gun violence causes essay

15 Root Causes of Gun Violence

According to Amnesty International, more than 1 billion firearms are in global circulation. Most of those guns belong to private individuals while the rest belong to the military and law enforcement agencies. Gun violence is a serious issue in many places. In the United States, guns recently outpaced car accidents as the leading cause of death for children. What drives gun violence? In this article, we’ll explore 15 of the root causes.

You may also like: Reducing Gun Violence in America: Evidence for Change (Online Course)

#1. Poverty

Poverty is a root cause of so many serious issues in society. Gun violence is just one example. According to data from the Center for Economic and Policy Research, the United States experienced an increase in firearm homicides between 2019 and 2020. Upon closer examination, the counties with the highest poverty levels saw a higher increase in firearm homicides compared to countries with the lowest poverty levels. The link between gun violence and poverty remains strong even after controlling for race, ethnicity, sex, age, and other factors.

#2. Income inequality

Income inequality is the gap between individuals’ or households’ income. The wider the gap, the more issues emerge. Gentrification, which is when wealthier people move into a lower-income area and displace current residents, is just one expression of income inequality. It can increase the risk of gun violence. According to one study, gentrified neighborhoods have a 62% higher firearm injury rate than non-gentrified neighborhoods. The reasons why are complex, but could include the social disruption that comes with gentrification. People experience higher levels of stress and fear as their neighborhoods undergo change and costs go up.

#3. Poor education

When people receive a poor-quality education, they’re more likely to face limited job opportunities, poverty, poor health and other serious, long-term issues. Education and poverty go hand in hand; poverty makes it hard to get a good education, whereas a good education can help people leave poverty. Because of its strong links to economic instability, poor-quality education also contributes to an environment where gun violence is more likely.

#4. Housing instability

Housing is a human right, but when people can’t access safe, affordable housing, the risk of gun violence increases. According to a Kansas City Star article about the city, experts named housing issues , like blight, evictions and homelessness, as one of the factors driving up gun violence. Without stable, safe housing, people experience high levels of stress and are more likely to arm themselves. People also struggle with more mental health issues, which can increase their risk for suicide.

Interested in housing justice? Read our article here .

#5. Lack of good employment

Unemployment (or underemployment) plays a big role in poverty and income inequality. When people are stressed financially, they may turn to risky, illegal activities that involve firearms. According to a study examining unemployment and crime during the COVID-19 pandemic, researchers found that “economically motivated” crimes can involve violence. They also wrote that employment can act as a buffer because it generates income, helps people form stronger bonds and reduces how much time people have to engage in crime. Another study found that the increase in unemployment during the first months of the pandemic was associated with an increase in firearm homicide and violence in 16 American cities .

#6. Lack of affordable healthcare

In places without Universal Health Coverage, the cost of healthcare is a serious concern for many people. It not only forces them to delay or avoid care entirely, but it can lead to bankruptcy. According to a 2019 article, medical issues are a key factor for ⅔ of those who file for bankruptcy in the United States. Because of the COVID-19 pandemic, the World Health Organization estimates that about 20 years of global progress toward Universal Health Coverage was lost. When people don’t have affordable healthcare, they’re more likely to slip into poverty, struggle with poor mental health, turn to substances or deal with other risk factors for gun violence.

Want to learn more about healthcare? Check out our article on health equity .

#7. Gun availability

One of the root causes of gun violence is very simple: the availability of guns increases the risk of violence. According to the Harvard Injury Control Research Center, a review of the literature found that gun availability is a risk factor for homicide in high-income countries like the United States. This makes sense; when something is easily available, it’s more likely to be used. Accidental shootings become more likely, as well. While it’s difficult to collect precise data, children in the US are at a higher risk of unintentional gun injury and death compared to other high-income countries.

#8. Weak gun control laws

The United States has the highest rate of death by firearms, and weak control laws are part of the reason why. The Center for American Progress examined some of the states with the weakest laws and what sort of gun violence they experience. Mississippi, which has the country’s weakest gun laws, also has the country’s highest firearm death rate . In 2020, the state also had the highest rate of crime gun exports. Nationwide, weak gun laws increase the risk of mass shootings. A 2019 study found that states with weak gun laws and higher gun ownership have higher rates of mass shootings .

#9. Gun trafficking

Gun trafficking is the illegal movement of guns. It’s a major issue in the United States. According to American Progress, trafficked guns often appear at crime scenes. From 2010 to 2020, the amount of out-of-state guns involved in violent crimes went up around 10% in New York. In Haiti, trafficked guns and ammunition are a big part of the increase in gang violence , which has contributed to murders, kidnappings and displacements. According to data, homicides and kidnappings doubled in 2022.

#10. Exposure to violence

Violence has a cyclical effect. When people are exposed to violence, they’re more likely to experience – and even perpetuate – more violence in the future. According to research, a study examining 500 Black American youth revealed that direct exposure to violence predicted whether an individual engaged in gun-related crimes at a later time. In another study, ⅓ of survey respondents who had been exposed to gun violence said they were now considering buying a gun. Only 1% already owned guns, which shows how exposure to violence can influence people to purchase firearms and possibly endanger themselves, family and friends.

#11. Poor mental health

Mental health is often scapegoated as the sole cause of gun violence, but the reality is most people with mental illnesses are never violent. According to the National Alliance on Mental Illness, mental illness only contributes to about 4% of all violence , not just gun violence. However, the risk for gun violence does increase when people have a history of physical and sexual abuse, or trauma, which can also cause mental illness. Mental illness may not be a significant factor for violence against others, but it is a predictor of suicide. According to a Stanford study, owning a handgun was associated with a “dramatically elevated” risk of suicide. Guns tend to be very effective as a method of death. Using a gun for a suicide attempt results in death nearly 85% of the time.

#12. Drug involvement

Drug involvement and guns have a close association. Many people who are involved with drugs in some way (use and/or sales) also have access to guns, which increases the risk for violence. In one study on opioid use, researchers found that those dependent on opioids were more likely to carry guns, commit gun violence or be victims of gun violence than those dependent on alcohol. The reasons vary but often have to do with feelings of safety. Those who use drugs struggle with fear and stress, so owning a gun can seem like a protective measure.

#13. Alcohol abuse

Drug use comes up a lot in discussions about gun violence, but alcohol is a serious factor, as well. According to research from the Center for Gun Violence Solutions, around ⅓ of gun homicide perpetrators had drunk heavily before the murder, while 30% of gun homicide victims had been drinking. Heavy drinking is also a factor in around ¼ of gun suicides. Research suggests that “acute and chronic” alcohol consumption can reduce a person’s inhibitions, trigger violent impulses and make them less likely to assess threats properly. Alcohol and guns are a dangerous combination, and while the solution isn’t to ban alcohol, it does need to be examined as a factor in gun violence.

#14. Violent misogyny

In the United States, more men than women die from gun violence, but women and girls are often targeted. According to research, around 53 women are shot and killed by an intimate partner every month. If an abusive partner has access to guns, they’re five times more likely to kill their female victim. Violent misogyny is also closely linked to mass shootings. One study found that around ⅓ of mass shooters from 2014-2017 were suspected of domestic violence.

#15. Distrust of law enforcement

Policing in the United States has deep roots in violent racism extending into the present day, which fuels distrust of police within the communities they’re supposed to be serving. According to a report by the Giffords Law Center to Prevent Gun Violence, a lack of trust between law enforcement and communities drives gun violence across the United States. Issues like police brutality, unsolved shootings and over-policing make people less likely to trust police and more likely to arm themselves. That distrust continues when police punish gun possession instead of gun violence. In Chicago, a 2017 investigation found that police were dropping off people in dangerous areas to coerce information about guns . This type of behavior contributes to violence.

Read more: 5 Essays about Gun Violence

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Introduction

• Why non-carceral community-based investments are key for preventing gun violence
• How state and local leaders are leveraging ARP funds to invest in non-carceral safety strategies
• Recommendations from the field: Maximizing ARP funds to promote holistic community safety

In June 2022, the most significant piece of gun violence prevention legislation in decades, the Bipartisan Safer Communities Act , became law. Alongside several common-sense gun regulations, the law allocates $250 million for community-based violence prevention initiatives—a promising step toward promoting safety through non-carceral and community-centered approaches. 1  

This federal action is important, but it only scratches the surface of what can be done to keep communities safe from gun violence. From investing in youth employment programs to revitalizing vacant lots to improving the quality of neighborhood housing, a wealth of community-based safety interventions are proven to reduce violent crime—including gun violence—in the places most impacted by it, and tackle the conditions of inequality that allow violence to concentrate in the first place. 2 But far too often, these community-based interventions are under-funded, particularly when compared to more punitive approaches. 3

Luckily, another source of federal aid can fund community-based safety investments: the American Rescue Plan’s (ARP) $350 billion in Coronavirus State and Local Fiscal Recovery Funds. In addition to helping states and localities recover from the pandemic, the funds also provide local leaders with an unparalleled opportunity to address the public health crisis of gun violence. Indeed, President Joe Biden recently called on state and local leaders to use portions of this funding to address gun violence, including by “expanding evidence-based community violence intervention programs, and preventing crime by making our neighborhoods stronger with more educational and economic opportunities.” 4    

This research brief documents how state and local leaders are leveraging ARP funds to invest in non-carceral community-based safety initiatives; presents perspectives and case studies from leaders on-the-ground innovating on such strategies; and offers recommendations for how state and local leaders can maximize ARP funds to promote community safety prior to 2024 (when all funds must be obligated) and 2026 (when all funds must be spent). This is an unparalleled—and time-limited—window of opportunity, and states and localities should be thinking strategically right now about how to not only invest in proven strategies to reduce gun violence, but also promote life-affirming safety investments that  support thriving communities. 

Why non-carceral community-based investments are key for preventing gun violence 

Despite news headlines to the contrary, the U.S. is not in the midst of a crime wave . But it is experiencing an unprecedented and alarming increase in murders, driven largely by gun homicides. 5 Between 2019 and 2020, murder rates nationwide rose nearly 30%, while other forms of crime went down. 6 Since then, homicides, gun assaults, and other forms of violent crime have continued to trend upward, and as of June 2022, the homicide rate was 39% higher than it was prior to the COVID-19 pandemic. 7 For this reason, this brief focuses primarily on the role that community-based safety investments can play in addressing gun violence but it is important to note that these investments can also have broader impacts on public safety and community well-being.  

To understand the effectiveness of community-based safety investments, it helps to look at where most gun violence occurs. 8 Within cities and towns, gun violence is spatially concentrated—disproportionately occurring within a select set of high-poverty and disinvested neighborhoods, and within these neighborhoods, a select set of streets. 9  These are also the places where indicators of structural disadvantage (such as poverty, racial segregation, lower educational attainment, and high unemployment) cluster. 10 This pattern held during the recent nationwide increase in gun violence. 11   

The spatial concentration of violence stems from generations of policies and public and private investment decisions. Numerous studies have found a connection between state-sponsored racial segregation and gun violence, with the same places historically deemed unworthy of economic investment (through redlining) being more likely to be where gun violence concentrates today. 12 Research has also identified a link between concentrated poverty, densely crowded housing, and vacant buildings with higher rates of violent crime, including gun homicides. 13   

Given the many place-based factors that contribute to gun violence, there is growing recognition that just like improving public health in other ways, reducing gun violence requires addressing its social determinants and looking outside traditional systems (such as courts or hospitals) to tackle its root causes. 14   This approach is consistent with the preferences of survivors of violent crime, who overwhelmingly prefer investments in non-punitive crime prevention over criminal legal system responses. 15 As the John Jay College of Criminal Justice recently pointed out , this approach is also consistent with an emerging and growing body of research that elevates the effectiveness of non-carceral public safety investments that put communities at the center and builds their capacity to advance safety, health, and economic opportunity. 16  

The next section of this brief examines four categories of non-carceral community safety investments that ARP funds are being used for. Before introducing examples of investments in each category, we provide further empirical justification for specific investments within that category. But while the empirical evidence matters, the underlying moral argument does as well: Mass incarceration is not a morally acceptable solution to systemic disinvestment . 17 Local leaders should support non-carceral community safety interventions not only because they are effective, but because investing in struggling communities is the right thing to do. 

Methodology   This brief pulls from public data state and local governments reported to the U.S. Treasury Department regarding ARP spending. 18 We filtered projects by “Expense Category Group- 3-Services to Disproportionately Impacted Communities,” and further filtered by “Category-3.16-Social Determinants of Health: Community Violence Interventions.” 19 These filters, which Treasury has since recategorized as “Category 1 Public Health, 1.11 Community Violence Intervention,” document instances in which state and local leaders are purposefully aiming to reduce violence by addressing social determinants. We recognize that there are many more projects that are not coded as violence interventions that can still have an outsized impact in reducing violence, such as those designed to restore vacant lots or pilot universal basic incomes. However, we believe it is important to highlight how states and localities are explicitly thinking about violence prevention through community-centered approaches.   Within the Community Violence Intervention designation, we also filtered out funding allocated to victim services. While such projects are commendable and necessary, they are responses to violence, whereas our brief is concerned with interventions that prevent violence. Additionally, this brief focuses entirely on non-carceral safety uses of ARP funds, meaning we excluded uses that expand the reach of the criminal legal system (such as increasing the size of the police force or acquiring new public safety technology). The justification behind this approach is to highlight forward-looking and life-affirming visions of community safety, rather than carceral approaches that produce negative intergenerational consequences (such as mental health ramifications, family separation, poor educational performance, and racialized class stratification). 20 Finally, we conducted qualitative interviews with 14 government and civic leaders working at the state, county, and city level. 21 In selecting interviewees, we balanced attention to government and civil society and sought to center Black voices, particularly in localities with a large Black population.

How state and local leaders are leveraging ARP funds to invest in non-carceral safety strategies 

While the most straightforward uses of the American Rescue Plan’s State and Local Fiscal Recovery Funds are to replace lost tax revenue or shore up general funds, the Treasury Department’s rules allow for a broad range of uses that “build a strong, resilient, and equitable recovery by making investments that support long-term growth and opportunity.” 22 Treasury also makes clear that community safety interventions are valid expenditure types for all communities, particularly those that have suffered an uptick in violence. 23 And as analysts at Civil Rights Corps , Alliance for Safety and Justice , the Center on Budget and Policy Priorities , and other organizations have pointed out, these flexible funds offer the largest-ever influx of federal dollars to support states and localities advance non-carceral interventions that promote a holistic vision of community safety. 24  

Below is a curated list of state and local investments in non-carceral community safety interventions, categorized along four key dimensions of community well-being. 25 While there are many more examples, our list represents a diverse set of locations with distinct approaches.  

Enhancing economic opportunity to promote safety 

A place’s economic health has a significant influence on its rates of violence; neighborhoods with higher poverty rates, unemployment, and income inequality have higher rates of violent crime. 26 On the other side of this relationship, a promising body of evidence demonstrates that by enhancing economic opportunity and reducing inequality within neighborhoods, places can significantly reduce crime. 27 For instance, evidence shows that youth workforce development and employment programs can reduce youth involvement in violent crime by as much as 45%. 28 Improving school quality has also been found to reduce violent crime arrests. 29 Finally, helping families avoid financial stress has been found to reduce crime and produce numerous other community benefits. 30   

Figure 1 illustrates how state and local governments are heeding this body of evidence and using ARP funds to advance community safety through economic mobility. For example, Illinois allocated $60 million investment toward youth employment programming, which subsidizes wages for high-risk youth and allows them to gain employability skills, participate in career development and apprenticeship programming, and receive wraparound services to address the root causes of employment barriers.  

Case study: How a small city in Virginia is using ARP funds to reduce violent crime through youth workforce development   Danville is a Black-majority (49%) city in southern Virginia with a population of approximately 42,000 . In 2016, it had the state’s highest per capita homicide rate , largely driven by gang-related violence . To tackle this, the city implemented a variety of community-centered programs to build trust in high-violence neighborhoods and prevent violence among at-risk youth. As Danville’s City Manager Ken Larking told us, “The best way to reduce crime is to prevent it and intervene before it happens.”  In 2020 (the year with the most recently reported data ), Danville saw a 50% reduction in violent crime from 2016. The city’s focus on prevention is also central to how it’s using ARP funds. Larking said that Danville is allocating funds on both “direct” violence prevention (including $236,000 on community violence initiatives) as well as “indirect” violence prevention, such as $1 million to address blight and additional grants to help residents of disinvested neighborhoods start businesses.   Of particular note is Project Imagine , a youth workforce development and violence prevention initiative that received $36,000 in ARP funding. Project Imagine provides gang-involved or at-risk youth with mentorship, apprenticeships, and employment opportunities, and enables former participants to become “ambassadors” who represent their neighborhoods in city meetings and provide input on the city’s strategic plan.  “One thing I knew coming into this city is that there was no voice from the Black community that was being heard,” Robert David, who leads Project Imagine, told us. When David was brought on in 2018, he had no staff or budget, but was able to access unused city funds from the federal Workforce Innovation and Opportunity Act to begin offering paid jobs to youth. He also turned everyday community spaces into hubs to promote workforce development. “We made the barbershop a haven,” he said, noting when one of his outreach workers isn’t there, people will ask the barber, “Where’s my man with the jobs?”  The infusion of ARP funds has helped David hire permanent outreach workers to connect with more youth, which has since significantly increased enrollment in the initiative. The funds have also enabled him to acquire a permanent building for Project Imagine, which will serve as a safe drop-in space and community center for youth. 

Investing in the built environment and public health to promote safety  

The most consistent evidence on the relationship between violence prevention and place exists in the realm of the built environment. Numerous studies find that the renovation of housing, vacant buildings, land, and lots as well as efforts to add greenery and improve air quality significantly reduce violent crime. 31 These place-based strategies aim to counter decades of public and private disinvestment by revitalizing the physical environment and improving the health and safety of entire communities, rather than focusing on a sub-set of high-risk individuals (which many violence prevention programs, such violence interrupters, tend to focus on). 32 These interventions also align with a public health approach to preventing violence, which addresses the environmental factors that increase susceptibility to violence and advances protective environments that nurture safety, health, and well-being. 33 Examples range from addressing air pollution to increasing Medicaid coverage to expanding access to substance abuse and mental health treatment. 34  

Figure 2 highlights how state and local governments are using ARP funds to advance built environment improvements in communities and bolster public health system responses to community violence. For example, Chicago allocated ARP dollars to fund public realm improvements, building restorations, the preservation of safe and affordable housing, and the reactivation of city-owned land in the 15 areas with the highest rates of homicide and nonfatal shootings. 

It is important to note that while Figure 2 includes built environment and public health interventions explicitly categorized as “community violence interventions,” there are many other examples of state and local governments investing in built environment improvements that have the potential to prevent violence and are not categorized as such. These include city beautification and a revitalized community park in Milwaukee , streetlight repair in Los Angeles , and weatherization efforts to remove lead and mold in Washington, D.C . 35  

Case study: How Multnomah County, Ore. is taking a public health approach to violence prevention Multnomah County is home to Portland, Oregon’s most populous city. During the pandemic, gun violence in the city nearly tripled . In response to this sharp uptick and an over-burdened social service system, county officials allocated over $61 million of their ARP funds to violence prevention, including $4 million in public health approaches .    “We drew a one-to-one connection between the uptick and gun violence and the pandemic,” said Adam Renon, senior policy advisor to the Multnomah County chair. “The loss of social cohesion, the isolation, the breakdown of traditional society norms. So, we said, let’s use ARP funds to address that.” The county allocated $300,000 to hire “community health specialists” who provide families directly impacted by gun violence with safety plans and trauma support. An additional $1.2 million went toward creating a behavioral health response team of clinicians and peers to serve youth and families affected by gun violence. And the county expanded existing programs, including the Habilitation, Empowerment, Accountability, Therapy (H.E.A.T.) curriculum —a cognitive behavioral therapy program meant to address generational traumas for justice-involved people.    Raffaele Timarchi, policy advisor to the county chair, explained the importance of embedding public health approaches to violence prevention across multiple county departments: “[Just because] we take a public health approach to violence prevention doesn’t mean that all of our investments have to be in a public health department…We want to spread the tools of public health into these other departments, including people working at the community level.” This approach ran through Multnomah County’s ARP safety allocations, which included significant investments to strengthen communities through emergency rental assistance, community organization incubators, and a $4.8 million investment in direct assistance to help pay for residents’ pressing financial needs, including food, child care, transportation, and living expenses 

“We drew a one-to-one connection between the uptick and gun violence and the pandemic. The loss of social cohesion, the isolation, the breakdown of traditional society norms. So, we said, let’s use ARP funds to address that.” Adam Renon, Senior Policy Advisor, Multnomah County

Nurturing social cohesion to promote safety  

A significant body of evidence demonstrates that social cohesion and feelings of belonging to a neighborhood are associated with lower violent crime rates. 36 Research has also found that increasing the number of spaces for informal contact between neighbors (e.g., parks, community centers) is linked to a greater sense of safety for people in urban areas. 37 A growing body of evidence even indicates that creative placemaking can enhance community safety. 38

The evidence linking social cohesion with reduced violence forms the basis for many evidence-based community violence intervention programs, such as Cure Violence or Advance Peace , 39 which rely on community outreach to reach individuals in neighborhoods at the highest risk for violence. 40 These violence interrupting programs have contributed to significant declines in violence in high-crime neighborhoods in Richmond, Calif., Stockton, Calif., Los Angeles, Washington, D.C., Chicago, Baltimore, and others. 41  

Figure 3 highlights how state and local governments are using ARP funds to either invest in community violence interruption programs or in activities and programs that promote social cohesion. For example, Elkhart, Ind. is using ARP dollars to host summer events with music and food, present talks by credible messengers (e.g., people who have formerly been involved with the criminal legal system and now work in violence prevention), distribute anti-gun-violence yard signs, and provide COVID-19 information. Cincinnati is funding the Save Our Youth: Kings & Queens program, in which at-risk teens participate in a three-month program involving field trips and speakers focusing on Black history.  

Case study: How St. Louis is preventing violence by investing in safe youth spaces St. Louis is a midsized city (45.7% Black) with a population of roughly 300,000 . Even with a slight decline in 2021, St. Louis continues to have one of the highest homicide rates in the nation . In recent years, there has been growing recognition among city officials that to prevent violence, they must target its root causes—starting with offering resources to those who are most at-risk for committing and be victims of violence, including youth in disinvested neighborhoods.  “We have over 50 kids that have been shot since the beginning of this year,” said Wilford Pinkney Jr., director of the Mayor’s Office of Children, Youth, and Families. “Most of our car jackings and car thefts are all juveniles…There was no one engaging with them to determine what is happening, why they engaged in that behavior, and to try to deal with addressing it early on. We need to deal with that before we get to the point that they’re car jacking and shooting people.”    As part of its ARP allocation, St. Louis devoted $5.5 million to violence interruption initiatives. One is Safer Summer St. Louis, which funds youth- and grassroots-led organizations to plan pop-up events aimed at providing safe, community-building spaces. Jessica Meyers, director for the St. Louis Area Violence Prevention Commission , said that motivation for the program came from youth themselves: “We heard from the youth that they feel like they do not have access to their whole neighborhood. They do not have access to safe spaces in their neighborhood. The spaces that should be safe, like parks, aren’t safe because of gun violence or drug dealing or gang activity. Or the spaces that are safe—like a recreation center or a YMCA or a business—they don’t feel welcome in them, or they feel there are barriers, whether that’s a fee or transportation.” Safer Summer St. Louis seeks to tackle this by providing funding (up to $5,000 per event) to youth in neighborhoods most impacted by gun violence to host events like block parties, bike rides, fitness events, and other activities of their choosing.  Meyers said that while the program is based on evidence about what works to prevent violence, it is really about showing St. Louis youth that the city is invested in their future. “[Safer Summer St. Louis] is about investing in youth and telling them we value them enough that we’re taking this $1 million in [ARP] funding and we’re going to put it directly to events that allow you to be young and have fun in St. Louis—in a safer St. Louis.” 

“[Safer Summer St. Louis] is about investing in youth and telling them we value them enough that we’re taking this $1 million in [ARP] funding and we’re going to put it directly to events that allow you to be young and have fun in St. Louis—in a safer St. Louis.” Jessica Meyers, Director of the St. Louis Area Violence Prevention Commission

Strengthening civic infrastructure to promote safety  

Nearly every non-carceral community-based safety intervention requires the leadership and dedication of civic and community-based organizations to be implemented. 42 And aside from that, research indicates that the mere presence of such organizations within a neighborhood leads to reductions in violent crime. 43 The challenge, however, is that while city resources are plentiful for increasing police in high-crime neighborhoods, cities routinely fail to fund the community infrastructure (such as grassroots organizations) that stabilize communities. 44  

Figure 4 highlights how state and local governments are using ARP funds to enhance the capacity of community-based and civic organizations to prevent violence. For example, New Haven, Conn. used $785,000 of its ARP funds to create Civic Space , a centralized public forum for citizens and grassroots organizations to share input on ARP investments, learn about new community-centered violence prevention initiatives, and partner with other organizations working on similar aims. 

Case study: How Minnesota is supporting locally led grassroots organizations prevent violence Minnesota has a population of 5.7 million , with the largest concentrations in the cities of Minneapolis and Saint Paul. Despite relatively strong gun laws, firearms are the leading cause of death for youth in the state. With Minneapolis being the site of George Floyd’s murder and the catalyst for global protests against racial injustice, the state knew it needed to act boldly in allocating ARP funds toward non-carceral public safety approaches—ultimately obligating $16.8 million for violence prevention and intervention activities as well as survivor support.   As part of this, state leaders allocated $5 million toward a new Innovation in Community Safety grant program . Kate Weeks, executive director of the Minnesota Department of Public Safety, said the program is “a new way for Minnesota to push out money that was community-focused,” where “decisions about where funds would go come directly from the community.” The grant program provides local organizations in targeted neighborhoods with up to $1 million for community safety programming, prioritizing areas with the highest rates of violent crime. According to Weeks, the recipients have been “virtually all nonprofits.”   The state made another $2.5 million available through Violence Intervention Grants , with a maximum per-grant amount of $250,000. These grants were designed to have a more equitable distribution of applicants, with a fiscal agent administering smaller funding amounts more quickly to grassroots organizations.

Recommendations from the field: Maximizing ARP funds to promote holistic community safety  

The state, county, and local leaders we interviewed offered five primary recommendations on how to more equitably and effectively allocate ARP spending toward non-carceral community safety interventions. These recommendations, which align with emerging research on best practices for the equitable use of ARP funds, include:  

• Build the capacity of smaller, grassroots nonprofits to deploy funds. States and municipalities rely on nonprofit partners to execute ARP obligations; small and grassroots nonprofits (which often serve and hold greater trust with disinvested communities) are at a structural disadvantage in becoming aware of and applying for federal funds, as well as in navigating the reporting requirements tied to federal dollars. 45 As Robert David explained, prior to Danville’s efforts to invest in violence prevention, there was a disconnect between grassroots organizations and “where the funding was,” which made the city “resource-rich but collaboratively poor.” Our interviewees explained how solving this mismatch requires direct outreach to nonprofits in disinvested communities to make them aware of ARP funds, simplifying the application process or dedicating state or municipal resources to support grassroots partners through the process, and loosening reporting requirements. For example, in St. Louis, the city hired a consultant to help grassroots nonprofits apply for funds. And in Minnesota, the state allocated different funding streams through a “social compact” model to allow some smaller nonprofits to pool their applications to make a stronger case for funding.  
• Employ participatory and community-informed processes to guide investment decisions . To be true to the White House’s directive to use ARP funds equitably , disproportionately impacted communities should be engaged in determining how these federal dollars are spent. A variety of traditional mechanisms can be used to do so, including surveys, online forms, public meetings, and listening sessions. But these tools alone can often exclude citizens who are not already highly engaged or who have limited broadband access. Leaders must be intentional about diversifying the forms of community engagement and ensuring engagement is meaningful. Some strategies include targeted outreach in disadvantaged census tracts, using paid community reviewers (including youth) to review proposals and help make grantmaking decisions, conducting outreach to incarcerated and returning citizens, and launching longer-term processes such as participatory budgeting . For example, the St. Louis Area Violence Prevention Commission hired youth to review proposals for their Safer Summer St. Louis program, and Danville leveraged previous community engagement processes to guide the allocation of ARP funds. Stakeholders across all cities emphasized the importance of engaging youth.

“When we give power to young people to use their voice, to be able to co-create, that is more powerful than [when] we are just ordaining from on high and not letting them be effective partners,” Devanshi Patel, CEO of the Center for Youth and Family Advocacy in Virginia. 

• Prioritize equity in the allocation, implementation, and evaluation of ARP funds. The Treasury Department explicitly urged states and localities to prioritize equity in their distribution of ARP funds. In terms of funding allocations, equity can mean ensuring funding flows to census tracts with disproportionate rates of violence or to organizations whose leadership and staff are demographically representative of the communities they serve (for example, by requiring grant seekers to disclose this information in applications, as Minnesota did). In terms of implementation, interviewees explained that equity means trusting community-based organizations—particularly those with deep ties to underserved places—to use their funding in nimble ways that respond to communities’ evolving needs. Equity also means recognizing that people involved in implementation might not have standard resumes or may have criminal records, but their lived experiences and community ties are valuable assets for expanding the success and impact of these interventions. As Multnomah County’s Adam Renon told us, “We need to learn from the individuals who have been incarcerated or who have committed gun violence, and ask them, ‘What would have prevented you from entering that life?’” Finally, in terms of evaluation, equity means thinking expansively about compliance requirements and reporting metrics—including incorporating qualitative data and perspectives from directly impacted communities—as burdensome requirements can strain capacity and limit the ability of smaller organizations to access funding.

“ We need to learn from the individuals who have been incarcerated or who have committed gun violence, and ask them, ‘What would have prevented you from entering that life?’” Adam Renon, Senior Policy Advisor, Multnomah County

• Use data to not just understand program effectiveness, but to respond to evolving community needs. Upticks in violence can be unpredictable and send shockwaves across entire communities—disrupting school, family, and social life even for residents who may not have been directly victimized themselves. For this reason, interviewees stressed the importance of using public safety indicators not just to gauge whether prevention initiatives are working, but also as a way to shift implementation and resource allocation to respond to communities’ needs. “We really tried to take a look at the data in front of us,” Multnomah County’s Raffaele Timarchi said. “We knew that mental health concerns were up, we knew youth were disconnected from school and social supports…The safety net had been frayed.” Timarchi explained how the intersecting challenges of rising gun homicide rates, school closures, and frontline workers’ burnout guided their cross-disciplinary approach to violence prevention. Wilford Pinkney Jr. described using St. Louis’ crisis response data to craft programs that better fit community needs: “If you’re doing crisis response right, you’re engaging people and gathering a lot of data that’s hard for people to refute in terms of what the needs are in the community. We don’t have to guess what people need. We have 6,000 interactions from people in this community saying what they need.” Interviewees stressed this imperative to use data not as a way to judge high-violence communities, but rather as a tool to more deeply understand their shifting needs.

“If you’re doing crisis response right, you’re engaging people and gathering a lot of data that’s hard for people to refute in terms of what the needs are in the community. We don’t have to guess what people need. We have 6,000 interactions from people in this community saying what they need.” Wilford Pinkney Jr., St. Louis

• Create dedicated and sustainable funding streams—including as line items in city budgets—and braid funding streams whenever possible to increase scale. ARP provides state and local leaders with a once-in-a-generation influx of funds, but it is time-limited. Multiple interviewees expressed their concern that too great a reliance on this one-time funding could lead to programmatic cliffs. They noted that creating line items in city, county, or state budgets, and/or creating permanent agencies devoted to community safety could provide stability in financing—especially since political cycles and new administrations can disrupt initiatives that lack permanency. 46 Our Brookings colleagues have also suggested braiding or blending funding streams to increase sustainability, which could involve braiding ARP dollars with  private funding , funding from  surrounding regional jurisdictions , or major new federal investments like those in the  Infrastructure Investment and Jobs Act . Finally, municipalities should harness revenue from traditional economic development initiatives to sustain public priorities. For example, Danville City Manager Ken Larking outlined a vision for current development that includes the goal of never being “in a budget crisis where a neighborhood park has to be sacrificed because there isn’t enough money to do police services or whatever else.” And as an added benefit, by tying revenue to priorities that reflect established city values and priorities, governments are held accountable to steering development that benefits the entire community.  

Conclusion 

At the end of 2021, cities and counties had budgeted only 40% of their total ARP allocation (82% of the first of two funding tranches). While more money has been budgeted this year, there is still plenty of funding left to be allocated prior to the 2024 deadline and spent prior to the 2026 deadline. It is vital that state and local leaders seize this once-in-a-generation opportunity to invest in community-based violence prevention efforts now, as these programs can take time to establish roots at the local level and scale up. 

By investing in critical community safety infrastructure before the next rise in gun violence, communities will be better supported and equipped to avoid such violence, while also averting the intergenerational consequences that accompany punitive responses to it. As Devanshi Patel of Virginia’s Center for Youth and Family Advocacy said, it is imperative to invest in “restorative justice and community-based programming now to help kids stay out of the legal system” because system-involvement and incarceration can create harms for people and communities that are felt for generations. 

Ultimately, the benefits of addressing the root causes of gun violence go far beyond the shots you don’t hear. In addition to the lives saved, the benefits can be seen in the children playing in parks, the youth finding employment, the sick accessing treatment, the entrepreneurs launching businesses, or neighbors hosting block parties. By investing in economic opportunity, bolstering social cohesion, upgrading the built environment, and strengthening neighborhoods’ civic ties, state and local leaders can create the conditions necessary for long-lasting individual and collective flourishing. 

Acknowledgments:

The authors express their sincere gratitude to the state and local leaders who participated in research interviews to inform this piece: Gregory Baldwin, Thomas Carr, Robert David, Patrick Hogan, Tricia Hummel, Ken Larking, Jessica Meyers, Ahna Minge, Dr. Kiah E. Nyame, Devanshi Patel, Wilford Pinkney Jr., Adam Renon, Raffaele Timarchi, and Kathryn Weeks. The authors also thank the following experts for their review of various drafts of the research brief: Alan Berube, Jennifer S. Vey, and Eli Byerly-Duke (of Brookings Metro), Sam Washington and Thea Sebastian (of Civil Rights Corps), and Leah Sakala (of Alliance for Safety and Justice).  

About the Authors

Research associate – brookings metro, anthony barr, senior research assistant – brookings metro, oluwasekemi odumosu, research intern – brookings metro.

• “Non-carceral” safety interventions are those that exist outside of the formal criminal justice system, and are implemented by actors who are not part of the criminal justice system.
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• Rowlands, D. & Love, H. (2022). Mapping gun violence: A closer look at the intersection between place and gun homicides in four cities. Brookings Institution.
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• Light, M. T., & Thomas, J. T. (2019). Segregation and violence reconsidered: Do whites benefit from residential segregation?. American sociological review, 84(4), 690-725. U.S. Department of Housing and Urban Development (n.d.). Neighborhoods and violent crime. https://www.huduser.gov/portal/periodicals/em/summer16/highlight2.html. Kondo, M. C., Andreyeva, E., South, E. C., MacDonald, J. M., & Branas, C. C. (2018). Neighborhood interventions to reduce violence. Annual review of public health, 39(1), 253-271. Branas, C. C., Rubin, D., & Guo, W. (2012). Vacant properties and violence in neighborhoods. International Scholarly Research Notices, 2012.
• U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (n.d.). Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
• Jones, A. (2020). Reforms without Results: Why states should stop excluding violent offenses from criminal justice reforms. Prison Policy Initiative. https://www.prisonpolicy.org/reports/violence.html#victims
• Branas, C., Buggs, S., Butts, J. A., Harvey, A., Kerrison, E. M., Meares, T., … & Webster, D. (2020). Reducing Violence Without Police: A Review of Research Evidence. John Jay College of Criminal Justice Research and Evaluation Center. Janetta, J., Sakala, L., & Rejon, F. (2020). Federal investment in community-driven public safety. Urban Institute. Sakala, L. and La Vigne, L. (2019). Community-driven models for safety and justice. Du Bois Review, 16:1 253–266.
• Barr, Anthony. & Broady, Kristen. (2021) Dramatically increasing incarceration is the wrong response to the recent uptick in homicides and violent crime. The Brookings Institution. Retrieved December 4, 2021, from http://www.brookings.edu/blog/the-avenue/2021/11/02/dramatically-increasing-incarceration-is-the-wrong-response-to-the-recent-uptick-in-homicides-and-violent-crime/
• U.S. Department of the Treasury. https://home.treasury.gov/policy-issues/coronavirus/assistance-for-state-local-and-tribal-governments/state-and-local-fiscal-recovery-funds/recipient-compliance-and-reporting-responsibilities
• In July 2022, The U.S. Department of Treasury released a new batch of reporting that includes data through March 2022 and can be found here: Recipient Compliance and Reporting Responsibilities | U.S. Department of the Treasury
• Geller, A., Fagan, J., & Tyler, T. (2017). Police contact and mental health. Columbia Public Law Research Paper, (14-571). Legewie, J., & Fagan, J. (2019). Aggressive policing and the educational performance of minority youth. American Sociological Review, 84(2), 220-247. Soss, J., & Weaver, V. (2017). Police are our government: Politics, political science, and the policing of race–class subjugated communities. Annual Review of Political Science, 20(1), 565-591. Underwood, E. & Krinsky, M.A. (2019). Millions of children lose their parents to incarceration. That doesn’t have to happen. The Appeal. https://theappeal.org/millions-of-children-lose-their-parents-to-incarceration-that-doesnt-have-to-happen/ Sakala, L., Harvell, S., & Thompson, C. (2018) Public investment in community-driven safety initiatives: Landscape study and key considerations. Urban Institute.
• Our list of interviewees consisted of the following: From Danville, Va.: Gregory Baldwin (Director of Restorative Practices at Center for Youth and Family Advocacy), Robert David (Youth and Gang Violence Prevention Coordinator), Ken Larking (City Manager), and Devanshi Patel (Co-Founder and CEO at Center for Youth and Family Advocacy. From St. Louis: Jessica Meyers (Director, St. Louis Area Violence Prevention Commission) and Wilford Pinkney Jr. (Director, Mayor’s Office of Children, Youth, and Families). From Multnomah County, Ore: Adam Renon (Senior Policy Advisor for Multnomah County Chair Deborah Kafoury) and Raffaele Timarchi (Policy Advisor for Multnomah County Chair Deborah Kafoury). From Minnesota: Thomas Carr (Executive Budget Officer at Minnesota Management & Budget), Patrick Hogan (Director of Communications at Minnesota Management & Budget), Tricia Hummel (Assistant Director, Minnesota Office of Justice Programs), Ahna Minge (Assistant Commissioner for Budget Services and State Budget Director, Minnesota Management & Budget), and Kathryn Weeks (Executive Director, Minnesota Office of Budget Programs). From Rochester, N.Y.: Dr. Kiah E. Nyame (Coordinator, Rochester Office of Neighborhood Safety).
• Coronavirus State and Local Fiscal Recovery Funds | U.S. Department of the Treasury
• https://www.govinfo.gov/content/pkg/FR-2022-01-27/pdf/2022-00292.pdf
• Civil Rights Corps. (n.d). Community safety & the American Rescue Plan: A guide to using fiscal recovery grants to advance holistic safety. https://civilrightscorps.org/wp-content/uploads/2021/10/Community-Safety-and-ARP_Policy-Guide_CivRightsCorps.pdf, Lazere, E. (2021). Using federal relief funds to invest in non-police approaches to public safety. Center on Budget and Policy Priorities. Heuvel, S., Nelson, M., & Nguyen, L. (2021). How the American Rescue Plan can foster an equitable recovery: An equitable recovery requires strategic investments in safety. Vera Institute of Justice.
• U.S. Department of Housing and Urban Development (n.d.). Neighborhoods and violent crime. https://www.huduser.gov/portal/periodicals/em/summer16/highlight2.html.
• Sebastian, T., Bou, L., & Washington, S. Getting Smart on Safety Evidence on Non-Carceral Investments That Work to Prevent Violence & Harm. Civil Rights Corps.
• Heller, S. B. (2014). Summer jobs reduce violence among disadvantaged youth. Science, 346(6214), 1219-1223.
• Branas, C., Buggs, S., Butts, J. A., Harvey, A., Kerrison, E. M., Meares, T., … & Webster, D. (2020). Reducing Violence Without Police: A Review of Research Evidence. John Jay College of Criminal Justice Research and Evaluation Center.
• South, E. C., MacDonald, J., & Reina, V. (2021). Association between structural housing repairs for low-income Homeowners and neighborhood crime. JAMA network open, 4(7), e2117067-e2117067. Branas, C. C., South, E., Kondo, M. C., Hohl, B. C., Bourgois, P., Wiebe, D. J., & MacDonald, J. M. (2018). Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear. Proceedings of the National Academy of Sciences, 115(12), 2946-2951. Kondo, M. C., South, E. C., Branas, C. C., Richmond, T. S., & Wiebe, D. J. (2017). The association between urban tree cover and gun assault: a case-control and case-crossover study. American journal of epidemiology, 186(3), 289-296. Bondy, M., Roth, S., & Sager, L. (2020). Crime is in the air: The contemporaneous relationship between air pollution and crime. Journal of the Association of Environmental and Resource Economists, 7(3), 555-585.
• American Public Health Association. (2018). Violence is a public health issue: Public health is essential to understanding and treating violence in the U.S. https://apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/28/violence-is-a-public-health-issue.
• Brookings Institution (2022). Interactive: Local government ARPA investment tracker. http://www.brookings.edu/interactives/arpa-investment-tracker/.
• Weisburd, D., White, C., & Wooditch, A. (2020). Does collective efficacy matter at the micro geographic level?: Findings from a study of street segments. The British Journal of Criminology, 60(4), 873-891. Branas, C., Buggs, S., Butts, J. A., Harvey, A., Kerrison, E. M., Meares, T., … & Webster, D. (2020). Reducing Violence Without Police: A Review of Research Evidence. John Jay College of Criminal Justice Research and Evaluation Center.
• Sullivan, William C., Frances E. Kuo, and Stephen F. Depooter. “The fruit of urban nature: Vital neighborhood spaces.” Environment and behavior 36, no. 5 (2004): 678-700.
• Treskon, M., Esthappan, S., Okeke, C., & Vásquez-Noriega, C. (2018). Creative Placemaking and Community Safety: Synthesizing Cross-Cutting Themes. Urban Institute.
• Dholakia, N. & Gilbert, D. (2021). Community violence intervention programs, explained. Vera Institute of Justice. https://www.vera.org/community-violence-intervention-programs-explained?emci=1e33529c-0d38-ec11-9820-c896653b26c8&emdi=c5fd9ca1-1738-ec11-9820-c896653b26c8&ceid=954462. Delgado, S. A., Alsabahi, L., Wolff, K., Alexander, N., Cobar, P., & Butts, J. A. (2021). Denormalizing violence: A series of reports from the John Jay College Evaluation of Cure Violence Programs in New York City. Advance Peace (n.d.). Learning and Evaluation. https://www.advancepeace.org/about/learning-evaluation-impact/.
• Pearl, B. (2020). Beyond policing: Investing in offices of neighbourhood safety. Washington: Center for American Progress. Rust, M., Calvert, S., & Elinson, Z. Murder in America: What makes cities safer. Wall Street Journal. Corburn, J. & Fukutome, A. Advance Peace Stockton: 2018-2020 evaluation. Center for Global Healthy Cities.
• Sakala, L., Harvell, S., Thompson, C. (2018) Public investment in community-driven safety initiatives: Landscape study and key considerations. Urban Institute.
• Sharkey, P., Torrats-Espinosa, G., & Takyar, D. (2017). Community and the crime decline: The causal effect of local nonprofits on violent crime. American Sociological Review, 82(6), 1214-1240. Sharkey, P. (2018). Uneasy peace: The great crime decline, the renewal of city life, and the next war on violence. WW Norton & Company.
• Holder, S., Akinnibi, F., Cannon, C. (2020). ‘We have not defunded anything’: Big cities boost police budgets, CityLab.
• Brachman, L. (2022). Nonprofits’ critical role in deploying federal investments: Observations from the Transforming Cities Lab. Brookings Institution.
• Pearl, B. (2020). Beyond Policing: Investing in Offices of Neighborhood Safety. Center for American Progress

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• Analysis & Opinion

Address Gun Violence by Going After the Root Causes

Gun violence has an outsized impact on Black communities. Solutions must prioritize economic and social justice, not inequitable retribution.

• Social & Economic Harm
• Second Amendment

After two weeks marred by numerous mass shootings, the air rings again with calls for gun reform in the United States. These calls, though, differ from past calls for reform: we have today a president and Congress inclined to act.

On April 8, President Biden issued a series of executive orders tightening restrictions on untraceable “ ghost guns ,” publishing a model for state red flag legislation, directing the Justice Department to study and report on gun trafficking, and ordering 26 programs to leverage existing grants to combat community violence.

Biden’s responses to these recent mass shootings are, to be sure, laudable. But they do not go far enough. While restricting access to guns will save lives, the president and Congress must home in on the circumstances that breed crime and violence — insufficient economic opportunity and lacking social mobility — to truly tackle the epidemic of gun violence ravaging this country. It has gotten even worse during the pandemic, triggering an increased police response.

The United States reports the 28th highest rate of gun deaths in the world, with an average of 39 people shot and killed by another person daily. Most of these homicides are instances of daily gun violence, not mass shootings which make up less than 1 percent of all U.S. gun deaths. Black Americans make up the largest share of those killed by guns, suffering nearly 10 times more gun homicides and 15 times more gun assaults than white Americans. This disproportionate impact cannot be divorced from institutional racism: studies have found that segregation , gender hierarchy , disinvestment, and poverty all increase the risk of homicide victimization for Black people.

How to confront daily gun violence differs from how to confront mass shootings. Many mass shootings could have been prevented by commonsense gun reforms, such as background checks, mandatory waiting periods, assault weapons bans, age limits, and red flag laws. In Charleston, South Carolina , for instance, the shooter received his gun without completing a background check due to the “ Charleston Loophole .” In Atlanta , to take another example, the shooter purchased his gun on the same day he committed the shootings. And in Parkland, Florida , the shooter bought an AR-15 at 18-years-old despite multiple police reports about his troubling behavior.

Such straightforward policies, however, are powerless to stem the tide of daily gun violence. When a person obtains a firearm illegally, waiting periods cannot prevent shootings, nor can background checks guarantee the legality of future behavior. And assault weapons bans cannot prevent the thousands of homicides by handgun.

Previous federal attempts to confront daily gun violence have relied heavily on the criminal legal system, and all have failed to significantly decrease gun homicides. In 2020, President Trump launched Operation Legend , a nine-city law enforcement initiative to address violent crime, resulting in over 2,000 arrests within its first two months. In 2016 , President Obama issued executive orders calling on state attorneys general to focus on prosecuting gun trafficking and violent offenders of gun crimes.

These attempts to address daily gun violence erred by depending on a racist and otherwise biased criminal legal system to address a problem that is perpetuated by inequality. Gun violence and mass incarceration are both propagated and reinforced by policies that punish lower income communities of color . In other words, the solution to one problem cannot be achieved by exacerbating the other.

Instead, reforms should prioritize addressing the root causes of gun violence in addition to limiting access to firearms through common sense reforms. The World Health Organization and the John Jay College of Criminal Justice both released similar recommendations to reduce violence without reliance on incarceration. Among the notable proposals are changing cultural and social norms around violence and promoting prosocial bonds. They also include identifying and supporting victims with the aim of preventing reoccurring violence, mitigating financial stress, and engaging youth.

Biden’s recent executive orders take steps to address some of these recommendations by directing federal agencies to leverage existing grants for community violence intervention programs. This funding will support restorative, community-oriented programs like group violence intervention and hospital-based intervention — strategies that develop anti-violence norms among peers by identifying individuals at high risk for committing gun crimes and connecting potential offenders with social services.

However, the funding from Biden’s executive orders is just a drop in the bucket compared to what is needed to significantly reduce daily gun violence. To adequately support community violence intervention, Congress must pass the American Jobs Plan which allocates $5 billion over eight years to community violence prevention programs and billions more to improving schools, expanding access to higher education, making homeownership more affordable, providing job training to young people, and promoting equitable infrastructure development.

If Congress wants to reduce gun homicides, it must address economic inequality and pass the American Jobs Plan with full funding. Furthermore, Congress should consider investing in neighborhood greening and cleaning initiatives, substance use treatment , co-responder models to minimize police interactions, and targeted welfare programs to reduce poverty.

Incorporating economic justice into violence prevention policy is a necessary step, and legislators should be cognizant of the preventative potential of policies like the American Jobs Plan. Gun violence is a distinctively American crisis, and the costs of pursuing incremental, limited-scope reforms are simply too great.

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Home > Topics > Gun Violence: The Impact on Society

Infographics

Gun Violence: The Impact on Society

Social Determinants of Health

Published on: January 16, 2024. Updated on: July 02, 2024.

$557 billion

The economic cost of gun violence across the US in 2022

This infographic explores the rapidly increasing health and economic costs of gun violence across the United States.

An average of 118 people a day died from a gun-related incident in 2023. For every person who dies by firearm, more than two survive, often with significant and expensive mental and physical injuries.

In June 2024, US Surgeon General, Vivek Murthy, MD, issued a Surgeon General’s Advisory on Firearm Violence, the first publication from the Office of the Surgeon General dedicated to the health issue.

Gun violence is a public health problem: Centers for Disease Control and Prevention, About Firearm Injury and Death, 2024

Gun-related deaths and injuries are still above pre-pandemic levels : Alexander Tin and Allison Elyse Gualtieri, CBS News, Gun injuries in 2023 still at higher rates than before the pandemic across most states, CDC reports, 2024

Total gun death 2019 - 2023 : Gun Violence Archive, Past Summary Ledgers, 2024

For every one person who dies by firearm, more than two survive : The Educational Fund to Stop Gun Violence, Nonfatal Gun Violence, 2020

Expensive and long-term mental and physical injuries : Alice Miranda Ollstein and Nicholas Wu, Politico , “Health costs of gun violence exceed $1 billion a year, GAO says”, 2021

Average of people wounded by guns nationally and by state : Everytown, How does gun violence impact the communities you care about?, 2024

Note: The analysis of nonfatal firearm injuries is based on hospital discharge data from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP).

Gun violence has significant health and economic consequences, especially among child and adolescent survivors. Gun violence can place a strain on health care systems, with survivors increasing hospitalizations and spending by 1,449% and 1,713% respectively.

Health outcomes following non-fatal firearm injury : Zirui Song et al., in Health Affairs, Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members, Vol. 42, No. 11, 2023

Gun violence in the US has steep economic consequences, totaling $557 billion in 2022. Most significant are the quality-of-life costs, which include the value of pain and well-being lost by survivors of firearm injuries, decedents, and their families.

$557 billion - Zirui Song, JAMA, The Business Case for Reducing Firearm Injuries, 2022

Economic cost of gun violence : Everytown Research, The Economic Cost of Gun Violence, 2022

Price Per Individual and Taxpayers : Everytown Research, How does gun violence impact the communities you care about?, 2023

Medicaid and other public programs : Zirui Song et al., Annals of Internal Medicine, Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members, 2022

Recent studies and cost per person post-injury:

Source 1 : Zirui Song et al., Annals of Internal Medicine, Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members, 2022

Source 2 : Zirui Song et al., Health Affairs, Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members, 2023

Between 2018 and 2023, there was a yearly average of around 603 mass shooting events. While mass shootings are often the most publicized events, they are not the primary source of gun violence.

There have been over 260 mass shootings this year alone, resulting in 274 deaths and over 1,131 injuries (as of July 2, 2024).

The metrics displayed in the graph do not include suspect deaths and injuries. For metrics including suspect deaths and injuries, please see the citations.

Mass shootings in 2024 : Gun Violence Archive, Gun Violence Archive 2024, 2024

• Note: The metrics displayed in the graphic do not include suspect injuries and deaths, only victim injuries and deaths.
• As of July 2: 261 total shootings, 296 deaths, and 1,150 injuries.

Gun violence definition : Gun Violence Archive, General Methodology, 2022

Mass shootings January 1 - December 31 (2019 - 2023) : Gun Violence Archive, Past Summary Ledgers, 2023

• 2019: 414 total shootings, 461 deaths, and 1,701 injuries
• 2020: 610 total shootings, 516 deaths, and 2,537 injuries
• 2021: 690 total shootings, 707 deaths, and 2,819 injuries
• 2022: 644 total shootings, 675 deaths, and 2,690 injuries
• 2023: 656 total shootings, 756 deaths, and 2,723 injuries

Historically, mass shootings typically occur in the latter half of the year : Shayanne Gal and Madison Hall, Insider , “The US has had 214 mass shootings so far in 2022. Here's the full list.”, 2022

Mass shootings account for less than 2% of gun deaths: Gun Violence Archive, Past Summary Ledgers, 2024

More typical acts of gun violence: German Lopez, The New York Times , “America’s Gun Problem”, 2022

Prior to 2020, motor vehicle accidents were consistently the leading cause of death for children and adolescents in the US. Since then, gun-related deaths have remained the leading cause of death among this age group.

In response to the number of deaths and injuries caused by motor vehicle accidents, numerous legislative steps have been taken to improve car and motor vehicle safety over time. Until recently, there had not been any widespread federal legislation in response to gun violence since 1994.

Guns are the leading cause of death for American children and adolescents : Jason E Goldstick et al., New England Journal of Medicine , Current Causes of Death in Children and Adolescents in the United States, 2022

Note: Children and adolescents are defined as persons 1 to 19 years old.

For the first time, guns surpassed motor vehicle accidents as cause of death : Daniel J Flannery and Ruth W Begun, “Guns surpass motor vehicles as top cause of death for U.S. children: What parents should know”, Case Western Reserve University, Jack, Joseph, and Morton Mandel School of Applied Social Sciences, 2022

Guns have remained the leading cause of death:

Source 1: Bailey K. Roberts et al., American Academy of Pediatrics, Trends and Disparities in Firearm Deaths Among Children, 2023

Source 2 : The Children’s Defense Fund, The State of America’s Children, 2023 Gun Violence, 2023

Firearm vs. motor vehicle deaths : Dan Keating, The Washington Post , “Guns killed more young people than cars did for the first time in 2020”, 2022

• Note: Data in the above article is from the Centers for Disease Control and Web-based Injury Statistics Query and Reporting System ( WISQARS ).

Half of all gun deaths occurred in 10 states : The Children’s Defense Fund, The State of America’s Children, 2023 Gun Violence, 2023

Breakdown of gun deaths Bailey K. Roberts et al., American Academy of Pediatrics, Trends and Disparities in Firearm Deaths Among Children, 2023

Overall, incidents of gunfire on school grounds have been on the rise since 2013. Across the US, Texas has the highest number of gunfire occurrences on school grounds in this timeframe, resulting in close to 70 deaths and 100 injuries.

This year alone, there have been 107 incidents of gunfire on school grounds, responsible for nearly 30 deaths (as of July 2, 2024) .

Cases of gunfire on school grounds since 2013 : Everytown, Gunfire on School Grounds in the United States, 2024

School shootings over time : Everytown, Gunfire on School Grounds in the United States, 2024

Only high-income country in which guns are the leading cause of child and adolescent deaths: Matt McGough, Krutika Amin, Nirmita Panchal, and Cynthia Cox, KFF, Child and Teen Firearm Mortality in the US and Peer Countries, 2023

Firearm deaths account for 20% of all child deaths : Matt McGough, Krutika Amin, Nirmita Panchal, and Cynthia Cox, KFF, Child and Teen Firearm Mortality in the US and Peer Countries, 2023

Mental illness is often stigmatized as being the cause of gun violence. However, only a minority of mass shooters have experienced serious mental illness. It is estimated that 96% of the common violence that occurs would continue even if the elevated risk of violence among people with mental illness was eliminated.

Mental Illness is not a predictor of violence towards others : Mental Health Alliance, Gun Deaths, Violence, and Mental Health, 2022

Mental illness is not a significant risk factor for gun violence : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Mental illness is blamed as the cause : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Only a minority of mass shooters have experienced serious mental illness : Jennifer Skeem and Edward Mulvey, Criminology and Public Policy , “What role does serious mental illness play in mass shootings, and how should we address it?”, 2019

People with mental illness are more likely to be victims of violence : Katie O’Connor, Psychiatric News , “Mental Illness Too Often Wrongly Associated With Gun Violence”, 2021

Gun violence may cause mental health issues : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Suicide among those with a diagnosis is rare:

Source 1 : Deborah M. Stone et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015, 2018

Source 2 : Joseph C. Franklin et al., American Psychological Association, Psychological Bulletin, Risk Factors for Suicidal Thoughts and Behaviors: A Meta-Analysis of 50 Years of Research, 2017

Increased risk of suicide with a gun in the home : Matthew Miller and David Hemenway, The New England Journal of Medicine, Guns and Suicide in the United States, 2008

Nearly half of all suicides involve a gun : Wojciech Kaczkowski et al., Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Notes from the Field: Firearm Suicide Rates, by Race and Ethnicity — United States, 2019–2022, 2023

United States rates of mental illness vs. gun violence compared to other countries : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

Comparison to other high-income countries : Institute for Health Metrics and Evaluation, On gun violence, the United States is an outlier, 2022

Deaths per 100,000 population by country:

Source 1 : Wisevoter, Gun Deaths by Country, 2023

Source 2 : Katherine Leach-Kemon and Rebecca Sirull, University of Washington, The Institute for Health Metrics and Evaluation, On gun violence, the United States is an outlier, 2023

25 times as often : The Educational Fund to Stop Gun Violence, Mental Illness and Gun Violence, 2020

On June 25, 2022, President Biden signed the bipartisan gun safety bill. This new legislation aims to improve mental health support and school safety, restrict firearm access for domestic violence offenders, enable states to put in place laws that will allow authorities to take weapons from those deemed “dangerous,” and toughen background checks for young gun buyers.

A 2022 US Supreme Court ruling has been interpreted by lower courts in such a way as to call some of these aspects of legislation into question. Clarification on whether these and similar restrictions are Constitutionally permissible is likely to come in during the summer of 2024.

Bipartisan Safer Communities Act : Congress.Gov, S.2938 - Bipartisan Safer Communities Act, 2022

Most significant federal legislation since 1994 : Executive Office of the President, Office of Management and Budget, Statement of Administration Policy: S.2938 - Bipartisan Safer Communities Act, 2022

Expanded background checks, “boyfriend loophole”, red flag laws, and illegal gun purchases : Stephanie Lai and Emily Cochrane, The New York Times , “Here’s what is in the Senate’s gun bill - and what was left out.”, 2022

Federally licensed gun dealers: Aaron Sanchez-Guerra, The News & Observer , “How the Senate’s bipartisan gun bill would affect firearm buyers and sellers in NC”, 2022

Mental health and school safety: Kelsey Snell, NPR , “Senators reach final bipartisan agreement on a gun safety bill”, 2022

2023 Court Rulings

New York State Rifle & Pistol Association Inc. v. Bruen : Oyez, New York State Rifle & Pistol Association Inc. v. Bruen, 597 U.S. 1, 2022

United States v. Rahimi : SCOTUS Blog, United States v. Rahimi, 61 F. 4 th 443 (5 th Cir. 2023), cert. granted 143 S.Ct. 2688, 2023

This infographic was reviewed by:

• Paul Helmke, JD, P rofessor of Practice at Indiana University's O'Neill School of Public and Environmental Affairs and Founding Director of the Civic Leaders Living-Learning Center
• Zirui Song, MD, PhD, Associate Professor of Health Care Policy and Medicine at Harvard Medical School (HMS) and Massachusetts General Hospital and Director of Research at the HMS Center for Primary Care

To learn more about covering important health care and public health topics, such as gun violence, read the recent work by NIHCM Grantee, Association for Health Care Journalists .

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After 19 children and two teachers were slaughtered by a gunman at Robb Elementary School in Uvalde, Texas, many Americans are asking, yet again, how to prevent future acts of senseless violence from occurring. What gun laws need to be changed? Why is it so difficult to pass regulations? How can Second Amendment rights be balanced with firearm safety? 

Stanford scholars have been studying these issues from a range of perspectives, including law, politics, economics, and medicine. Here are some of their findings.

Update: May 25, 2022: This story was originally published on Feb. 26, 2018, and has been updated to include new content.

Causes, impacts of gun violence

Uncovering the causes of gun violence has been a challenge, in part because research is limited by federal legislation that constrains research funding on the issue. Scholar Nigam Shah at the Stanford School of Medicine has written about how this has affected empirical study. But that has not deterred scholars from examining its impacts. David Studdert, also at the School of Medicine, has studied the devastating consequences of gun violence, particularly the risks it poses to public health.  

Maya Rossin-Slater, an associate professor of medicine and a senior fellow at the Stanford Institute for Economic Policy Research (SIEPR), has also looked at the long-term impact of gun violence, specifically among American children who experienced a shooting at their school. Rossin-Slater found that they have higher rates of absenteeism, lower high school and college graduation rates, and by their mid-twenties, earn lower incomes.

Below is some of that research. 

Californians living with handgun owners more than twice as likely to die by homicide, study finds

Residents who don’t own a handgun but live with someone who does are significantly more likely to die by homicide compared with those in gun-free homes, research shows.

New study of gun violence in schools identifies long-term harms

Research from SIEPR’s Maya Rossin-Slater finds that students exposed to school shootings face “lasting, persistent” adversity in their educational and long-term economic outcomes.

Shirin Sinnar on the Buffalo shooting, hate crimes, and domestic terrorism

In the wake of the Buffalo shooting, Stanford Law School’s Shirin Sinnar discusses the scale of white supremacist violence in the U.S. and the rise of hate crimes.

Disconnect: The gap between gun violence and research in numbers

Gun violence is much discussed but little studied, largely due to federal decisions governing research funding. A new analysis highlights just how big the gap between the violence and our knowledge of it is. The answer? It’s huge.

Supporting students exposed to school shootings

Maya Rossin-Slater talks about her research into the mental health impact of severe school violence.

Panel discusses how shootings affect those unscathed by bullets

A panel of faculty members at the School of Medicine said shootings can affect the mental health of people close to the violence.

California handgun sales spiked after two mass shootings

In the six weeks after the Newtown and San Bernardino mass shootings, handguns sales jumped in California, yet there is little research on why – or on the implications for public health, according to a Stanford researcher.

Mass shootings: Public face of a much larger epidemic

While mass shootings have become the public face of gun violence, they account for less than 1% of the 40,000 firearm deaths each year.  

Short-term hospital readmissions for gun injuries cost $86 million a year

A study from Stanford researchers has found that readmissions account for 9.5% of the $911 million spent annually on gun-injury hospitalizations.

Supporting children through loss

Rabbi Patricia Karlin-Neumann talks about how to help young people experiencing grief.

Firearm injuries in children, teens costly for U.S. health care system, Stanford study finds

The average cost of initial hospitalization to treat pediatric gun injuries is about $13,000 per patient and has risen in recent decades, a Stanford Medicine study found.

Investigating psychiatric illnesses of mass shooters

Ira Glick and his collaborators studied the psychiatric state of 35 mass shooters in the United States who survived the incidents, which took place between 1982 and 2019.

The silent cost of school shootings

SIEPR’s Maya Rossin-Slater finds the average rate of antidepressant use among youths under age 20 rose by 21 percent in the local communities where fatal school shootings occurred.

New study analyzes recent gun violence research

Consensus is growing in recent research evaluating the impact of right-to-carry concealed handgun laws, showing that they increase violent crime, despite what older research says.

Handgun ownership associated with much higher suicide risk

Men who own handguns are eight times more likely to die of gun suicides than men who don’t own handguns, and women who own handguns are 35 times more likely than women who don’t.

Advice on how to cope with the threat of school shootings

Victor Carrion offers advice on how families can cope with the stress of school safety.

Reducing gun violence

Many Americans are demanding practical steps to reduce gun crime. One way is to have more stringent gun safety policies, such as legislation requiring guns to be stored safely, more stringent background checks, or as President Biden announced Tuesday, a federal ban on assault weapons and high-capacity magazines. 

Research has shown that states with tighter policies save lives: One study by Stephanie Chao found that states with stricter gun laws have lower rates of gun deaths among children and teenagers, and states with child prevention access laws are linked with fewer gun suicides in this age group.

“If you put more regulations on firearms, it does make a difference,” said Chao, assistant professor of surgery and senior author of the study. “It does end up saving children’s lives.” Her analysis found that states with the strictest laws had a mortality rate of 2.6 per 100,000 and for states with the least strict laws, mortality rate was almost double at 5.0 per 100,000.  

John Donohue: One tragic week with two mass shootings and the uniquely American gun problem

In a Q&A, Stanford Law School gun law expert John J. Donohue III discusses mass shootings in the U.S., the challenges facing police when confronting powerful automatic weapons and the prospect of gun safety laws.

Lax state gun laws linked to more child gun deaths

States with strict gun laws have lower rates of gun deaths among children and teenagers, and laws to keep guns away from minors are linked with fewer gun suicides in this age group, a Stanford study found.

Improved gun buyer background checks would impede some mass shootings, Stanford expert says

Stanford Law Professor John Donohue says a background check system that was universal and effectively operated could impede gun acquisition by people who commit mass shootings.

How to solve more gun crimes without spending more money

Simple tweaks to how police process bullet casings could dramatically improve their forensic data.

Reducing civilian firepower would boost police and community safety, Stanford expert says

In addition to restricting the firepower a person can amass, Stanford law Professor John J. Donohue advocates efforts to build trust between communities and law enforcement agencies as a way to enhance both police and citizen safety.

Stricter gun laws reduce child and adolescent gun deaths, Stanford study finds

Laws that keep guns away from young people are especially strongly linked to lower rates of gun suicides in youth.

Gun legislation and policy

For nearly three decades, law Professor John Donohue III has studied what can be done to prevent gun violence in the United States. A lawyer and economist, Donohue explores how law and public policy are connected to gun violence, including how gun laws in the U.S. compare to other countries, as well as how legislation varies across the states, to better understand the effect that has on rates of violence. 

“The U.S. is by far the world leader in the number of guns in civilian hands,” Donohue explained . “The stricter gun laws of other ‘advanced countries’ have restrained homicidal violence, suicides and gun accidents – even when, in some cases, laws were introduced over massive protests from their armed citizens.” 

Here are some of his findings, and other research related to legislating gun safety in the U.S.

Stanford’s John Donohue on guns, mass shootings and the law in the U.S.

On Nov. 30, American students were once again the victims of a school shooting. Stanford law Professor John Donohue discusses the case and gun violence in the U.S.

How U.S. gun control compares to the rest of the world

While deaths from mass shootings are a relatively small part of the overall homicidal violence in America, they are particularly wrenching. The problem is worse in the U.S. than in most other industrialized nations. And it’s getting worse.

4 gun control steps U.S. needs now

John Donohue pens an opinion piece for CNN laying out four steps the United States should take to strengthen gun legislation.

Violent crime increases in right-to-carry states

Stanford Law School Professor John Donohue found that states that adopted right-to-carry concealed handgun laws have experienced a 13 to 15 percent increase in violent crime in the 10 years after enacting those laws.

Another mass shooting: An update on U.S. gun laws

In a Q&A, John Donohue discusses gun safety law and legislative developments.

Stanford GSE holds teach-in on research into gun violence in schools

Education scholars look at the evidence behind policy ideas to address school shootings.

Will Americans ever think differently about guns?

Stanford medicine and law professor David Studdert thinks more public health evidence is needed before cultural attitudes around gun safety and violence will change.

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Article Contents

Introduction, the burden of firearm violence, understanding and reducing firearm violence is complex and multi-factorial, interventions and recommendations, conclusions, research ethics.

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Firearm Violence in the United States: An Issue of the Highest Moral Order

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Chisom N Iwundu, Mary E Homan, Ami R Moore, Pierce Randall, Sajeevika S Daundasekara, Daphne C Hernandez, Firearm Violence in the United States: An Issue of the Highest Moral Order, Public Health Ethics , Volume 15, Issue 3, November 2022, Pages 301–315, https://doi.org/10.1093/phe/phac017

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Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted research to inform and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges.

Firearm violence poses a pervasive public health burden in the United States. Firearm violence is the third leading cause of injury related deaths, and accounts for over 36,000 deaths and 74,000 firearm-related injuries each year ( Siegel et al. , 2013 ; Resnick et al. , 2017 ; Hargarten et al. , 2018 ). In the past decade, over 300,000 deaths have occurred from the use of firearms in the United States, surpassing rates reported in other industrialized nations ( Iroku-Malize and Grissom, 2019 ). For example, the United Kingdom with a population of 56 million reports about 50–60 deaths per year attributable to firearm violence, whereas the United States with a much larger population, reports more than 160 times as many firearm-related deaths ( Weller, 2018 ).

Given the pervasiveness of firearm violence, and subsequent long-term effects such as trauma, expensive treatment and other burdens to the community ( Lowe and Galea, 2017 ; Hammaker et al. , 2017 ; Jehan et al. , 2018 ), this paper seeks to examine how various evidence-based recommendations might be applied to curb firearm violence, and substantiate those recommendations using a blend of the three major ethics theories which include—rights based theories, consequentialism and common good. To be clear, ours is not a morally neutral paper wherein we weigh the merits of an ethical argument for or against a recommendation nor is it a meta-analysis of the pros and cons to each public health recommendation. We intend to promote evidence-based interventions that are ethically justifiable in the quest to ameliorate firearm violence.

It is estimated that private gun ownership in the United States is 30% and an additional 11% of Americans lived with someone who owed a gun in 2017 ( Gramlich and Schaeffer, 2019 ). Some of the reported motivations for carrying a firearm include protection against people (anticipating future victimization or past victimization experience) and hunting or sport shooting ( Schleimer et al. , 2019 ). A vast majority of firearm-related injuries and death occur from intentional harm (62% from suicides and 35% from homicides) versus 2% of firearm-related injuries and death occurring from unintentional harm or accidents (e.g. unsafe storage) ( Fowler et al. , 2015 ; Lewiecki and Miller, 2013 ; Monuteaux et al. , 2019 ; Swanson et al. , 2015 ).

Rural and urban differences have been noted regarding firearms and its related injuries and deaths. In one study, similar amount of firearm deaths were reported in urban and rural areas ( Herrin et al. , 2018 ). However, the difference was that firearm deaths from homicides were higher in urban areas, and deaths from suicide and unintentional deaths were higher in rural areas ( Herrin et al. , 2018 ). In another study, suicides accounted for about 70% of firearm deaths in both rural and urban areas ( Dresang, 2001 ). Hence, efforts to implement these recommendations have the potential to prevent most firearm deaths in both rural and urban areas.

The burden of firearm injuries on society consists of not only the human and economic costs, but also productivity loss, pain and suffering. Firearm-related injuries affect the health and welfare of all and lead to substantial burden to the healthcare industry and to individuals and families ( Corso et al. , 2006 ; Tasigiorgos et al. , 2015 ). Additionally, there are disparities in firearm injuries, whereby firearm injuries disproportionately affect young people, males and non-White Americans ( Peek-Asa et al. , 2017 ). The burden of firearm also affects the healthcare system, racial/ethnic minorities, women and children.

Burden on Healthcare System

Firearm-related fatalities and injuries are a serious public health problem. On average more than 38 lives were lost every day to gun related violence in 2018 ( The Education Fund to Stop Gun Violence (EFSGV), 2020 ). A significant proportion of Americans suffer from firearm non-fatal injuries that require hospitalization and lead to physical disabilities, mental health challenges such as post-traumatic stress disorder, in addition to substantial healthcare costs ( Rattan et al. , 2018 ). Firearm violence and related injuries cost the U.S. economy about $70 billion annually, exerting a major effect on the health care system ( Tasigiorgos et al. , 2015 ).

Victims of firearm violence are also likely to need medical attention requiring high cost of care and insurance payouts which in turn raises the cost of care for everyone else, and unavoidably becomes a financial liability and source of stress on the society ( Hammaker et al. , 2017 ). Firearm injuries also exert taxing burden on the emergency departments, especially those in big cities. Patients with firearm injuries who came to the emergency departments tend to be overwhelmingly male and younger (20–24 years old) and were injured in an assault or unintentionally ( Gani et al. , 2017 ). Also, Carter et al. , 2015 found that high-risk youth (14–24 years old) who present in urban emergency departments have higher odds of having firearm-related injuries. In fact, estimates for firearm-related hospital admission costs are exorbitant. In 2012, hospital admissions for firearm injuries varied from a low average cost of $16,975 for an unintentional firearm injury to a high average cost of $32,237 for an injury from an assault weapon ( Peek-Asa et al. , 2017 ) compared with an average cost of $10,400 for a general hospital admission ( Moore et al. , 2014 ).

Burden on Racial/Ethnic Minorities, Women and Children

Though firearm violence affects all individuals, racial disparities exist in death and injury and certain groups bear a disproportionate burden of its effects. While 77% of firearm-related deaths among whites are suicides, 82% of firearm-related deaths among blacks are homicides ( Reeves and Holmes, 2015 ). Among black men aged 15–34, firearm-related death was the leading cause of death in 2012 ( Cerdá, 2016 ). The racial disparity in the leading cause of firearm-related homicide among 20- to 29-year-old adults is observed among blacks, followed by Hispanics, then whites. Also, victims of firearms tend to be from lower socioeconomic status ( Reeves and Holmes, 2015 ). Understanding behaviors that underlie violence among young adults is important. Equally important is the fiduciary duty of public health officials in creating public health interventions and policies that would effectively decrease the burden of gun violence among all Americans regardless of social, economic and racial/ethnic backgrounds.

Another population group that bears a significant burden of firearm violence are women. The violence occurs in domestic conflicts ( Sorenson and Vittes, 2003 ; Tjaden et al. , 2000 ). Studies have shown that intimate partner violence is associated with an increased risk of homicide, with firearms as the most commonly used weapon ( Leuenberger et al. , 2021 ; Gollub and Gardner, 2019 ). However, firearm threats among women who experience domestic violence has been understudied ( Sullivan and Weiss, 2017 ; Sorenson, 2017 ). It is estimated that nearly two-thirds of women who experience intimate partner violence and live in households with firearms have been held at gunpoint by intimate partners ( Sorenson and Wiebe, 2004 ). Firearms are used to threaten, coerce and intimidate women. Also, the presence of firearms in a home increases the risk of women being murdered ( Campbell et al. , 2015 ; Bailey et al. , 1997 ). Further, having a firearm in the home is strongly associated with more severe abuse among pregnant women in a study by McFarlane et al. (1998) . About half of female intimate partner homicides are committed with firearms ( Fowler, 2018 ; Díez et al. , 2017 ). Some researchers reported that availability of firearms in areas with fewer firearms restrictions has led to higher intimate partner homicides ( Gollub and Gardner, 2019 ; Díez et al. , 2017 ).

In the United States, children are nine times more likely to die from a firearm than in most other industrialized nations ( Krueger and Mehta, 2015 ). Children here include all individuals under age 18. These statistics highlight the magnitude of firearm injuries as well as firearms as a serious pediatric concern, hence, calls for appropriate interventions to address this issue. Unfortunately, children and adolescents have a substantial level of access to firearms in their homes which contributes to firearm violence and its related injuries ( Johnson et al. , 2004 ; Kim, 2018 ). About half of all U.S. households are believed to have a firearm, making firearms one of the most pervasive products consumed in the United States ( Violano et al. , 2018 ). Consequently, most of the firearms used by children and youth to inflict harm including suicides are obtained in the home ( Johnson et al. , 2008 ). Beyond physical harm, children experience increased stress, fear and anxiety from direct or indirect exposure to firearms and its related injuries. These effects have also been reported as predictors of post-traumatic stress disorders in children and could have long-term consequences that persist from childhood to adulthood ( Holly et al. , 2019 ). Additionally, the American Psychological Association’s study on violence in the media showed that witnessing violence leads to fear and mistrust of others, less sensitivity to pain experienced by others, and increases the tendency of committing violent acts ( Branas et al. , 2009 ; Calvert et al. , 2017 ).

As evidenced from the previous sections, firearm violence is a complex issue. Some argue that poor mental health, violent video games, substance abuse, poverty, a history of violence and access to firearms are some of the reasons for firearm violence ( Iroku-Malize and Grissom, 2019 ). However, the prevalence and incidence of firearm violence supersedes discrete issues and demonstrates a complex interplay among a variety of factors. Therefore, a broader public health analysis to better understand, address and reduce firearm violence is warranted. Some important factors as listed above should be taken into consideration to more fully understand firearm violence which can consequently facilitate processes for mitigation of the frequency and severity of firearm violence.

Lack of Research Prevents Better Understanding of Problem of Firearm Violence

A major stumbling block to understanding the prevalence and incidence of firearm related violence exists from a lack of rigorous scientific study of the problem. Firearm violence research constitutes less than 0.09% of the Centers for Disease Control and Prevention’s annual budget ( Rajan et al. , 2018 ). Further research on firearm violence is greatly limited by the Dickey Amendment, first passed in 1996 and annually thereafter in budget appropriations, which prohibits use of federal funds to advocate or promote firearm control ( Rostron, 2018 ). As such, the Dickey Amendment impedes future federally funded research, even as public health’s interest in firearm violence prevention increased ( Peetz and Haider, 2018 ; Rostron, 2018 ). In the absence of rigorous research, a deeper understanding and development of evidence-based prevention measures continue to be needed.

Lack of a Public Health Ethical Argument Against Firearm Use Impedes Violence Prevention

We make an argument that gun violence is a public health problem. While some might think that public health is primarily about reducing health-related externalities, it is embedded in key values such as harm reduction, social justice, prevention and protection of health and social justice and equity ( Institute of Medicine, 2003 ). Public health practice is also historically intertwined with politics, power and governance, especially with the influence of the states decision-making and policies on its citizens ( Lee and Zarowsky, 2015 ). According to the World Health Organization, health is a complete physical, mental and social well-being that is not just the absence of injury or disease ( Callahan, 1973 ). Health is fundamental for human flourishing and there is a need for public health systems to protect health and prevent injuries for individuals and communities. Public health ethics, then, is the practical decision making that supports public health’s mandate to promote health and prevent disease, disability and injury in the population. It is imperative for the public health community to ask what ought to be done/can be done to curtail firearm violence and its related burdens. Sound public health ethical reasoning must be employed to support recommendations that can be used to justify various public policy interventions.

The argument that firearm violence is a public health problem could suggest that public health methods (e.g. epidemiological methods) can be used to study gun violence. Epidemiological approaches to gun violence could be applied to study its frequency, pattern, distribution, determinants and measure the effects of interventions. Public health is also an interdisciplinary field often drawing on knowledge and input from social sciences, humanities, etc. Gun violence could be viewed as a crime-related problem rather than public health; however, there are, of course, a lot of ways to study crime, and in this case with public health relevance. One dominant paradigm in criminology is the economic model which often uses natural experiments to isolate causal mechanisms. For example, it might matter whether more stringent background checks reduce the availability of guns for crime, or whether, instead, communities that implement more stringent background checks also tend to have lower rates of gun ownership to begin with, and stronger norms against gun availability. Therefore, public health authorities and criminologists may tend to have overlapping areas of expertise aimed to lead to best practices advice for gun control.

Our paper draws on three major theories: (1) rights-based theories, (2) consequentialism and (3) the common good approach. These theories make a convergent case for firearm violence, and despite their significant divergence, strengthen our public health ethics approach to firearm. The key aspects of these three theories are briefly reviewed with respect to how one might use a theory to justify an intervention or recommendation to reduce firearm injuries.

Rights-Based Theories

The basic idea of the rights framework is that people have certain rights, and that therefore it is impermissible to treat people in certain ways even if doing so would promote the overall good. People have rights to safety, security and an environment generally free from risky pitfalls. Conversely, people also have a right to own a gun especially as emphasized in the U.S.’s second amendment. Another theory embedded within our discussion of rights-based theories is deontology. Deontological approaches to ethics hold that we have moral obligations or duties that are not reducible to the need to promote some end (such as happiness or lives saved). These duties are generally thought to specify what we owe to others as persons ( rights bearers ). There are specific considerations that define moral behaviors and specific ways in which people within different disciplines ought to behave to effectively achieve their goals.

Huemer (2003) argued that the right to own a firearm has both a fundamental (independent of other rights) and derivative justification, insofar as the right is derived from another right - the right to self-defense ( Huemer, 2003 ). Huemer gives two arguments for why we have a right to own a gun:

People place lots of importance on owning a gun. Generally, the state should not restrict things that people enjoy unless doing so imposes substantial risk of harm to others.

People have a right to defend themselves from violent attackers. This entails that they have a right to obtain the means necessary to defend themselves. In a modern society, a gun is a necessary means to defend oneself from a violent attacker. Therefore, people have a right to obtain a gun.

Huemer’s first argument could be explained that it would be permissible to violate someone’s right to own or use a firearm in order to promote some impersonal good (e.g. number of lives saved). Huemer’s second argument also justifies a fundamental right to gun ownership. According to Huemer, gun restrictions violate the right of individual gun owners to defend themselves. Gun control laws will result in coercively stopping people to defend themselves when attacked. To him, the right to self-defense does seem like it would be fundamental. It seems intuitive to argue that, at some level, if someone else attacks a person out of the blue, the person is morally required to defend themselves if they cannot escape. However, having a right to self-defense does not entail that your right to obtain the means necessary to that thing cannot be burdened at all.

While we have a right to own a gun, that right is weaker than other kinds of rights. For example, gun ownership seems in no way tied to citizenship in a democracy or being a member of the community. Also, since other nations/democracies get along fine without a gun illustrates that gun ownership is not important enough to be a fundamental right. Interestingly, the UK enshrines a basic right to self-defense, but explicitly denies any right to possess any particular means of self-defense. This leads to some interesting legal peculiarities where it can be illegal to possess a handgun, but not illegal to use a handgun against an assailant in self-defense.

In the United States, implementing gun control policies to minimize gun related violence triggers the argument that such policies are infringements on the Second Amendment, which states that the rights to bear arms shall not be infringed. The constitution might include a right to gun ownership for a variety of reasons. However, it is not clear from the text itself that the right to bear arms is supposed to be as fundamental as the right to freedom of expression. Further, one could argue, then, that any form of gun regulation is borne from the rationale to retain our autonomy. Protections from gun violence are required to treat others as autonomous agents or as bearers of dignity. We owe others certain protections and affordances at least in part because these are necessary to respect their autonomy (or dignity, etc.). We discuss potential recommendations to minimize gun violence while protecting the rights of individuals to purchase a firearm if they meet the necessary and reasonable regulatory requirements. Most of the gun control regulations discussed in this article could provide an opportunity to ensure the safety of communities without unduly infringing on the right to keep a firearm.

Consequentialism

Consequentialism is the view that we should promote the common good even if doing so infringes upon some people’s (apparent) rights. The case for gun regulation under this theory is made by showing how many lives it would save. Utilitarianism, a part of consequentialist approach proposes actions which maximize happiness and the well-being for the majority while minimizing harm. Utilitarianism is based on the idea that a consequence should be of maximum benefit ( Holland, 2014 ) and that actions are right in proportion as they tend to promote happiness as the ultimate moral norm. If one believes that the moral purpose of public health is to make decisions that will produce maximal benefits for most affected, remove or prevent harm and ensure equitable distribution of burdens and benefits ( Bernheim and Childress, 2013 ), they are engaging in a utilitarian theory. Rights, including the rights to bear arms, are protected so long as they preserve the greater good. However, such rights can be overridden or ignored when they conflict with the principle of utility; that is to say, if greater harm comes from personal possession of a firearm, utilitarianism is often the ethical theory of choice to restrict access to firearms, including interventions that slow down access to firearms such as requiring a gun locker at home. However, it is important to note that utilitarians might also argue that one has to weigh how frustrating a gun locker would be to people who like to go recreationally hunting. Or how much it would diminish the feeling of security for someone who knows that if a burglar breaks in, it might take several minutes to fumble while inputting the combination on their locker to access their gun.

Using a utilitarian approach, current social statistics show that firearm violence affects a great number of people, and firearm-related fatalities and injuries threaten the utility, or functioning of another. Therefore, certain restrictions or prohibitions on firearms can be ethically justifiable to prevent harm to others using a utilitarian approach. Similarly, the infringement of individual freedom could be warranted as it protects others from serious harm. However, one might argue that a major flaw in the utilitarian argument is that it fails to see the benefit of self-defense as a reasonable benefit. Utilitarianism as a moral theory would weigh the benefits of proposed restrictions against its costs, including its possible costs to a felt sense of security on the part of gun owners. A utilitarian argument that neglects some of the costs of regulations wouldn’t be a very good argument.

One might legitimately argue that if an individual is buying a firearm, whether for protection or recreation, they are morally responsible to abide by the laws and regulations regarding purchasing that firearm and ensuring the safety of others in the society. Additionally, vendors and licensing/enforcement authorities would have the responsibility to ensure the safety of the rest of the society by ensuring that the firearm purchase does not compromise the safety of the community. Most people who own firearms would not argue against this position. However, arguments in support of measures that will reduce the availability of firearms center around freedom and liberty and are not as well tolerated by those who argue from a libertarian starting point. Further, this would stipulate that measures against firearm purchase or use impinge upon the rights of individuals who have the freedom to pursue what they perceive as good ( Holland, 2014 ). However, it seems as though the state has a fundamental duty to help ensure an adequate degree of safety for its citizens, and it seems that the best way to do that is to limit gun ownership.

Promoting the Common Good

A well-organized society that promotes the common good of all is to everyone’s advantage ( Ruger, 2015 ). In addition, enabling people to flourish in a society includes their ability to be healthy. The view of common good consists of ensuring the welfare of individuals considered as a group or the public. This group of people are presumed to have a common interest in protection and preservation from harms to the group ( Beauchamp, 1985 ). Health and security are shared by members of a community, and guns are an attempt to privatize public security and safety, and so is antithetical to the common good. Can one really be healthy or safe in a society where one’s neighbors are subject to gun violence? Maybe not, and so then this violence is a threat to one’s life too. If guns really are an effective means of self-defense, they help one defend only oneself while accepting that others in one’s community might be at risk. One might also argue that the more guns there are, the more that society accepts the legitimacy of gun ownership and the more that guns have a significant place in culture etc., and consequently, the more that there is likely to be a problem.

Trivigno (2018) suggests that the willingness to carry a firearm indicates an intention to use it if the need arises and Branas et al (2009) argue that perpetually carrying a firearm might affect how individuals behave ( Trivigno, 2018 ; Branas et al. , 2009 ). When all things are equal, will prudence and a commitment to the flourishing of others prevail? Trivigno (2013) wonders if such behaviors as carrying or having continual access to a firearm generates mistrust or triggers fear of an unknown armed assailant, allowing for aggression or anger to build; the exact opposite of flourishing ( Trivigno, 2013 ). One could suggest, then, that the recreational use of firearms is also commonly vicious. Many people use firearms to engage in blood sport, killing animals for their own amusement. For example, someone who kicks puppies or uses a magnifying glass to fry ants with the sun seems paradigmatically vicious; why not think the same of someone who shoots deer or rabbits for their amusement?. Firearm proponents might suggest that the fidelity (living out one’s commitments) or justice, which Aristotle holds in high regard, could justify carrying a firearm to protect one’s life, livelihood, or loved ones insofar as it would be just of a person to defend and protect the life of another or even one’s own life when under threat by one who means to do harm. Despite an argument justifying the use of a firearm against another for self-defense after the fact, the action might not have been right when evaluated through the previous rationale, or applying the doctrine of double effect as described by Aquinas’ passage in the Summa II-II, which mentions that self-defense is quite different than taking it upon one’s self to mete out justice ( Schlabach, n.d. ). The magistrate is charged with seeing that justice is done for the common good. At best, if guns really are an effective means of self-defense, they help one defend only oneself while accepting that others in one’s community might be at risk. They take a common good, the health and safety of the community, and make it a private one. For Aquinas and many other modern era ethicists, intention plays a critical part in judgment of an action. Accordingly, many who oppose any ownership of firearms do so in both a paternalistic fashion (one cannot intend harm if they don’t have access to firearms) and virtuous fashion (enabling human flourishing).

Classical formulations of the double doctrine effect include necessity and proportionality conditions. So, it’s wrong to kill in self-defense if you could simply run away (without giving up something morally important in doing so), or to use deadly force in self-defense when someone is trying to slap you. One thing the state can do, in its role of promoting the common good, is to reduce when it is necessary to use self-defense. If there were no police at all, then anyone who robs you without consequence will probably be back, so there’s a stronger reason to use deadly force against them to feel secure. That’s bad, because it seems to allow violence that truly isn’t necessary because no one is providing the good of public security. So, one role of the state is to reduce the number of cases in which the use of deadly force is necessary for our safety. Since most homicides in the United State involve a firearm, one way to reduce the frequency of cases in which deadly force is necessary for self-defense is to reduce the instances of gun crime.

We have attempted to lay the empirical and ethical groundwork necessary to support various interventions, and the recommendations aimed at curbing firearm violence that will be discussed in this next section. Specifically, by discussing the burden of the problem in its various forms (healthcare costs, disproportionate violence towards racial/ethnic minority groups, women, children, vulnerable populations and the lack of research) and the ethics theories public health finds most accessible, we can now turn our attention to well-known, evidence-based recommendations that could be supported by the blended ethics approach: rights-based theories, consequentialism and the common-good approach discussed.

Comprehensive, Universal Background Checks for Firearm Sales

Of the 17 million persons who submitted to a background check to purchase or transfer possession of a firearm in 2010, less than 0.5% were denied approval of purchase ( Federal Bureau of Investigation, 2014 ). At present, a background check is required only when a transfer is made by a licensed retailer, and nearly 40% of firearm transfers in recent years were private party transfers ( Miller et al. , 2017 ). As such, close to one-fourth of individuals who acquired a firearm within the last two years obtained their firearm without a background check ( Miller et al. , 2017 ). Anestis et al. , (2017) and Siegel et al. , (2019) evaluated the relationship between the types of background information required by states prior to firearm purchases and firearm homicide and suicide deaths ( Anestis et al. , 2017 ; Siegel et al. , 2019 ). Firearm homicide deaths appear lower in states checking for restraining orders and fugitive status as opposed to only conducting criminal background checks ( Sen and Panjamapirom, 2012 ). Similarly, suicide involving firearm were lower in states checking for a history of mental illness, fugitive status and misdemeanors ( Sen and Panjamapirom, 2012 ).

Research supports the evidence that comprehensive universal background checks could limit crimes associated with firearms, and enforcement of such laws and policies could prevent firearm violence ( Wintemute, 2019 ; Lee et al. , 2017 ). Comprehensive, universal background check policies that are applicable to all firearm transactions, including private party transfers, sales by firearm dealers and sales at firearm shows are justifiable using a blend of the ethics theories we have previously discussed. With the rights-based approach, one could still honor the right to own a firearm by a competent person while also enforcing the obligation of the firearm vendor to ensure only a qualified individual purchased the firearm. To further reduce gun crime, rather than ensure only the right people own guns, we can just reduce the number of guns owned overall. Consequentialism could be employed to ensure the protection of the most vulnerable such as victims of domestic violence and allowing a firearm vendor to stop a sale to an unqualified individual if they had a history of suspected or proven domestic violence. Also, having universal background checks that go beyond the bare minimum of assessing if a person has a permit, the legally required training, etc., but delving more deeply into a person’s past, such as the inclusion of a red flag ( Honberg, 2020 ), would be promoting the common good approach by creating the conditions for persons to be good and do good while propelling community safety.

Renewable License Before Buying and After Purchase of Firearm and Training Firearm Owners

At present, federal law does not require licensing for firearm owners or purchasers. However, state licensing laws fall into four categories: (1) permits to purchase firearms, (2) licenses to own firearms, (3) firearm safety certificates and (4) registration laws that impose licensing requirements ( Anestis et al. , 2015 ; Giffords Licensing, n.d. ). A study conducted in urban U.S. counties with populations greater than 200,000 indicated that permit-to-purchase laws were associated with 14% reduction in firearm homicides ( Crifasi et al. , 2018 ). In Connecticut, enforcing a mandatory permit-to-purchase law making it illegal to sell a hand firearm to anyone who did not have an eligible certificate to purchase firearms was associated with a reduction in firearm associated homicides ( Rudolph et al. , 2015 ). This also resulted in a significant reduction in the rates of firearm suicide rates in Connecticut ( Crifasi et al. , 2015 ). Conversely, the permit-to-purchase law was repealed in Missouri in 2007, which resulted in an increase of homicides with firearms and firearm suicides ( Crifasi et al. , 2015 ; Webster et al. , 2014 ). Similarly, two large Florida counties indicated that 72% of firearm suicides involved people who were legally permitted to have a firearm ( Swanson et al. , 2016 ). According to the study findings, a majority of those who were eligible to have firearms died from firearm-related suicide, and also had records of previous short-term involuntary holds that were not reportable legal events.

In addition to comprehensive, universal background checks for firearm purchases, licensing with periodic review requires the purchaser to complete an in-person application at a law enforcement agency, which could (1) minimize fraud or inaccuracies and (2) prevent persons at risk of harming themselves or others to purchase firearms ( Crifasi et al. , 2019 ). Subsequent periodic renewal could further reduce crimes and violence associated with firearms by helping law enforcement to confirm that a firearm owner remains eligible to possess firearms. More frequent licensure checks through periodic renewals could also facilitate the removal of firearms from individuals who do not meet renewal rules.

Further, including training on gun safety and shooting with every firearm license request could also be beneficial in reducing gun violence. In Japan, if you are interested in acquiring a gun license, you need to attend a one-day gun training session in addition to mental health evaluation and background check ( Alleman, 2000 ). This training teaches future firearm owners the steps they would need to follow and the responsibilities of owning a gun. The training completes with passing a written test and achieving at least a 95% accuracy during a shooting-range test. Firearm owners need to retake the class and initial exam every three years to continue to have their guns. This training and testing have contributed to the reduction in gun related deaths in Japan. Implementing such requirements could reduce gun misuses. Even though, this is a lengthy process, it could manage and reduce the risks associated with firearm purchases and will support a well-regulated firearm market. While some may argue that other forms of weapons could be used to inflict harm, reduced access to firearms would lead to a significant decrease in the number of firearm-related injuries in the United States.

From an ethics perspective, again, all three theories could be applied to the recommendation for renewable licenses and gun training. From a rights-based perspective, renewable licensure and gun training would still allow for the right to bear arms but would ensure that the right belongs with qualified persons and again would allow the proper state agency to exercise its responsibility to its citizens. Additionally, a temporary removal of firearms or prohibiting firearm purchases by people involuntarily detained in short-term holds might be an opportunity to ensure people’s safety and does so without unduly infringing on the Second Amendment rights. Renewable licenses and gun training create opportunities for law enforcement to step in periodically to ascertain if a licensee remains competent, free from criminal behavior or mental illness, which reduces the harm to the individual and to the community—a tidy application of consequentialism. Again, by creating the conditions for people to be good, we see an exercise of the common good.

Licensing Firearm Dealers and Tracking Firearm Sales

In any firearm transfer or purchase, there are two parties involved: the firearm vendor and the individual purchaser. Federal law states that “it shall be unlawful for any person, except for a licensed importer, licensed manufacturer, or licensed dealer, to engage in the business of importing, manufacturing, or dealing in firearms, or in the course of such business to ship, transport, or receive any firearm in interstate or foreign commerce” (18 U.S.C. 1 922(a)(1)(A)(2007). All firearm sellers must obtain a federal firearm license issued by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF). However, ATF does not have the complete authority to inspect firearm dealers for license, revoke firearm license, or take legal actions against sellers providing firearms to criminals ( Vernick and Webster, 2007 ). Depending on individual state laws, typically the firearm purchaser maintains responsibility in obtaining the proper license for each firearm purchase whereas the justice system has the responsibility to enforce laws regulating firearm sales. Firearm manufacturers typically sell their products through licensed distributors and dealers, or a primary market (such as a retail store). Generally, firearms used to conduct a crime (including homicide) or to commit suicide are the product of secondary markets ( Institute of Medicine, 2003 ) such as retail secondhand sales or private citizen transfers/sales. Such secondary firearm transfers are largely unregulated and allow for illegal firearm purchases by persons traditionally prohibited from purchasing in the primary market ( Vernick and Webster, 2007 ; Chesnut et al. , 2017 ).

According to evidence from Irvin et al. (2014) in states that require licensing for firearm dealers and/or allow inspections, the reported rates of homicides were lower ( Irvin et al. , 2014 ). Specifically, after controlling for race, urbanicity, poverty level, sex, age, education level, drug arrest rate, burglary rates and firearm ownership proxy, the states that require licensing for firearm dealers reported ~25% less risk of homicides, and the states that allow inspection reported ~35% less risk of homicides ( Irvin et al. , 2014 ). This protective effect against homicides was stronger in states that require both licensing and inspections compared to states that require either alone. The record keeping of all firearm sales is important as it facilitates police or other authorized inspectors to compare a dealer’s inventory with their records to identify any secondary market transactions or other discrepancies ( Vernick et al. , 2006 ). According to Webster et al. (2006) , a change in firearm sales policy in the firearm store that sold more than half of the firearms recovered from criminals in Milwaukee, resulted in a 96% reduction in the use of recently sold firearms in crime and 44% decrease in the flow of new trafficked firearms in Milwaukee ( Webster et al. , 2006 ).

The licensing of firearm vendors and tracking of firearm sales sits squarely as a typical public health consequentialist argument; in order to protect the community, an individual’s right is only minimally infringed upon. An additional layer, justifiable by consequentialism, includes a national repository of all firearm sales which can be employed to minimize the sale of firearms on the secondary market and dealers could be held accountable for such ‘off-label’ use ( FindLaw Attorney Writers, 2016 ). Enforcing laws, mandating record keeping, retaining the records for a reasonable time and mandating the inspection of dealers could help to control secondary market firearm transfers and minimize firearm-related crimes and injuries.

One could argue from a rights perspective that routine inspections and record keeping are the responsibility of both firearms vendors and law enforcement, and in doing so, still ensure that competent firearm owners can maintain their rights to bear arms. In Hume’s discussion of property rights, he situates his argument in justice; and that actions must be virtuous and the motive virtuous ( Hume, 1978 ). Hume proposes that feelings of benevolence don’t form our motivation to be just. We tend (perhaps rightly) to feel stronger feelings of benevolence to those who deserve praise than to those who have wronged us or who deserve the enmity of humanity. However, justice requires treating the property rights or contracts of one’s enemies, or of a truly loathsome person, as equally binding as the property rights of honest, decent people. Gun violence disproportionately impacts underserved communities, which are same communities impacted by social and economic injustice.

Standardized Policies on Safer Storage for Firearms and Mandatory Education

Results from a cross-sectional study by Johnson and colleagues showed that about 14-30% of parents who have firearms in the home keep them loaded, while about 43% reported an unlocked firearm in the home ( Johnson et al. , 2006 ; Johnson et al. , 2008 ). The risk for unintentional fatalities from firearms can be prevented when all household firearms are locked ( Monuteaux et al. , 2019 ). Negligent storage of a firearm carries various penalties based on the individual state ( RAND, 2018 ). For example, negligent storage in Massachusetts is a felony. Mississippi and Tennessee prohibit reckless or knowingly providing firearms to minors through a misdemeanor charge, whereas Missouri and Kentucky enforce a felony charge. Also, Tennessee makes it a felony for parents to recklessly or knowingly provide firearms to their children ( RAND, 2018 ).

While a competent adult may have a right to bear arms, this right does not extend to minors, even in recreational use. Many states allow for children to participate in hunting. Wisconsin allows for children as young as 12 to purchase a hunting license, and in 2017 then Governor Scott Walker signed into law a no age minimum for a child to participate in a mentored hunt and to carry a firearm in a hunt when accompanied by an adult ( Wisconsin Department of Natural Resources, 2020 ). The minor’s ‘right’ to use a firearm is due in part to the adult taking responsibility for the minor’s safety. As such, some have argued that children need to know how to be safe around firearms as they continue to be one of the most pervasive consumer products in the United States ( Violano et al. , 2018 ).

In addition to locking firearms, parents are also encouraged to store firearms unloaded in a safe locked box or cabinet to prevent children’s access to firearms ( Johnson et al. , 2008 ). It follows then that reducing children and youth’s access to firearm injuries involves complying with safe firearm storage practices ( McGee et al. , 2003 ). In addition to eliminating sources of threat to the child, it is also important for children to be trained on how to safely respond in case they encounter a firearm in an unsupervised environment. Education is one of the best strategies for firearm control, storage and reduction of firearm-related injuries via development of firearm safety trainings and programs ( Jones, 1993 ; Holly et al. , 2019 ). Adults also need firearm safety education and trainings; as such, inclusion of firearm safety skills and trainings in the university-based curriculum and other avenues were adults who use guns are likely to be, could also mitigate firearm safety issues ( Puttagunta et al. , 2016 ; Damari et al. , 2018 ). Peer tutoring could also be utilized to provide training in non-academic and social settings.

Parents have a duty to protect their children and therefore mandating safe firearm storage, education and training for recreational use and periodic review of those who are within the purview of the law. Given that someone in the U. S. gets shot by a toddler a little more frequently than once a week ( Ingraham, 2017 ), others might use a utilitarian argument that limiting a child’s access to firearms minimizes the possibility of accidental discharge or intentional harm to a child or another. Again, the common good approach could be employed to justify mandatory safe storage and education to create the conditions for the flourishing of all.

Firearm and Ammunition Buy-Back Programs

Firearm and ammunition buy-back programs have been implemented in several cities in the United States to reduce the number of firearms in circulation with the ultimate goal of reducing gun violence. The first launch in Baltimore, Maryland was in 1974. The Los Angeles Police Department (LAPD) has conducted a gun buy-back program for nearly eight years to remove more guns off the streets and improve security in communities. Currently there is a plan for a federal gun buy-back program in the United States. The objective of such programs is to reduce gun violence through motivating marginal criminals to sell their firearms to local governments, encourage law-abiding individuals to sell their firearms available for theft by would-be criminals, and to reduce firearm related suicide resulting from easy access to a gun at a time of high emotion ( Barber and Miller, 2014 ).

According to Kuhn et al. (2002) and Callahan et al. (1994) , gun buy-back programs are ineffective in reducing gun violence due to two main facts: 1- the frequently surrendered types of firearms are typically not involved in gun-related violence and 2- the majority of participants in gun buyback programs are typically women and older adults who are not often involved in interpersonal violence ( Kuhn et al. , 2002 ; Callahan et al. , 1994 ). However, as a result of implementation of the ‘‘good for guns’’ program in Worcester, Massachusetts, there has been a decline in firearm related injuries and mortality in Worcester county compared to other counties in Massachusetts ( Tasigiorgos et al. , 2015 ). Even though, there is limited research indicating a direct link between gun buy-back programs and reduction in gun violence in the United States, a gun buy-back program implemented in Australia in combination with other legislations to reduce household ownership of firearms, firearm licenses and licensed shooters was associated with a rapid decline in firearm related deaths in Australia ( Bartos et al. , 2020 ; Ozanne-Smith et al. , 2004 ).

The frequency of disparities in firearm-related violence, injuries and death makes it a central concern for public health. Even though much has been said about firearms and its related injuries, there continues to be an interest towards its use. Some people continue to desire guns due to fear, feeling of protection and safety, recreation and social pressure.

Further progress on reforms can be made through understanding the diversity of firearm owners, and further research is needed on ways to minimize risks while maximizing safety for all. Although studies have provided data on correlation between firearm possession and violence ( Stroebe, 2013 ), further research is needed to evaluate the interventions and policies that could effectively decrease the public health burden of firearm violence. Evidence-based solutions to mitigating firearm violence can be justified using three major public health ethics theories: rights-based theories, consequentialism and common good. The ethical theories discussed in this paper can direct implementation of research, policies, laws and interventions on firearm violence to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and the society-at-large. We support five major steps to achieve those goals: 1. Universal, comprehensive background checks; 2. Renewable license before and after purchase of firearm; 3. Licensing firearm dealers and tracking firearm sales; 4. Standardized policies on safer storage for firearms and mandatory education; and 5. Firearm buy-back programs. For some of the goals we propose, there might be a substantial risk of non-compliance. However, we hope that through education and sensibilization programs, overtime, these goals are not met with resistance. By acknowledging the proverbial struggle of individual rights and privileges paired against population health, we hope our ethical reasoning can assist policymakers, firearm advocates and public health professionals in coming to shared solutions to eliminate unnecessary, and preventable, injuries and deaths due to firearms.

The conducted research is not related to either human or animal use.

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Gun Violence in the United States

Gun violence is a preventable public health tragedy affecting communities all over the United States. Every day, more than 100 Americans die by gun violence, including 64 who die by firearm suicide, 39 Americans who die by firearm homicide, and 3 who are killed by other forms of gun violence. In addition, every day nearly 200 Americans visit the emergency department for nonfatal firearm injuries. Over half of these cases are a result of a firearm assault and an additional 37% are unintentional injuries. Overwhelming evidence shows that firearm ownership and access is associated with increased suicide, homicide, unintentional firearm deaths, and injuries. These injuries and deaths are preventable, and we must advocate for evidence-based solutions to make gun violence in the U.S. rare and abnormal.

Gun Ownership

How does gun ownership and access to firearms affect gun deaths, an in-depth look at gun violence in the united states, gun death rates by state, gun deaths by demographics, recommendations.

Gun violence is a public health epidemic in the United States. Every year nearly 40,000 Americans are killed by guns, including more than 23,000 who die by firearm suicide, 14,000 who die by firearm homicide, more than 500 who die by legal intervention, 12 nearly 500 who die by unintentional firearm injuries, and more than 300 who die by undetermined intent. 12 This equates to more than 100 gun deaths every single day. In addition, every day nearly 200 Americans visit the emergency department for nonfatal firearm injuries. 13

In 2019, the most recent year of data available, there were 39,707 gun deaths – 109 every single day. 14 Three in every five gun deaths are suicides and more than one-third are homicides, while the remainder are unintentional, of unknown intent, or law enforcement intervention.

Among high-income countries, the United States is an outlier in terms of gun violence. It has been well-documented that firearm ownership rates ? are associated with increased firearm-related death rates. The U.S. has the highest firearm ownership and highest firearm death rates of 27 high-income countries. 15 The firearm homicide rate in the U.S. is nearly 25 times higher than other high-income countries and the firearm suicide rate is nearly 10 times that of other high-income countries. 16

It is a common misconception that individuals living with mental illness are responsible for gun violence. When compared to other countries, the United States has similar rates of mental illness, yet we have much higher rates of gun violence. 17, 18 To be clear, mental illness does not cause gun violence – the problem is access to firearms.

While gun death data are the most reliable type of gun violence data currently available, it is important to recognize that gun deaths are only the tip of the iceberg of the gun violence epidemic. In addition to gun deaths, many more people are shot and survive their injuries, are shot at but not hit, or witness gun violence. Many experience gun violence in other ways, for example by living in impacted communities, losing loved ones to gun violence, or being threatened with a gun.

The CDC Plays a Vital Role in Providing Public Health Data to Researchers

Researchers need robust and reliable data to study and develop solutions to address the epidemic of gun violence in the United States. The Centers for Disease Control and Prevention (CDC) is the federal agency responsible for protecting the health of Americans by ensuring that data is properly collected to develop solutions to our nation’s public health crises, including gun violence. The CDC’s National Violent Death Reporting System (NVDRS) plays an instrumental role for gun violence prevention advocates and researchers. The NVDRS uses death certificates, police reports, and hospital records to report information about the victim, the cause of death, and the circumstances surrounding their death. 19 The CDC makes this data publicly available and easily accessible through their Web-based Injury Statistics Query and Reporting System (WISQARS).

To learn more, visit our page on nonfatal firearm injuries.

The following data presented on this page focuses on the impact to those who were killed by gun violence.

Many Americans celebrate guns in our culture and disregard the inherent public safety issues that a gun-friendly culture creates. U.S. firearm ownership rates exceed those of other high-income countries 20 and Americans own 46% of the world’s civilian-owned firearms. 21 Thirty percent of Americans report owning a gun, 22 with estimates of the total number of privately-owned guns in the U.S. ranging from 265 million to nearly 400 million. 23, 24, 25 The majority of gun owners (66%) report owning multiple guns, 26 and it is estimated that half of all guns are in the hands of just 3% of the U.S. population. 27

Gun Ownership by State

Gun ownership varies significantly by state. For example, one study found that gun ownership varies from 61.7% in Alaska to 5.2% in Delaware. 28 Higher levels of gun ownership are correlated with higher rates of suicide, 29, 30, 31, 32, 33 homicide, 34, 35, 36, 37 unintentional firearm deaths, 38, 39 law enforcement killings, 40 and violent crime. 41

Reasons for Gun Ownership – “Protection”

More than 6 in 10 Americans believe that a gun in the home makes the family safer – a figure that has nearly doubled since 2000. 42 This increase in perceived safety is reflected in shifting reasons for gun ownership. In a 2017 Pew Research survey, two-thirds (67%) of gun owners cited protection as a major reason for gun ownership. 43 This represents a notable increase from the mid-1990s, when the majority of American gun owners cited recreation as their primary reason for gun ownership and fewer than half owned guns primarily for protection. 44

However, the evidence is clear: guns don’t make you safer. Contrary to the gun lobby’s talking points, overwhelming research shows that gun ownership and easy access to guns inherently puts individuals and their families at higher risk of death and injury. 22, 23 With a recent study estimating that there are more guns than people in the United States 45 and with a rate of gun violence continually increasing, it is imperative to know the facts about guns and gun violence.

“We must remember that stopping gun violence isn’t only about preventing high-profile mass shootings. It is about stopping gun violence in all its forms. We must acknowledge that gun violence comes in many different forms — from gun suicide to police brutality to domestic violence to unintentional shootings to daily gun violence in neighborhoods across the country.”

- Bryan Barks, Director of Strategic Communications

Every year, nearly 40,000 Americans are killed by guns, including: 46

• More than 23,000 who die by firearm suicide
• 14,000 who die by firearm homicide
• More than 500 who die by legal intervention ?
• Nearly 500 who die by unintentional firearm injuries
• More than 300 who die by undetermined intent

This equates to more than 100 gun deaths every single day.

More than 60% of all gun deaths are suicides. 58 Evidence consistently shows that access to firearms increases the risk of suicide. 48, 49, 50, 51, 52, 53, 54 Access to a gun in the home increases the odds of suicide more than three-fold. 55 Firearms are so dangerous when someone is at risk for suicide because they are the most lethal suicide attempt method.

Though research shows that few individuals substitute means for suicide if their preferred method is not available, if firearms are not available, the person at risk for suicide is much more likely to survive even if they attempt using another method. 56 Delaying a suicide attempt can also allow suicidal crises to pass and lead to fewer suicides. Ninety percent of individuals who attempt suicide do not go on to die by suicide. 57 The use of a firearm in a suicide attempt often means there is no second chance.

To learn more, visit PreventFirearmSuicide.com or visit our page on firearm suicide .

Over 35% of all gun deaths are homicides. 58 Access to firearms – such as the presence of a gun in the home – is correlated with an increased risk for homicide victimization. 58, 59 States with high rates of gun ownership consistently have higher firearm homicide rates. 60, 61, 62 Studies show that access to firearms doubles the risk of homicide. 63 Nearly 75% of all U.S. homicides are by firearm. 64 Firearm homicide is a complex issue that includes different types of gun violence – domestic violence, interpersonal community violence, and mass shootings – and requires an array of different policies, programs, and practices if we want to see meaningful change.

Gun ownership also has implications for the number of mass shootings in a state. A 2019 study found that the permissiveness of state gun laws and an increase in a state’s gun ownership were associated with higher rates of mass shootings. Specifically, every 10 unit increase in the permissiveness of a state’s gun laws is associated with a 9% higher rate of mass shootings. For every 10% increase in gun ownership, states have a 35.1% higher rate of mass shootings. 65 The authors wrote, “This means that a state like California, which has approximately two mass shootings per year, will have an extra mass shooting for every 10 unit increase in permissiveness over five years. It will also have three to five more mass shootings per five years for every 10 unit increase in gun ownership.” 66

To learn more, visit our pages on firearm homicide or mass shootings .

Unintentional Shootings

About 1% of all gun deaths are unintentional. 67 “Unintentional” is the description used for a death that was not caused purposely. In gun violence, examples include fatal injuries that occur when a weapon misfires or is mishandled by a child and results in the victim being shot (in contrast with homicide and suicide, both of which involve an intent to pull the trigger and cause harm). Easy access to firearms, particularly unsecured firearms and the presence of firearms in risky situations, increases risk of unintentional injury and death by firearm. Mitigating access with safer storage practices and through evidence-based policy prevents unintentional gun violence.

To learn more, visit our page on unintentional shootings .

Legal Intervention / Police-Involved Shootings

“Legal intervention” is the description used by the CDC for injuries inflicted by the police or other law enforcement agents, including military on duty, in the course of arresting or attempting to arrest lawbreakers, suppressing disturbances, maintaining order, and other legal actions. In gun violence, these are also known as police-involved shootings. According to the CDC, more than 500 Americans die by legal intervention every year.

However, the government’s data (including the CDC data) provide a substantial under-count of police-involved injuries and deaths. To address this gap, a number of media sources have tracked police-involved shootings in recent years, most notably the Washington Post’s Fatal Force database. This database found that 1,000 Americans are shot and killed by police every year – more than double the number of police-involved fatal shootings than are reported in FBI and CDC databases. 68 Black Americans are disproportionately impacted by police-involved shootings and are killed at more than twice the rate as White Americans. 69

Ultimately, better data on police-involved injuries and deaths are sorely needed. Compulsory and comprehensive data collection at the local level, reporting to the federal government, and transparency in public dissemination of data will be critical for understanding this unique kind of gun violence and developing evidence-based solutions to minimize police-involved shootings.

Gun Violence in America - A Public Health Crisis Decades in the Making

A report from the Educational Fund to Stop Gun Violence and Coalition to Stop Gun Violence, A Public Health Crisis Decades in the Making: A Review of 2019 CDC Gun Mortality Data , draws on the most recent gun death data from the Centers for Disease Control and Prevention (CDC) to illustrate the fatal toll of the gun violence epidemic in the U.S. The report outlines gun death data from 2019, including demographic details, state-by-state breakdowns, and reviews trends over the last two decades.

Gun Death Trends Over Time

39,707 Americans died by gun violence in 2019, a small decrease of 33 gun deaths from 2018. 70

• An average of 109 people died of gun violence each day in 2019, bringing the most recent five-year average (2015-2019) to 106 gun deaths per day.
• 23,941 Americans died by firearm suicide in 2019, 66 people every day.
• 14,414 Americans died by firearm homicide in 2019, more than 39 people every day.

Gun Deaths in the United States, 2010-2019

Number of deaths

Source: CDC WONDER.

Gun Death Rate Trends Over Time

The overall gun death rate increased 17% over the last decade – the gun suicide rate increased 12.5% and the gun homicide rate increased nearly 26%. 71

• While the firearm suicide rate decreased slightly from 2018 to 2019, the rate has trended upward  over the last decade.
• The firearm homicide rate increased over the last decade spiking 31% from 2014 to 2016 and remaining at at this elevated level.

Gun Death Rates in the United States, 2010-2019

Age-adjusted rate per 100,000

All rates listed are age-adjusted in order to allow for accurate comparisons between populations with differing age distributions.

Gun violence is an epidemic that reaches communities large and small, but it is more common in some places than others. Among the states in 2019, Alaska had the highest gun death rate (24.40 per 100,000 people), followed by Mississippi, Wyoming, and New Mexico (24.23, 22.33, and 22.27 per 100,000, respectively). Conversely, Massachusetts had the lowest gun death rate (3.40 per 100,000 people), followed by New York, New Jersey, and Hawaii (3.94, 4.13, and 4.42 per 100,000, respectively). 72

Age-adjusted gun death rate, 2019

• 3.40 to 8.70
• 8.71 to 14.01
• 14.02 to 19.32
• 19.33 to 24.40

For all forms of gun violence, males die at much higher rates than females. 72 In 2019:

• 87% of firearm suicide decedents were male
• 84% of firearm homicide decedents were male
• 90% of unintentional firearm decedents were male
• 96% of police-involved shooting decedents were male

Firearm Suicide Deaths by Sex, 2019

Firearm homicide deaths by sex, 2019, unintentional firearm deaths by sex, 2019, police-involved shooting firearm deaths by sex, 2015-2020.

Source: Washington Post.

By Race, Ethnicity, and Age

Overall: 73

• Firearm suicide rates are highest among White people, followed by American Indian/Alaska Native people. Firearm suicide risk is highest among people age 75 and older across the population as a whole, but that is primarily due to the very high rate of suicide among White males in that age group. Firearm suicide rates peak at younger ages (ages 20-34) for American Indian/Alaska Native, Asian, and Black males and females.
• Firearm homicide rates are highest among Black people as compared to people of other racial and ethnic identities and firearm homicide risk is highest among people ages 20-34 across the entire population.
• Unintentional firearm death rates are highest among American Indian/Alaska Native and Black Americans, followed by White Americans. Nearly one-quarter of all unintentional firearm decedents are 0-19 years old.
• Police-involved shootings disproportionately affect Black Americans and Hispanic/Latino Americans. Black Americans are killed in police-involved shootings at more than twice the rate of White Americans. Hispanic/Latino Americans are killed by police-involved shootings at nearly twice the rate of White Americans. 74

Stop gun violence in all its forms through a multifaceted public health approach.

Gun violence is a complex issue requiring many approaches to its prevention. We are committed to evidence-based policies, programs, and practices and ensuring that all of these preventative measures are designed and implemented equitably. To stop gun violence in all its forms:

• Apply the public health approach for effective gun violence prevention. See Public Health Approach for more information.
• Fund and conduct gun violence research, which is fundamental for effective gun violence prevention. See Gun Violence Research for more information.
• Enact and implement policies, programs, and practices that create time and space between individuals who may be at risk of suicide and firearms. See Firearm Suicide for more information.
• Enact and implement policies, programs, and practices that reduce easy access to firearms by people at risk of interpersonal violence and invest in interventions that address the root causes of gun violence in structurally disadvantaged communities. See Firearm Homicide , Community Violence , and Nonfatal Injuries for more information.
• Expand both federal and state domestic violence firearm prohibitions to reduce abusers’ access to firearms and improve collection and reporting of domestic violence related data. See Domestic Violence for more information.
• Enact and implement policies that reduce easy access to firearms by people at elevated risk of interpersonal violence and ban assault weapons and large capacity magazines that increase lethality in mass shootings. See Mass Shootings for more information.
• Implement programs and practices that promote safer firearm storage and handling. See Unintentional Shootings for more information.
• Train healthcare professionals on lethal means safety counseling so they are prepared to ask patients about firearm access and provide effective and respectful counseling when appropriate. See Lethal Means Safety Counseling for more information.
• Enact and implement a true universal background check law that requires background checks on all gun sales and transfers, including private and online sales, and eliminate “default proceed” sales. See Universal Background Checks for more information.
• Enact and implement state extreme risk laws to prevent tragedy before it occurs and support robust implementation through federal funding. See Extreme Risk Laws for more information.
• Reinstate the federal ban on assault weapons and large capacity magazines. In the absence of federal action, states should continue to enact and implement assault weapons and large capacity magazine bans. See Assault Weapons and Large Capacity Magazines for more information.
• Focus gun violence prevention policies on evidence-based risk factors — not mental illness. Use appropriate language and avoid harmful stereotypes. See Mental Illness for more information.

Educational Materials

• A Public Health Crisis Decades in the Making: A Review of 2019 CDC Gun Mortality Data
• Gun Violence in America: An Analysis of 2018 CDC Data
• Gun Violence in America: Data Brief

Fact sheets

• Overview of U.S. Gun Deaths: 2020
• United States Gun Deaths: 2019
• Guns Don’t Make You Safer    
• Staying Safe At Home    
• December 2018 op-ed in The Hill , Five gun violence prevention priorities for the incoming Congress
• June 2018 blog, On Wear Orange Day, we must focus on gun violence in all its forms
• November 2017 op-ed in The Hill ,  The path forward for Democrats starts with gun violence prevention
• Anglemyer A, Horvath T, & Rutherford G. (2014). The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis . Annals of Internal Medicine.
• Bangalore S & Messerli FH. (2013). Gun ownership and firearm-related deaths. American Journal of Medicine.
• Choron R, Spitzer S, & Sakran JV. (2019). Firearm violence in America: Is there a solution? Advances in Surgery.
• Dahlberg LL, Ikeda RM, & Kresnow MJ. (2004). Guns in the home and risk of a violent death in the home: findings from a national study. American Journal of Epidemiology.
• Grinshteyn E & Hemenway D. (2019). Violent death rates in the U.S. compared to those of the other high-income countries, 2015. Preventive Medicine.
• Kalesan B, Villarreal MD, Keyes KM, & Galea S. (2016). Gun ownership and social gun culture. Injury Prevention.
• Karp A. (2018). Estimating global civilian-held firearms numbers. Small Arms Survey.
• Knopov A, Sherman RJ, Raifman JR, Larson E, & Siegel MB. (2019). Household gun ownership and youth suicide rates at the state level, 2005–2015. American Journal of Preventive Medicine.
• Miller M, Azrael D, & Hemenway D. (2002). Rates of household firearm ownership and homicide across U.S. regions and states, 1988-1997. American Journal of Public Health.
• Miller M, Hemenway D, & Azrael D. (2007). State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003. Social Science & Medicine.
• Monuteaux MC, Lee LK, Hemenway D, Mannix R, & Fleegler EW. (2015). Firearm ownership and violent crime in the US: an ecologic study. American Journal of Preventive Medicine.
• Parker K, Horowitz JM, Igielnik R, Oliphant JB, & Brown A. (2017). America’s complex relationship with guns. Pew Research Center.
• Reeping PM, Cerdá M, Kalesan B, Wiebe DJ, Galea S, & Branas CC. (2019). State gun laws, gun ownership, and mass shootings in the US: cross sectional time series. British Medical Journal.
• Siegel M, Ross CS, & King C. (2014). Examining the relationship between the prevalence of guns and homicide rates in the USA using a new and improved state-level gun ownership proxy. Injury Prevention.

Additional resources

• Reducing Gun Violence in America: Informing Policy with Evidence and Analysis by Daniel Webster and Jon Vernick.
• Gunfight: The Battle Over the Right to Bear Arms in America by Adam Winkler.

Last updated February 2021

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© 2020 Educational Fund to Stop Gun Violence Information on this website does not constitute legal or medical advice. Every factual situation is unique; if you want advice specific to your particular circumstances, you should consult knowledgeable counsel or medical personnel.