How many more must die from firearm violence?

Once again, the headlines are dominated by a gruesome mass shooting, this time resulting in the deaths of 19 school children and two teachers in Uvalde, Texas, right on the heels of the white supremacist attack in a Buffalo, New York supermarket that killed 10 people. Public mass shootings have profound impacts on survivors, families, and communities of victims, and the wider public's feelings of safety. Concerningly, a new FBI report shows a significant increase in "active shooter" attacks since the start of the pandemic. 

These types of events are the tip of the iceberg when it comes to the devastation wrought by firearm violence, as mass shootings account for less than 1% of all firearm deaths. And the problem is getting worse: in 2020, the U.S. saw its highest rate of firearm homicide in 25 years. That year, the most recent for which CDC data are available, 268 children ages 0-12 were killed in firearm homicides -- the equivalent of the shooting in Uvalde every 26 days. 

According to a recent report from the CDC, there were 19,350 firearm homicides in the U.S. in 2020 -- 53 deaths per day. This rate (6.1 firearm homicides/100,000 people) was up nearly 35% from the preceding year and 75% over the previous decade. When combined with the 24,245 firearm suicide deaths that year, 2020 reinforced our country's exceptionally when it comes to gun-related deaths: the U.S. far outpaces all other wealthy countries, despite unmatched spending on policing, imprisonment, and healthcare. 

Notably, the increase in firearm homicides in 2020 was not spread equally across the population. The highest increases in firearm homicide rates were seen among young, Black males, and people living in high poverty areas. These groups already bore an unequal burden of firearm homicide compared to white, wealthy Americans, but 2020 widened the gap. And that gap is stark: Black boys and men 10-24 years old experienced a firearm homicide rate 21.6 times higher than white males of the same age group. 

There are many possible contributors to this upward trend: pandemic-related stress resulting from stay-at-home orders; increased concerns about physical illness, social isolation, and financial strain; increased grief and rage following the televised murder of George Floyd and subsequent protests and incidents of police brutality; political turmoil surrounding the 2020 presidential election; and collective loss and trauma at living through all this chaos. Most of these factors disproportionately burdened historically marginalized communities because of the ongoing legacy of structural racism in the U.S., and each of these core disruptions in 2020 likely compounded to drive the rise in firearm homicides. 

Further, the U.S. has the most civilian guns per capita of any country and experienced a gun purchasing surge in early 2020, perhaps unsurprising timing given that fears about personal safety and civil unrest are common motivations for gun procurement. Calls for policy action on guns, as are particularly prominent following public mass shootings, are well-founded. Research consistently links the presence of more guns with more gun homicides. Prevention strategies focusing on access to firearms, such as firearm purchaser licensing laws, domestic violence-related firearms prohibitions, and strategies focused on individuals at highest risk for violence all have the potential to reduce firearm homicide. 

While addressing firearms access is a crucial risk reduction step, we must go further by investing in strategies to address the deep-rooted social and economic drivers of violence.

Communities that have been subjected to historic and persistent racial oppression and disinvestment are those now suffering the highest rates of firearm homicide. This is no coincidence. The concentrated disadvantages resulting from that legacy, including poverty, under-funded schools, unemployment, over-policing and police violence, mass incarceration, and limited access to affordable healthcare, housing, and green spaces, are all associated with increased risk for exposure to and involvement in violence. Some of these factors have also contributed to widespread skepticism and distrust of police and the criminal legal system, which is linked with decreased feelings of safety and increased firearm acquisition, thus further perpetuating cycles of violence. These same communities were also disproportionately burdened by the social, health, and economic impacts of 2020. 

Immediate and long-term investments in people and communities most impacted are needed to close the inequity gaps and reduce risk of firearm violence. Interventions like ensuring access to affordable housing, food, and healthcare, high-quality education, stronger employment protections, living wages, and other protections for social and economic stability (e.g., reparations or universal basic income) all serve to strengthen communities and reduce violence. 

Society- and community-strengthening investments will also improve collective efficacy -- the combination of social cohesion and capacity for a community to achieve a common set of goals -- which is a protective factor against community gun violence. Collective efficacy, like community-police relations, has been negatively impacted by the health and economic disruptions of COVID-19 and co-occurring period of social and political turmoil. However, both can be repaired. The people in and from impacted communities possess knowledge and experiences that make them uniquely qualified to reimagine safety and remedy the cycles of trauma and violence in their communities. Therefore, shifting power and resources to community-led safety practices, policies, and violence prevention efforts is another strategy to improve collective efficacy, increase feelings of safety, and reduce firearm death. 

From the publicly grieved mass shootings -- Uvalde being only the latest horrifying example -- to the quieter epidemic that has been smoldering every day for decades, firearm homicides are devastating families and communities across the country.

But it doesn't have to be this way. In addition to enacting life-saving firearm policies, we must invest in historically marginalized communities and support community-driven violence prevention. Through this multidimensional approach, we can create a safer, healthier, and more equitable future. The time to act is now. 

Originally published in MedPage Today

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