Gun Violence as a Public Health Crisis: An Update | Milken Institute Future of Health Summit 2022

Current Statistics and Public Health Impact

• Gun violence is now the number one cause of death for U.S. children and adolescents (19 and under), surpassing automobile fatalities.
• During the pandemic, the rate of firearm-related injuries in Washington, D.C. hospitals nearly tripled, rising from 10–12% of all trauma victims to 35% in a single year.
• Current firearm injury rates in D.C. remain elevated at 24–25%, which panelists assert will not revert to pre-pandemic levels due to a permanently flooded gun market.
• Approximately 60% of all gun deaths in the U.S. are suicides, often impulsive acts where access to a firearm increases the completion rate to roughly 90%, compared to 3% for other methods.
• Nine children are killed or injured daily in the U.S. by loaded firearms found in their own homes.
• 75% of school shooters obtain their weapons from unsecured locations within a home.

Legislative and Policy Developments

• The Bipartisan Safer Communities Act (BSCA) was passed with 12 Republican votes, providing millions in funding to train medical professionals, law enforcement, and the public on Extreme Risk Protection Orders (ERPOs).
• The BSCA addresses the failure to fund gun violence research, securing $25 million annually for the CDC and NIH after 20 years of zero funding.
• Brady United Against Gun Violence notes that the Brady Law has prevented over 4 million gun sales to prohibited purchasers over 30 years.
• California is the only state currently mandating background checks for ammunition sales, though a federal bill to replicate this is pending.
• The Supreme Court decision in Bruen overturned New York's 109-year-old concealed carry permitting system, establishing a new standard that panelists argue is hostile to public safety balances.
• Panelists criticize "state-level preemption" laws that prohibit local communities and school boards from enacting their own safety measures, urging the repeal of these restrictions.

Medical and Societal Observations

• Dr. Bob Serrani clarifies that most firearm assailants are not mentally ill, and the messaging that better mental health care alone would solve gun violence is "factually incorrect."
• The "demand side" of gun violence in urban areas is driven by a perception that "everyone else has a gun," leading to cycles of retaliatory violence and weapon carrying.
• A 15-year-old patient at George Washington University Hospital survived a shooting through which bullets passed his heart, liver, and stomach, only to be shot again three more times before dying four years later.
• Healthcare providers face significant secondary trauma; nurses report high rates of emotional distress watching young patients die or suffer permanent injury, compounding the burden of the pandemic.
• Communities experience "societal trauma" where children learn to hide from gunshots; an East St. Louis preschool was noted teaching children where to hide upon hearing gunfire.
• Research suggests trauma from gun violence is intergenerational, with stress from violence in utero impacting the resilience and ability to handle stress of unborn children.

Systemic Barriers and Industry Influence

• The firearm industry's business model relies on "flood the market" strategies similar to the tobacco industry, targeting younger demographics and normalizing ownership for life.
• Only 5% of federally licensed firearm dealers are responsible for 90% of guns recovered in crime, yet the ATF is unable to publish this list due to lobbying by the NRA.
• There are currently more gun dealers in the U.S. than McDonald's and Starbucks combined, yet federal regulations allow one in five guns to be sold without a background check (at gun shows or online by private sellers).
• Panelists argue that the ease of purchasing high-capacity automatic weapons, which can kill 10–20 people in milliseconds, presents a technological mismatch with the era of the Second Amendment's drafting.
• The "good guy with a gun" myth is cited as a persistent but unsubstantiated rationale for arming citizens, with evidence suggesting it does not outweigh the risks of accidental or retaliatory shootings.

Future Outlook and Demographic Shifts

• Gen Z and younger Millennials view gun violence as a top-three or top-four political issue, significantly driving election outcomes in 2018, 2020, and 2022 compared to older voters.
• Panelists anticipate a cultural shift similar to the anti-smoking movement of the 1970s and 80s, where physicians and social norms eventually discourage gun ownership in homes.
• Proposals for "gun insurance" are discussed, suggesting that insurers should assess risk and require safety protocols (like safe storage) for homes with firearms, similar to pools.
• Advocates are pushing for the expansion of the Brady Law to close loopholes for private sales and the implementation of an assault weapons ban via executive action or Congress.
• Efforts are underway to leverage sports influencers (e.g., Steve Kerr) and corporate platforms (e.g., MLB, NFL) to promote safe storage and change social norms around gun violence.
• The panel emphasizes that solutions must be multi-sectorial, combining policy changes with social norm shifts, similar to the multi-pronged approach used to reduce automobile fatalities.