We Don't Know Enough About Gun Injuries. That's Hurting Local Economies
On Oct. 21, the District of Columbia hit a grim milestone for the year — 10 assaults with a firearm in one day. Data from the Metropolitan Police Department also showed 140 gun deaths since January, outpacing last year’s numbers with two more months to go on the calendar.
A 2017 report by the Urban Institute found that gun homicide surges have a strong correlation with economic outcomes in the District. Every 10 additional gunshots in a census tract each year is associated with 20 fewer jobs among new establishments, one less new business opening, and one more business closing the same year.
Researchers are studying the economic cost of firearm injury as a mechanism for data-driven policy decisions to prevent violence. But a 20-year lapse in gun violence research by the federal government has made it harder for local governments to react quickly to recent surges.
Named for its author, Republican Arkansas Rep. Jay Dickey, Congress passed the Dickey Amendment in 1996 — which prohibited the Centers for Disease Control from using funds available for injury prevention to “advocate or promote gun control.” The amendment was added to an appropriations bill after intense lobbying efforts by the National Rifle Association following a CDC-funded report in the New England Journal of Medicine that outlined the risks of gun ownership in the home, and was part of every spending bill for 20 years.
The result was a chilling effect on federally funded gun violence research.
In 2018, as firearm injuries emerged as a leading public health crisis, House Democrats agreed to keep the Dickey Amendment in place if Senate Republicans would attach a clarification to the amendment that would no longer prevent federal health agencies from studying gun violence altogether. With the change, Congress allocated $25 million in federal funds each to the CDC and National Institutes of Health for gun violence research last December for the first time in 20 years.
But the delay in large-scale data collection and study has made it tough for city and state governments to meet this moment according to Megan Ranney, chief research officer for the American Foundation for Firearm Injury Reduction in Medicine. “They don’t fully know what works,” she says. “Ideally, our local governments should not be investing money in solutions, unless they have some confidence that that solution is really going to make a difference.”
Take the number of COVID-19 patients in the United States, for example. Ranney says developing large patient databases has helped us better understand who is at risk of getting sick and what interventions work to prevent death. We can also gain a basic understanding of how much this disease is costing the health care system. The lack of similar data for firearm injury makes injury prevention extremely difficult for local governments.
“Because of the lack of federal funding over 24 years, we don’t have these same longitudinal data sets for firearm injury,” Ranney says. “We don’t even know exactly how many people were injured last year from a gun in the United States. So it’s impossible to accurately estimate the cost when we don’t even have the basic numbers to agree upon.”
Joseph Richardson at the University of Maryland, directed the Violence Intervention Research Project for the University of Maryland Shock Trauma Center from 2017-19. His research examined the risk factors for repeat visits to the emergency room for trauma wounds among Black youth admitted to the hospital from around the Washington metro region. Like Ranney, Richardson has conducted his research on shoestring budgets in the absence of large federal grants — and that’s had a negative impact on finding new ways to study the issue.
“For almost 25 years there was no funding for gun violence research, which affected the pipeline of gun violence researchers,” Richardson says. “What emerging scholar would enter a field of research where there was no promise of funding?”
Even with the new funding available this year, both Ranney and Richardson say it’s really not enough. “Considering that around 35,000-40,000 people are killed with guns every year and another 100,000 non-fatal, this should be a federal priority and it’s not,” Richardson says in an email.
Filling In The Gaps
D.C. Ward 5 Councilmember Kenyan McDuffie proposed a bill last year for the city government to fund a new gun violence research center in an attempt to truly learn which prevention strategies work best. At that time in 2019, McDuffie cited a 54% year-over-year increase in gun homicides. The center was to be modeled after the California-based Firearm Violence Research Center and was intended to be housed at a research institution in the District.
“I’ve had many conversations with residents about the violence taking place across communities. We talked about their grief, fear, and feelings of helplessness. Violent crime is a public health crisis and we need a holistic, evidence-based approach grounded in research to combat this issue,” McDuffie says in a statement at the time.
The bill was first introduced in 2018 and received a public hearing, but did not advance to the D.C. City Council’s Committee on the Judiciary and Public Safety until it was reintroduced in February 2019. It has yet to receive a public hearing.
Private organizations have had to step up over the years to fill the void in research left by the federal government. Ted Miller is a health economist and senior scientist for the Pacific Institute for Research and Evaluation. His job is to find the true economic impact of firearm injury to the United States — and just to clarify, a death is still considered an injury by the Pacific Institute’s standards.
According to Miller’s research, the U.S. paid about $280 billion in 2017 dollars for firearm injuries. That Includes medical costs and mental health care for victims and their families, and incorporates many other financial factors like loss of work, income tax revenue over time, and quality of life.
“It [also] includes police investigation, criminal justice, courts, jails and prisons. It includes the work that a perpetrator loses if they wind up in jail.” And according to Miller, state and local governments paid about $20 billion of that bill.
“Fatalities dominate the costs, and that’s because of the loss of quality of life and lost future earnings. People who die of firearm injuries are often fairly young. And they lose essentially a lifetime of earnings.”
Sounding The Alarm In Congress
The Democratic staff of Congress’ Joint Economic Committee released a report in September 2019 that used non-government research sources to estimate the cost of gun violence by state. The report suggests the federal government should be collecting this data to really understand the totality of these costs.
“If it’s 1.4% of the GDP, as estimated by other sources, that’s something that we should be looking at. And if there is any increase or higher rates on a local level, that is very alarming and we obviously have a responsibility to understand the patterns,” says Sol Espinoza, a senior researcher for the report.
The report estimates that Maryland, for instance, lost $1.3 billion in directly measurable costs — like loss of income and cost to the criminal justice system — that may otherwise have been prevented. Virginia’s annual cost of gun violence is over $5 billion according to the report, breaking down to about $641 per resident.
In Ohio, gun violence accounts for 1.1% of the state GDP, with suicide accounting for 61% of gun deaths. According to the report, both the suicide rate and gun death rate among 15- to 24-year-olds in Ohio is above the national average. Gun deaths result in $820 million in lost income for Oregon — more than 22 times the cost of shootings to the health care system.
“The pandemic does create a context to really push for the need for this real-time data,” Espinoza says. “It’s very difficult to understand what these effects might be if we don’t have that real-time data.” Absent this data, Congress also relied on research from Miller, produced as part of a Mother Jones investigation into the true cost of gun violence.
The Pacific Institute’s Miller says the information the federal government does have regarding the cost of firearm injury is related only to the cost of the injury itself. It doesn’t include the ripple effect of a violent event. Miller often contextualizes this fact by comparing it with motor vehicles, something U.S. regulatory agencies have been collecting data on for decades. According to Miller, Americans own more guns than they own motor vehicles by a long shot.
“Americans had about 360 million guns and 250 million motor vehicles [in 2016]. But far more households own motor vehicles,” Miller says. Only around 40% of households currently own firearms, and that number continues to rise.
But Miller says the cost of firearm injury per household with guns is higher than the cost of motor vehicle injury per household with motor vehicles: “It’s about $5,200 per household with guns for [firearm injury] costs, and about $4,900 per household for motor vehicle crash costs. Firearm injuries cost about 1.75 times [what] alcohol impaired driving [costs] annually, and we know how much we do about alcohol impaired driving.”
According to Ranney, “It’s not just about homicide.” She says it’s really important that decision-makers understand firearm injuries are a wider issue than just shootings and intentional violence in communities.
“It’s also about suicide and unintentional injury. It’s about the effect of a firearm suicide on a family or on a community. It’s about looking at the ripple effect across generations of exposure to every type of gun injury and death,” Ranney says. “And those impacts have been largely ignored.”
Ranney says she and other researchers in the field are hoping to create a more holistic approach in finding out the true cost of these injuries and the economic benefit to preventing them.
‘A Perfect Storm’
According to a 2019 national poll by American Public Media, most Americans are not aware that suicides are the leading cause of gun death in America by far. Although the murder rate in the United States is well above other developed nations, gun homicides account for around 12,000 deaths per year — compared with 23,854 suicides by firearm in 2017, according to the U.S. Centers for Disease Control and Prevention.
Firearm injury prevention researchers particularly worry that the risk factors associated with suicide are on the rise during the COVID-19 pandemic. “We know that there is a high overlap between hopelessness, desperation, access to lethal means — specifically an unsecured firearm — and risk of firearm injury and death,” says Ranney. “This pandemic really seems to present the perfect storm of all three.”
Miller says he tries hard to steer clear of advocating for a particular solution to these issues and studies the costs of firearm injury to provide objective data so any side of the violence prevention debate can use it to make a decision.
“I want cost to inform decision-making,” says Miller. “And when people start talking about the effects of firearm injury, I want them to be able to compare those effects to the effects of other problems in a fair way.”
Guns & America is a public media reporting project on the role of guns in American life.
Copyright 2020 Guns and America. To see more, visit Guns and America.