In another study, regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and suicide in the home (Dahlberg, Ikeda and Kresnow, 2004). Persons who own a gun and who engage in abuse of intimate partners such as a spouse are more likely to use a gun to threaten their intimate partner. (Rothman et al, 2005). Individuals in possession of a gun at the time of an assault are 4.46 times more likely to be shot in the assault than persons not in possession (Branas et al, 2009). It would appear that, rather than being used for defense, most of these weapons inflict injuries on the owners and their families.

Hunting accidents with firearms, despite the large gun ownership in the U.S. and numerous game seasons in most states, remain relatively rare and do not appear to be increasing. (Huiras, et al, 1990) In a study of accidental hunting firearm injuries and fatalities from 1961 to 1992 in Germany, there were 257 cases, most involving experienced hunters. 26% of the gunshot wounds were fatal. 23% of cases were self-inflicted and 77% injuries caused by another person. The firearms/ammunition included shotguns (63%) and shotgun slugs (3.5%), rifle bullets (31%), and handgun butllets (2.5%). 22% of pellet accidents produced severe eyeball injuries. 38% of the wounds occurred at a distance of 5 m or less, including all self-inflicted injuries. The most frequent factors responsible for the accident were: improper handling of the firearm (37%), failure to notice the victim (24.1%), covering the victim while swinging on the game (14.8%), ricocheting projectiles (13.6%), inadequate storage of the firearm (11.7%) and mistaking the victim for game (9.3%). (Karger et al, 1996)


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