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Public Health and the Need for Gun Violence Research

Bullet holes in a front windshieldOn average, gun violence kills 33,000 Americans each year.

Over the 2016 Christmas weekend, 27 Chicago citizens were shot, seven of them fatally. While studying in a Chicago medical school in 2011, I saw the effects of gun violence firsthand. It saddens me to know that six years later, little if anything has changed. In 2016, Chicago reported 745 homicides, a 56 percent increase over 2015 and the first time in over 20 years that the city reported more than 700 homicides.

Gun violence is often framed as a divisive, partisan political issue. As a physician, I instead see it as a major public health issue. It’s been an epidemic for years and the disease continues to spread. A distinct lack of public health research into decreasing gun violence has left our country without any viable comprehensive solutions. Only by increasing funding for research into this epidemic can we begin to study and solve the problem.

In my work in the Bronx, I see the daily impact of environmental factors on my patients’ lives and health For example, I have a patient suffering from serious asthma. We were able to get her symptoms under control only when the construction across the street from her home stopped. On a daily basis, I read medical research on such issues as how decreasing pollution helps patients with asthma, and how increasing the availability of fresh foods and vegetables helps combat obesity. The National Institutes of Health and the Centers for Disease Control (CDC) facilitate studies to research these problems and offer solutions to inform policy makers.

Gun violence is part of the environment. Where, then, is the research to inform policy on this environmental challenge affecting the health of a number of my patients and our citizens?

Stifling gun violence research

In 1996, Congress stripped the CDC of $2.6 million devoted to researching this issue. The “Dickey Amendment,” named after Rep. Jay Dickey of Arkansas, declared, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” From 1996 to 2013, CDC funding for this research decreased by 96 percent and the CDC effectively stopped studying and making research-based recommendations on one of America’s leading health problems. (In 2014, the CDC reported that gun violence mortality equaled 10.6 deaths for every 100,000 people—approximately equal to that for motor vehicle accidents.)

I see firsthand the effect that the resulting lack of research has taken on my patients. The consequences are not limited to those who are shot; they also affect their families, friends and communities. There are patients who now suffer from heart disease and diabetes because they are too worried for their safety to go outside and exercise; there are elderly individuals who suffer from anxiety and panic attacks after seeing their families and friends suffer; there are children who are skipping health classes because they are afraid to go to school.

The future of research funding

It took the Sandy Hook elementary school shooting in 2012, in which 20 six- and seven-year-old children were killed, to get Congress finally to consider restoring funding. Even Rep. Dickey flipped his position, stating “somehow or some way we should slowly but methodically fund such research until a solution is reached. Doing nothing is no longer an acceptable solution.”

Now, in 2017, some funding has been restored, yet the CDC has little to show for it. Given gun violence’s role in U.S. deaths, we should expect up to $1.4 billion annually to be allocated for this research. Yet only $22 million was provided for this research in 2016. Without adequate funding, research cannot be completed, and without research, evidence-based policies cannot be recommended. Without evidence-based policies, there is little hope for the future of my patients’ health.

Editor’s Note: A version of this blog post first appeared on KevinMD.com.

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Ashley Ceniceros, M.D., M.P.H.,

Ashley Ceniceros, M.D., M.P.H.,

Ashley Ceniceros is a second-year resident physician in Einstein-Montefiore's primary care and social internal medicine program. She plans to pursue a career addressing the social determinants of health both in clinical and community settings.

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