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Doctor organization declares gun violence ‘public health threat’

“Firearm violence is not only a criminal justice issue but also a public health threat,” the group’s position paper states.

Dr. Vivek Murthy, President Obama’s surgeon general nominee, has asserted  “guns are a health care issue,” based on treating gunshot victims. 

He’s not alone, which became even clearer on Thursday when the American College of Physicians (ACP), the country’s second-largest physician group, issued a new policy recommendations to reducing gun-related injuries and death.

“Firearm violence is not only a criminal justice issue but also a public health threat,” the group’s position paper states. “A comprehensive, multifaceted approach is necessary to reduce the burden of firearm-related injuries and deaths on individuals, families, communities, and society in general.”

And that burden is enormous, as the paper details. Each year, gun-related homicides, suicides and accidents kill more than 32,000 Americans. That’s about 88 deaths each day — the equivalent of “a good-sized airplane crash every three days,” as Dr. Molly Cooke, the president of the ACP, told Washington Post reporter Lenny Bernstein.

Another 73,000 people are injured every year from gunshot wounds. Many of those wounds lead to permanent and often devastating disabilities.

Number #1 in the world

The actual number of injuries is probably much higher, the ACP paper acknowledges. Research suggests that current reporting practices cause many gun-related injuries to be misclassified, particularly when children are the victims.

Furthermore, U.S. gun-related death rates still remain the highest in the industrialized world.

Though the rate of gun-related murders may have decreased by almost half since its 1993 peak, the number of gun-related deaths is down a smaller 20 percent (39,595 in 1993 versus 31,672 in 2010).

Some studies have reported that guns can serve a protective function, but the ACP notes that evidence suggests that guns are much more likely to end up killing or maiming someone for a reason that has nothing to do with self-defense.

One study involving data from three U.S. cities found, for example, that “for every time a gun was used in self-defense or for a legally justifiable reason, there were 4 accidental shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides.”

Witnesses to the devastation

Why should physicians care about firearm injury prevention?

“Whether it is a 75-year-old widower who commits suicide; a 17-year-old who accidentally shoots himself; a 20-year-old bystander killed on a city street; or a horrific mass shooting, such as the one that occurred in Newtown, Connecticut, physicians witness first-hand the devastating consequences of firearm violence for victims and their families,” the ACP explains in its position paper.

The group also notes that its own ethics manual states that “physicians should help the community and policy-makers recognize and address the social and environmental causes of disease, including human rights concerns, discrimination poverty, and violence.”

And, indeed, physicians may be uniquely positioned to make a difference in gun-related deaths and injury. Research has shown that even brief safety-related gun counseling from physicians can have a positive effect on how patients store their guns.  One study found, for example, that 64 percent of patients made safe changes in the storage of their guns after receiving gun-safety advice from their physicians compared to 33 percent who receive no such advice.

And 12 percent of the study’s participants who received gun-safety advice from their physicians reported removing the guns from their homes altogether.

Nine recommendations

Here are brief summaries of the nine recommendations in the ACP’s new policy paper:

  • Gun safety needs to be approached as a public health issue, and policy decisions related to guns need to be based on scientific evidence.
  • Doctors have a special responsibility to speak to patients and the general public about the prevention of gun-related injuries and deaths, and they should be protected from laws that interfere with their ability to talk with patients on this health issue.
  • The purchase of legal firearms should be appropriately regulated, including the implementation of universal background checks.
  • Guns should be subject to consumer-product regulations, including the required use of tracer elements or taggants on ammunition and weapons.
  • Firearm owners should be encouraged to “adhere to best practices” in regard to gun safety. The ACP supports laws that would require gun owners to report the theft or loss of a gun within 72 hours of becoming aware of the loss so that law enforcement officials can attempt to track down the gun.
  • Greater efforts should be undertaken to ensure that individuals with a mental illness who are at risk of hurting themselves or others receive care and treatment. The ACP cautions, however, “against broadly including those with mental illness in a category of dangerous individuals.”
  • Effective legislation to ban the sale and manufacture of assault weapons needs to be enacted.
  • Efforts should be undertaken to improve and modify firearms to make them as safe as possible, including the use of trigger locks and other built-in safety devices.
  • Government agencies like the Centers for Disease Control and Prevention and the National Institutes of Health should provide more funding for more research on gun violence and on effective strategies for reducing injuries caused by guns. Furthermore, access to gun-related data should not be restricted

The policy paper was published Thursday in the ACP’s Annals of Internal Medicine, where it can be downloaded and read in full.

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Comments (7)

  1. Submitted by Steve Titterud on 04/12/2014 - 03:00 pm.

    Here comes the NRA – of course, in opposition…

    …to consider gun violence as a public health issue.

    I wonder what kind of issue they think 32,000 deaths per year is, anyway ?

    In a letter to Senators, the NRA opposes the current nominee to the post of Surgeon General precisely because he views gun violence as a public health issue. They villify him in their public pronouncements on the issue as well.

    See http://thinkprogress.org/health/2014/02/27/3337931/vivek-murthy-nra-guns-public-health/

  2. Submitted by Dennis Tester on 04/13/2014 - 10:20 am.

    Here’s an idea

    that would go to the heart of the gun violence that the ER doctors are most likely to see on a daily basis:

    Using police and emergency room statistics, identify those city blocks where gun violence is most prevalent. Start with the 5 city blocks most likely to be the source of gun violence. Use the SWAT team to go door to door and confiscate all unlicensed firearms in each home or apartment on that block and charge each gun owner with unlawful possession of a firearm, a felony.

    Once you’ve pulled that off successfully, we can talk about measures that will affect the law-abiding citizenry.

  3. Submitted by Bill Gleason on 04/13/2014 - 07:04 pm.

    Mr Tester

    I’d suggest that you get up to speed on Minnesota gun laws, Mr. Tester:

    “No state permit is required to possess a rifle, shotgun, or handgun.”
    What are the Gun Laws in Minnesota? http://ow.ly/vKdvH

    What you have proposed in the second paragraph is unconstitutional.

  4. Submitted by Steve Rose on 04/14/2014 - 09:12 am.

    Policy Papers

    I will be interested in reading the ACP’s policy paper on this “public health threat” once they have taken on the bigger dangers in our society.

    For reference, here is a link to the ACP policy papers,

    From NPR News:

    “Nearly a million children worldwide die every year as a result of unintentional injuries, and the biggest killer is traffic accidents, according to a report from the World Health Organization. The report said traffic accidents, followed by drowning, fires and burns, falls, and poisoning, are the five major causes of unintentional injuries. About 830,000 children under 18 die every year, and millions more children suffer disabling injuries that could have been prevented”


    Firearms deaths aren’t in the top five globally nor in America. Let’s consider the biggest one, traffic deaths and injuries. How many children could be saved if we imposed a national speed limit of 30 MPH. I think this one change could save the lives of about 1000 children each year. The only problem with my proposal is that it would be terribly inconvenient. So, the lives of these children is a price that we readily pay to travel between points A and B swiftly.

    When we as a society take action on the major causes of unintended deaths and injuries, I will interested in addressing the minor threats, those not in the top five.

  5. Submitted by Bill Gleason on 04/14/2014 - 11:32 am.

    Gun deaths are not a minor threat to black kids

    “African-American children and teens represented 45 percent of all guns deaths in their age group in 2008 and 2009, but only 15 percent of the total U.S. population of children.

    The top cause of death for black teens ages 15 to 19 was gun homicide, while for white teens it was motor vehicle accidents followed by gun homicides.”

    link: http://ow.ly/vLXii
    Children’s Defense Fund report on kids’ gun deaths, new gun laws

    Denial is not going to make the problem go away.

    • Submitted by Steve Rose on 04/14/2014 - 03:51 pm.


      Denial is finding one age segment of one race (and mainly one gender), and using that to define the scope of the problem. The term is cherry picking. Ambiguously mixing terms like “teens” and “children” in the same sentence helps to obscure the truth about children. 18 and 19 year old people are adults.

      In round numbers, and for the most recent available year’s data, there are over 34,000 highway fatalities each year in the U.S.; over 400 of those are in Minnesota. Almost all of these are accidental deaths, not people trying to kill one another. Yet, no ACP policy paper. I might find that curious if not for the message between the lines of the ACP paper; their agenda is showing It is customary to apply a thin veneer, to provide cover for the propaganda. Poorly played on their part.

    • Submitted by Steve Rose on 04/15/2014 - 12:29 pm.

      Hit a pit in your cherry pie?

      It is disingenuous for an organization to feign concern, to present a facade of social conscience, while overlooking the biggest problems we collectively face as a society. The silence of having no position paper about the 90+ daily highway fatalities is complicity; it accepts that the wheels of commerce and convenience are lubricated by the blood spilled on our nation’s roads. Either get in the game or stand on the sidelines. You can try to do both, but I for one am here to call you out.

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