Matt
Active Member
Dak, I'm interested to know if there is any compromise you would agree with on this topic? Speaking mainly of Obama's proposals so far.
Gun Master Debate
- Thread starter King Richard
- Start date
Dak
mentat
Mathiäs;10562340 said:
There's absolutely nothing valuable in any proposals I've seen so far. They are either laughably ill-informed (The Feinstein bill) or broadly unenforceable (universal background checks). Biden already said we can't enforce existing gun laws. Why add more?
I've probably said it >100 times now on multiple boards: Anyone serious about reducing homicides should be working towards a repeal of the War on Drugs. Anyone doing anything else in regards to reducing homicides is absolutely not serious about the issue.
Edit: In fact, a chunk of the proposal's on the Administrations list is about expanding the police state (more money for cops). Hell the fuck no.
Edit2: The one thing that I think would be beneficial is to encourage (not force) responsibility. You do have a chunk of the population that owns guns that bought it, loaded it, and stuck it somewhere thinking they would obviously know how to use it properly should the need arise, because they have seen one fired a million times on tv/movies. Making it easier to build/operate ranges, along with an ad campaign encouraging professionally supervised training (if we are going to start spending tax dollars) would be much better. Hell, put some Marine or Spec Ops vets to work teaching proper weapons handling so we might reduce accidental discharges.
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848468/
Guns: Dangerous, Especially for Suicide, and Costly for America
Steven Lippmann, MD
Gun ownership is common in America. People report that they need them for safety and/or sport. However, having a firearm in the home actually increases the rate for suicide, homicide, domestic violence, and accidents. The presumed security is questioned, especially since owner and family suicide vastly outnumbers self-protective events. Gun-related suicide in America accounts for most of the violent death occurrences. This high suicide rate is shockingly under appreciated. The deaths, injuries, and disabilities significantly escalate healthcare costs, insurance premiums, criminal justice system expenses, and taxes. Nevertheless, regulation of firearms has neither been popular with the public nor legislatures; perhaps the degree of carnage might now kindle discussion about the way we control these weapons.
The Second Amendment to the Constitution states that, “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Despite current gun regulations, firearms can be bought at gun shows or privately from unlicensed dealers with no background checks.
In 2005, out of a total of 541 firearm-related deaths in Kentucky, 375 were gun-shot suicides (69%), homicides accounted for 143, accidents claimed 11, nine died in police shootings, and three fatalities were unspecified.1 During 2006 and 2007, again, approximately 70 percent of gun-shot deaths were suicides.1 Most Americans are unaware that gun-shot suicide occurs much more often than all other shooting deaths combined. Suicide by gun fire is the fastest growing and most common means of suicide regardless of age, gender, race, or educational level. It is the leading cause of death in those who purchase firearms for the first time.2 Despite being obtained for personal security, 83 percent of gun fatalities in a home are suicide.3 Among 395 shooting deaths in Seattle during one year, 333 were by suicide, 41 were domestic violence incidents, 12 were accidents, and only nine involved an intruder.3 Women commit suicide three times as often when firearms are present in a home than in domiciles without them.4 Despite mental illness being an important factor, most suicide attempts are impulsive and done under stress, when upset and/or intoxicated, but without psychopathology. Awareness about the frequency of such unplanned acts is limited. Having firearms readily available increases the lethality of such impulsivity.
Guns are the most frequently used means involved in deaths by domestic violence, increasing the rate of killing an intimate partner. Five times as many women are shot to death in homes where such weaponry is available in contrast to households without them.4 Family member homicide is much more likely than stopping a trespasser. Sadly, many American children are shot to death every day.
Gun violence has a negative impact on society. Beyond death and disability, survivors of a shooting endure psychological trauma and grief. Violence-exposed children experience developmental consequences and adults also evidence personal compromise. Living in communities where fear of getting shot is common has detrimental effects on people and teaches inappropriate role modeling about responsible behavior to future generations.
Hospitals, trauma centers, and rehabilitation or nursing home facilities are flooded with victims of shootings. Acute healthcare expenditures for injured individuals are enormous and most of these patients are uninsured. The economic impact extends well beyond emergency treatment and continues with chronic dysfunction, rehabilitation, and long-term disability. Medical expense outlays increase for everyone, covered largely by government and ultimately affecting tax-payers. These costs inflate the price of medical, disability, and life insurance; escalating premiums are paid by companies, governments, and private individuals. Acute care medical bills for gun violence in the United States reportedly is over $4 billion per year, and it exceeds $100 billion annually, when including follow up and long-term care.5 A serious attempt to reduce healthcare costs, would include consideration at limiting gun usage.
Firearm use also adds to the expenses of police work, court prosecutions, legal involvements, and incarcerations, again borne by tax-payers. Loss of productivity, disability payments, and emotional or physical dysfunction all add to the cost. Guns are so much a part of our culture, that Americans have become accustomed to the resulting bloodshed and huge expenses.
Firearms have a negative impact on our society, both emotionally and physically. They heighten expenditures for us all in taxes and insurance premiums, but gun regulation still remains socially and politically controversial.
Americans can make choices. We should decide whether to accept our current status or whether a reassessment of our gun-regulation system is a potential legal alternative.
With regards,
Rupinder Johal, MD
Steven Lippmann, MD
University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences
William Smock, MD
Cynthia Gosney, RN
University of Louisville School of Medicine, Department of Emergency Medicine
Guns: Dangerous, Especially for Suicide, and Costly for America
Steven Lippmann, MD
Gun ownership is common in America. People report that they need them for safety and/or sport. However, having a firearm in the home actually increases the rate for suicide, homicide, domestic violence, and accidents. The presumed security is questioned, especially since owner and family suicide vastly outnumbers self-protective events. Gun-related suicide in America accounts for most of the violent death occurrences. This high suicide rate is shockingly under appreciated. The deaths, injuries, and disabilities significantly escalate healthcare costs, insurance premiums, criminal justice system expenses, and taxes. Nevertheless, regulation of firearms has neither been popular with the public nor legislatures; perhaps the degree of carnage might now kindle discussion about the way we control these weapons.
The Second Amendment to the Constitution states that, “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Despite current gun regulations, firearms can be bought at gun shows or privately from unlicensed dealers with no background checks.
In 2005, out of a total of 541 firearm-related deaths in Kentucky, 375 were gun-shot suicides (69%), homicides accounted for 143, accidents claimed 11, nine died in police shootings, and three fatalities were unspecified.1 During 2006 and 2007, again, approximately 70 percent of gun-shot deaths were suicides.1 Most Americans are unaware that gun-shot suicide occurs much more often than all other shooting deaths combined. Suicide by gun fire is the fastest growing and most common means of suicide regardless of age, gender, race, or educational level. It is the leading cause of death in those who purchase firearms for the first time.2 Despite being obtained for personal security, 83 percent of gun fatalities in a home are suicide.3 Among 395 shooting deaths in Seattle during one year, 333 were by suicide, 41 were domestic violence incidents, 12 were accidents, and only nine involved an intruder.3 Women commit suicide three times as often when firearms are present in a home than in domiciles without them.4 Despite mental illness being an important factor, most suicide attempts are impulsive and done under stress, when upset and/or intoxicated, but without psychopathology. Awareness about the frequency of such unplanned acts is limited. Having firearms readily available increases the lethality of such impulsivity.
Guns are the most frequently used means involved in deaths by domestic violence, increasing the rate of killing an intimate partner. Five times as many women are shot to death in homes where such weaponry is available in contrast to households without them.4 Family member homicide is much more likely than stopping a trespasser. Sadly, many American children are shot to death every day.
Gun violence has a negative impact on society. Beyond death and disability, survivors of a shooting endure psychological trauma and grief. Violence-exposed children experience developmental consequences and adults also evidence personal compromise. Living in communities where fear of getting shot is common has detrimental effects on people and teaches inappropriate role modeling about responsible behavior to future generations.
Hospitals, trauma centers, and rehabilitation or nursing home facilities are flooded with victims of shootings. Acute healthcare expenditures for injured individuals are enormous and most of these patients are uninsured. The economic impact extends well beyond emergency treatment and continues with chronic dysfunction, rehabilitation, and long-term disability. Medical expense outlays increase for everyone, covered largely by government and ultimately affecting tax-payers. These costs inflate the price of medical, disability, and life insurance; escalating premiums are paid by companies, governments, and private individuals. Acute care medical bills for gun violence in the United States reportedly is over $4 billion per year, and it exceeds $100 billion annually, when including follow up and long-term care.5 A serious attempt to reduce healthcare costs, would include consideration at limiting gun usage.
Firearm use also adds to the expenses of police work, court prosecutions, legal involvements, and incarcerations, again borne by tax-payers. Loss of productivity, disability payments, and emotional or physical dysfunction all add to the cost. Guns are so much a part of our culture, that Americans have become accustomed to the resulting bloodshed and huge expenses.
Firearms have a negative impact on our society, both emotionally and physically. They heighten expenditures for us all in taxes and insurance premiums, but gun regulation still remains socially and politically controversial.
Americans can make choices. We should decide whether to accept our current status or whether a reassessment of our gun-regulation system is a potential legal alternative.
With regards,
Rupinder Johal, MD
Steven Lippmann, MD
University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences
William Smock, MD
Cynthia Gosney, RN
University of Louisville School of Medicine, Department of Emergency Medicine
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pubmed/15522849
Guns in the home and risk of a violent death in the home: findings from a national study.
Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.
Guns in the home and risk of a violent death in the home: findings from a national study.
Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829336/
Firearm Injuries: Epidemic Then, Endemic Now
Katherine Kaufer Christoffel, MD, MPH
There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world.
The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.
IN THE UNITED STATES, firearm injuries are off the front pages, just a few years after they were identified as one of the leading problems facing the nation.1 Within the firearm injury prevention community, discussions about why have focused on the early-21st-century US political landscape. The factors discussed have included a shift in the focus of violence prevention to terrorism since September 11, 2001, and opposition by the Republican presidential administration to firearm regulation. Although these factors are surely relevant, it is necessary to consider whether the epidemiology of firearm injuries may have changed in ways that have promoted the shift in public attention.
I propose that there has been such a transition: firearm injury data in the United States has indicated a change from an epidemic phase (from the mid-1980s to the early 1990s) to an endemic one (since the mid- to late 1990s). My aim is not to prove a hypothesis but to begin a discussion about whether such a transition has occurred and its potential significance for efforts to prevent firearm injuries. To that end, I (1) present evidence suggesting that firearm injuries in the United States have passed from an epidemic to an endemic and (2) review what is known about links between endemic and epidemic conditions—including models of endemic disease management—and consider how this information might be applied to firearm injuries. I conclude with a call to open a wide-ranging conversation about endemic conditions.
For the purposes of this discussion, endemic conditions are ones that are always present in an area, and epidemic conditions are ones that are rising and are well above historic levels. Both condition counts and rates are relevant (the former perhaps more for public awareness, the latter for public health reckoning).
Go to:
HOW US FIREARM INJURY PATTERNS HAVE CHANGED.
There has been substantial stability in US firearm deaths since 1999 (range=27700–29200 annually; rate=9.8–10.2 per 100000 population).2 As seen in Figure 1 , which shows firearm death counts from 1910 to 2002, this stability is in sharp contrast to the rising tolls that were seen in epidemic periods (i.e., the 1920s–1930s, 1960s–1970s, and 1980s–1990s). The peak year of the most recent firearm injury epidemic was 1993, with a record 39595 gun deaths (15.4 per 100000). There was then a more than 25% decline in deaths to 28663 in 2000 (with a 34% fall in rates to 10.2 per 100000). Whereas gun deaths increased after 2000, reaching 30242 (10.5 per 100000) in 2002, the average 1% rise in rates from 1999 to 2002 was less than half the average 2.2% rise from 1987 to 1993; the largest single yearly rise was almost 7%, from 1989 to 1990. The death toll in 2003 was 30136 (10.3 per 100000).3
FIGURE 1—
Firearm deaths in the United States from 1910 to 2002.
Data on nonfatal firearm injuries are much less available than are data on fatalities. Figure 2 shows the available data for the period 2000 to 2004. After 2000, the annual number of medically attended injuries was 58 000–64 000 (20.4–21.9 per 100 000).2 This pattern is consistent with the recent pattern for deaths.
FIGURE 2—
Nonfatal firearm injuries in the United States from 2000 to 2004.
These flat trends mean that the current level of US firearm injuries has become routine to the general population, most of whom are not victims of gun violence. In this context, reduced public attention to firearm injuries is not difficult to understand.
In the 1990s, when US public health efforts to prevent firearm injuries began in earnest, the situation was different: US gun deaths and injuries had been rising for close to a decade,4 and young people were dying at unprecedented rates.5 Although this was especially true in inner cities, suburban areas were also beginning to feel the lap of the rising tide of injuries.
Prevention strategies were dictated by the understanding that public health and government officials were dealing with an emergency. The factors guiding prevention work were therefore those that were most salient under epidemic conditions: meeting the immediate burden on the health system related to recent and looming deaths and injuries, dealing with the near-term social consequences of this burden (e.g., fear, grief, anger, short-term lost income), and creating opportunities for immediate benefits (even ones that might not be long lasting).
With these priorities in mind, the largest coalition of medical and allied groups working to prevent gun deaths and injuries, the HELP Network (1993–2006), originally named the Handgun Epidemic Lowering Plan, was formed. Prevention work focused on death counts, public and clinical education aimed at immediate change,6–13 experiments with removing guns quickly from communities through buy-back programs,14,15 and policy initiatives designed to bring quick and measurable changes (e.g., reducing rogue gun dealing by stiffening requirements for gun dealer licenses and taking tougher criminal justice approaches to areas with outbreaks of gun crime16–18). These efforts presumably contributed to falling rates of gun ownership,19 more focus on safe gun storage,20–24 and the development of improved approaches to collecting data on gun deaths.25–28
If it is true that firearm injuries have entered an endemic phase, prevention work may need to adapt to this altered situation. Experience with endemic health problems of other types may offer useful information about the differences between endemic and epidemic contexts.
Go to:
ENDEMIC VERSUS EPIDEMIC CONDITIONS.
Public health work is characterized by adaptation to ever-changing conditions—for example, the changing antibiotic resistance of pathogens, lifestyle changes that alter disease and injury patterns, and natural and man-made disasters. How public health work adapts depends, in part, on whether the target condition is in an epidemic or endemic phase. The following are 3 salient dangers associated with endemic conditions.
First, a disease may be imported from an endemic area into an area where the disease is unknown, resulting in an epidemic. This is illustrated by the iconic introduction of smallpox into native populations in North America.
Second, endemic diseases always pose a risk of “epidemic flare”—that is, a sudden epidemic outbreak of the disease. Such concerns were evident after the 2004 tsunami and 2005 hurricane disasters. The immediate concern of disaster relief organizations is always rescue, followed by the establishment of vital services (food, water, and shelter). Quickly thereafter comes suppression of endemic disease to prevent epidemic outbreaks.
Third, endemic conditions exact an ongoing toll. Over years, total deaths in a region from endemic disease may well exceed those seen during an epidemic outbreak.29 The public health community therefore focuses resources on endemic diseases through immunization and other health promotion efforts intended to maintain low rates and to lower rates over time. Examples of noninfectious endemic conditions addressed in this way in the United States include adolescent pregnancy and injury from motor vehicles.
There is an extensive body of public health literature on the burdens associated with and management of epidemic and endemic conditions, and on the relationships between the two.30–41 The best-developed approaches for handling endemic and epidemic phases in an integrated way relate to influenza.
The US Department of Health and Human Services has an extensive program of influenza surveillance,42 as does the Communicable Disease Surveillance and Response program of the World Health Organization (WHO).43 These programs include designated preparedness phases and phase levels, which are based on objectively defined conditions and warrant specified actions. WHO’s plan recommends that national pandemic planning committees generate and implement control strategies, strengthen surveillance systems, engage scientific and medical experts, ensure the availability of needed supplies, address legal issues that may arise, and ensure effective communications with health professionals and the general public. The planning explicitly takes into account resource allocation based on pressing health needs and long-term, potentially disastrous health problems (e.g., for pandemic flu).44
Go to:
FIREARM INJURIES AS AN ENDEMIC CONDITION.
All 3 of the major risks associated with endemic conditions apply to firearm injuries.
•
Endemic conditions are mobile. As the world’s leading gun producer and exporter, the United States needs to consider its role in preventing the adverse health consequences of gun injury from spreading. The spread of gun deaths and injuries to countries that have low rates of both—such as England (0.3 deaths per 100 000 population in 1999) and Japan (0.1 deaths per 100 000 population in 1995)—should be prevented.45
•
Endemic conditions can flare up as epidemics. We have learned much over the past 20 years about the factors that promote gun injury. These include easy access to guns (especially handguns),46,47 the introduction of new weapon models,48 gang and drug turf wars,49,50 domestic violence without escape options,51,52 and depression in adolescents53 and elderly men.54,55 It is likely that if several of these factors again surge, rates of gun injury will again rise. In addition, there are probably “unknown” factors that could drive a rise in gun injuries (such as the introduction of semiautomatic pistols, which was a wild card in the last epidemic outbreak). Development of a repertoire to monitor and respond to known risk factors is all the more important given the likelihood of such an unknown factor.
•
Endemic conditions cause much suffering. Gun deaths and injuries continue to afflict families and communities in the United States, where there were 147 488 shooting deaths from 1999 to 2003. The burden is particularly heavy for families that suffer from depression, communities wracked by drugs and gangs, and states and rural areas with high gun ownership rates.56,57
To further reduce ongoing firearm deaths and prevent or mitigate the next epidemic outbreak, an approach similar to that used for influenza might be considered. The approach would entail assessment and monitoring of local risk factors over time and the application of proven measures to reduce these factors. The approach would include the development of new means to address changing circumstances and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday lives.
During the current endemic period, a challenging agenda could be undertaken without the visibility and sense of urgency present in an epidemic context. Such an agenda could include the creation of structures to establish firearm injury management phases predetermined and tied to local risk factors and conditions (such as gang violence; many isolated, elderly farmers; and high adolescent drug use), changing incidence rates (fluctuations in shootings per time interval or per population group), and similar activities to foster the creation of prevention planning committees (national, regional, and local). During the peak of the last epidemic outbreak of firearm injuries, those structures and procedures were needed but were not available. The evolving National Violent Death Reporting System58 can facilitate the needed work by providing data at state levels.
Over the next few years, efforts to prevent US firearm injuries might include the following initiatives.
•
Health departments could strengthen their monitoring of deaths and nonfatal injuries to guide prevention planning and ensure that an outbreak is recognized.
•
Health departments could begin to monitor risk factors that are likely to contribute to future epidemic outbreaks of firearm injuries and to develop response repertoires for those factors to prevent outbreaks from occurring.
•
Public health and medicine could begin to institutionalize firearm injury prevention methods, including initiating processes to act on changes in injury patterns and educating health professionals on how to include gun injury prevention in routine history-taking and health-promotion counseling. This would be a change from epidemic-born prioritization of assessing and reducing immediate danger.
•
US injury prevention professionals could become more involved in international public health work aimed at reducing violence from small arms. This work is led by the International Action Network on Small Arms59 and International Physicians for Prevention of Nuclear War (through its Aiming for Prevention campaign, which addresses small arms by fostering public education, medical education, and health-sector advocacy).60 This move would be a change from the exclusively domestic focus on US public health work related to firearm injuries.
Firearm Injuries: Epidemic Then, Endemic Now
Katherine Kaufer Christoffel, MD, MPH
There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world.
The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.
IN THE UNITED STATES, firearm injuries are off the front pages, just a few years after they were identified as one of the leading problems facing the nation.1 Within the firearm injury prevention community, discussions about why have focused on the early-21st-century US political landscape. The factors discussed have included a shift in the focus of violence prevention to terrorism since September 11, 2001, and opposition by the Republican presidential administration to firearm regulation. Although these factors are surely relevant, it is necessary to consider whether the epidemiology of firearm injuries may have changed in ways that have promoted the shift in public attention.
I propose that there has been such a transition: firearm injury data in the United States has indicated a change from an epidemic phase (from the mid-1980s to the early 1990s) to an endemic one (since the mid- to late 1990s). My aim is not to prove a hypothesis but to begin a discussion about whether such a transition has occurred and its potential significance for efforts to prevent firearm injuries. To that end, I (1) present evidence suggesting that firearm injuries in the United States have passed from an epidemic to an endemic and (2) review what is known about links between endemic and epidemic conditions—including models of endemic disease management—and consider how this information might be applied to firearm injuries. I conclude with a call to open a wide-ranging conversation about endemic conditions.
For the purposes of this discussion, endemic conditions are ones that are always present in an area, and epidemic conditions are ones that are rising and are well above historic levels. Both condition counts and rates are relevant (the former perhaps more for public awareness, the latter for public health reckoning).
Go to:
HOW US FIREARM INJURY PATTERNS HAVE CHANGED.
There has been substantial stability in US firearm deaths since 1999 (range=27700–29200 annually; rate=9.8–10.2 per 100000 population).2 As seen in Figure 1 , which shows firearm death counts from 1910 to 2002, this stability is in sharp contrast to the rising tolls that were seen in epidemic periods (i.e., the 1920s–1930s, 1960s–1970s, and 1980s–1990s). The peak year of the most recent firearm injury epidemic was 1993, with a record 39595 gun deaths (15.4 per 100000). There was then a more than 25% decline in deaths to 28663 in 2000 (with a 34% fall in rates to 10.2 per 100000). Whereas gun deaths increased after 2000, reaching 30242 (10.5 per 100000) in 2002, the average 1% rise in rates from 1999 to 2002 was less than half the average 2.2% rise from 1987 to 1993; the largest single yearly rise was almost 7%, from 1989 to 1990. The death toll in 2003 was 30136 (10.3 per 100000).3
FIGURE 1—
Firearm deaths in the United States from 1910 to 2002.
Data on nonfatal firearm injuries are much less available than are data on fatalities. Figure 2 shows the available data for the period 2000 to 2004. After 2000, the annual number of medically attended injuries was 58 000–64 000 (20.4–21.9 per 100 000).2 This pattern is consistent with the recent pattern for deaths.
FIGURE 2—
Nonfatal firearm injuries in the United States from 2000 to 2004.
These flat trends mean that the current level of US firearm injuries has become routine to the general population, most of whom are not victims of gun violence. In this context, reduced public attention to firearm injuries is not difficult to understand.
In the 1990s, when US public health efforts to prevent firearm injuries began in earnest, the situation was different: US gun deaths and injuries had been rising for close to a decade,4 and young people were dying at unprecedented rates.5 Although this was especially true in inner cities, suburban areas were also beginning to feel the lap of the rising tide of injuries.
Prevention strategies were dictated by the understanding that public health and government officials were dealing with an emergency. The factors guiding prevention work were therefore those that were most salient under epidemic conditions: meeting the immediate burden on the health system related to recent and looming deaths and injuries, dealing with the near-term social consequences of this burden (e.g., fear, grief, anger, short-term lost income), and creating opportunities for immediate benefits (even ones that might not be long lasting).
With these priorities in mind, the largest coalition of medical and allied groups working to prevent gun deaths and injuries, the HELP Network (1993–2006), originally named the Handgun Epidemic Lowering Plan, was formed. Prevention work focused on death counts, public and clinical education aimed at immediate change,6–13 experiments with removing guns quickly from communities through buy-back programs,14,15 and policy initiatives designed to bring quick and measurable changes (e.g., reducing rogue gun dealing by stiffening requirements for gun dealer licenses and taking tougher criminal justice approaches to areas with outbreaks of gun crime16–18). These efforts presumably contributed to falling rates of gun ownership,19 more focus on safe gun storage,20–24 and the development of improved approaches to collecting data on gun deaths.25–28
If it is true that firearm injuries have entered an endemic phase, prevention work may need to adapt to this altered situation. Experience with endemic health problems of other types may offer useful information about the differences between endemic and epidemic contexts.
Go to:
ENDEMIC VERSUS EPIDEMIC CONDITIONS.
Public health work is characterized by adaptation to ever-changing conditions—for example, the changing antibiotic resistance of pathogens, lifestyle changes that alter disease and injury patterns, and natural and man-made disasters. How public health work adapts depends, in part, on whether the target condition is in an epidemic or endemic phase. The following are 3 salient dangers associated with endemic conditions.
First, a disease may be imported from an endemic area into an area where the disease is unknown, resulting in an epidemic. This is illustrated by the iconic introduction of smallpox into native populations in North America.
Second, endemic diseases always pose a risk of “epidemic flare”—that is, a sudden epidemic outbreak of the disease. Such concerns were evident after the 2004 tsunami and 2005 hurricane disasters. The immediate concern of disaster relief organizations is always rescue, followed by the establishment of vital services (food, water, and shelter). Quickly thereafter comes suppression of endemic disease to prevent epidemic outbreaks.
Third, endemic conditions exact an ongoing toll. Over years, total deaths in a region from endemic disease may well exceed those seen during an epidemic outbreak.29 The public health community therefore focuses resources on endemic diseases through immunization and other health promotion efforts intended to maintain low rates and to lower rates over time. Examples of noninfectious endemic conditions addressed in this way in the United States include adolescent pregnancy and injury from motor vehicles.
There is an extensive body of public health literature on the burdens associated with and management of epidemic and endemic conditions, and on the relationships between the two.30–41 The best-developed approaches for handling endemic and epidemic phases in an integrated way relate to influenza.
The US Department of Health and Human Services has an extensive program of influenza surveillance,42 as does the Communicable Disease Surveillance and Response program of the World Health Organization (WHO).43 These programs include designated preparedness phases and phase levels, which are based on objectively defined conditions and warrant specified actions. WHO’s plan recommends that national pandemic planning committees generate and implement control strategies, strengthen surveillance systems, engage scientific and medical experts, ensure the availability of needed supplies, address legal issues that may arise, and ensure effective communications with health professionals and the general public. The planning explicitly takes into account resource allocation based on pressing health needs and long-term, potentially disastrous health problems (e.g., for pandemic flu).44
Go to:
FIREARM INJURIES AS AN ENDEMIC CONDITION.
All 3 of the major risks associated with endemic conditions apply to firearm injuries.
•
Endemic conditions are mobile. As the world’s leading gun producer and exporter, the United States needs to consider its role in preventing the adverse health consequences of gun injury from spreading. The spread of gun deaths and injuries to countries that have low rates of both—such as England (0.3 deaths per 100 000 population in 1999) and Japan (0.1 deaths per 100 000 population in 1995)—should be prevented.45
•
Endemic conditions can flare up as epidemics. We have learned much over the past 20 years about the factors that promote gun injury. These include easy access to guns (especially handguns),46,47 the introduction of new weapon models,48 gang and drug turf wars,49,50 domestic violence without escape options,51,52 and depression in adolescents53 and elderly men.54,55 It is likely that if several of these factors again surge, rates of gun injury will again rise. In addition, there are probably “unknown” factors that could drive a rise in gun injuries (such as the introduction of semiautomatic pistols, which was a wild card in the last epidemic outbreak). Development of a repertoire to monitor and respond to known risk factors is all the more important given the likelihood of such an unknown factor.
•
Endemic conditions cause much suffering. Gun deaths and injuries continue to afflict families and communities in the United States, where there were 147 488 shooting deaths from 1999 to 2003. The burden is particularly heavy for families that suffer from depression, communities wracked by drugs and gangs, and states and rural areas with high gun ownership rates.56,57
To further reduce ongoing firearm deaths and prevent or mitigate the next epidemic outbreak, an approach similar to that used for influenza might be considered. The approach would entail assessment and monitoring of local risk factors over time and the application of proven measures to reduce these factors. The approach would include the development of new means to address changing circumstances and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday lives.
During the current endemic period, a challenging agenda could be undertaken without the visibility and sense of urgency present in an epidemic context. Such an agenda could include the creation of structures to establish firearm injury management phases predetermined and tied to local risk factors and conditions (such as gang violence; many isolated, elderly farmers; and high adolescent drug use), changing incidence rates (fluctuations in shootings per time interval or per population group), and similar activities to foster the creation of prevention planning committees (national, regional, and local). During the peak of the last epidemic outbreak of firearm injuries, those structures and procedures were needed but were not available. The evolving National Violent Death Reporting System58 can facilitate the needed work by providing data at state levels.
Over the next few years, efforts to prevent US firearm injuries might include the following initiatives.
•
Health departments could strengthen their monitoring of deaths and nonfatal injuries to guide prevention planning and ensure that an outbreak is recognized.
•
Health departments could begin to monitor risk factors that are likely to contribute to future epidemic outbreaks of firearm injuries and to develop response repertoires for those factors to prevent outbreaks from occurring.
•
Public health and medicine could begin to institutionalize firearm injury prevention methods, including initiating processes to act on changes in injury patterns and educating health professionals on how to include gun injury prevention in routine history-taking and health-promotion counseling. This would be a change from epidemic-born prioritization of assessing and reducing immediate danger.
•
US injury prevention professionals could become more involved in international public health work aimed at reducing violence from small arms. This work is led by the International Action Network on Small Arms59 and International Physicians for Prevention of Nuclear War (through its Aiming for Prevention campaign, which addresses small arms by fostering public education, medical education, and health-sector advocacy).60 This move would be a change from the exclusively domestic focus on US public health work related to firearm injuries.
UltimateApathy
Infinite Idiocy
http://rothkopf.foreignpolicy.com/posts/2011/01/09/how_can_a_gun_crazed_society_lead_the_world
How can a gun-crazed society lead the world?
According to a 2007 survey, the United States leads the world in gun ownership: 90 guns per 100 people. We are a country with five percent of the world's people and between 35 and 50 percent of its civilian-owned guns. That's something like 270 million weapons.
Repeated studies have shown that the United States is far and away the leader among the world's developed countries in gun violence and gun deaths. There is no other developed country that is even close. Over 30,000 Americans die every year from gun violence. Most of these are suicides but in excess of 12,000 a year are homicides. Another 200,000 Americans are estimated to be injured each year due to guns.
In 2009, Bob Herbert of the New York Times wrote a compelling column noting that since 9/11 over 120,000 people have died in the United States as a result of gun violence. By now, the number is in excess of 140,000.
For those in the world who are mystified by this, the legal explanation associated with it by gun rights defenders is that the right to own guns is protected by the U.S. Constitution. The Second Amendment of the U.S. Constitution states: "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed."
This statement has taken on quasi-theological importance for many in the United States even though it is clearly being misinterpreted by those who believe it provides every individual the right to own such guns -- including advanced, highly-destructive automatic weapons. The misinterpretation begins with the deliberate ignoring of the first half of the sentence associating the right with the need for a "well-regulated militia." This is a clear qualifier associated with the so-called right to bear arms and had it not been important to the sentence, one can only conclude it would not have been included in the famously sparely written document. If militias don't exist, one can therefore conclude this "right" should be reconsidered if not eliminated.
Further, of course, there have been many elements of the Constitution that have required amending because the views, values, and circumstances of the nation have evolved since the country's founding. Strangely, many of those who consider the Second Amendment sacrosanct would vigorously support those subsequent adjustments to the document.
Congresswoman Giffords, the targeted victim of this attack, was a supporter of "Second Amendment rights." This is a tragic irony, but it does not suggest this case should not reopen the discussion on this important issue. Consider the case of the shooter, a drug-using, clearly unhinged loser who responded to a requirement from his community college to seek a mental evaluation due to troubling behavior not by seeking help but by going out and buying a weapon … legally.
The attack also rightfully raises a question about the tenor of political discourse in the United States. This was not an attack by the venom-tongued and reckless political extremists and hate-mongers who have become so common in recent years. But it was certainly a consequence of the culture of disrespect and violence they have fomented. With some luck this attack my cause all parties to be more circumspect and embrace civility.
But in a global context we have to ask as dispassionately as we can: What do these events say about America's culture, and what are their impact on America's ability to lead? Many will reflexively note that other societies also have similar shortcomings. That is no doubt the case. But no society that holds itself up as an example to the world should, as the United States does, brazenly shrug off what are clearly deep national character flaws when it comes to our love of guns or our celebration of hate politics. Tragedies like that which unfolded in Arizona this weekend not only wound the victims, but also America's ability to lead and to advance our interests and values worldwide. Think, to take just one example, how the shadow of events like this and the patterns and history they reveal impact America's ability to advance its human rights agenda internationally -- as it will no doubt attempt to do during the upcoming visit of China's president next week.
The problem is that we are not talking about the aberrant behavior of a lone gunman here. Instead we should see that what we are discussing are grossly uncivilized aspects of American society, aspects of ourselves that we ought to change not because we fall below international norms, but because we fall so short of doing what is right, moral, or sensible.
How can a gun-crazed society lead the world?
According to a 2007 survey, the United States leads the world in gun ownership: 90 guns per 100 people. We are a country with five percent of the world's people and between 35 and 50 percent of its civilian-owned guns. That's something like 270 million weapons.
Repeated studies have shown that the United States is far and away the leader among the world's developed countries in gun violence and gun deaths. There is no other developed country that is even close. Over 30,000 Americans die every year from gun violence. Most of these are suicides but in excess of 12,000 a year are homicides. Another 200,000 Americans are estimated to be injured each year due to guns.
In 2009, Bob Herbert of the New York Times wrote a compelling column noting that since 9/11 over 120,000 people have died in the United States as a result of gun violence. By now, the number is in excess of 140,000.
For those in the world who are mystified by this, the legal explanation associated with it by gun rights defenders is that the right to own guns is protected by the U.S. Constitution. The Second Amendment of the U.S. Constitution states: "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed."
This statement has taken on quasi-theological importance for many in the United States even though it is clearly being misinterpreted by those who believe it provides every individual the right to own such guns -- including advanced, highly-destructive automatic weapons. The misinterpretation begins with the deliberate ignoring of the first half of the sentence associating the right with the need for a "well-regulated militia." This is a clear qualifier associated with the so-called right to bear arms and had it not been important to the sentence, one can only conclude it would not have been included in the famously sparely written document. If militias don't exist, one can therefore conclude this "right" should be reconsidered if not eliminated.
Further, of course, there have been many elements of the Constitution that have required amending because the views, values, and circumstances of the nation have evolved since the country's founding. Strangely, many of those who consider the Second Amendment sacrosanct would vigorously support those subsequent adjustments to the document.
Congresswoman Giffords, the targeted victim of this attack, was a supporter of "Second Amendment rights." This is a tragic irony, but it does not suggest this case should not reopen the discussion on this important issue. Consider the case of the shooter, a drug-using, clearly unhinged loser who responded to a requirement from his community college to seek a mental evaluation due to troubling behavior not by seeking help but by going out and buying a weapon … legally.
The attack also rightfully raises a question about the tenor of political discourse in the United States. This was not an attack by the venom-tongued and reckless political extremists and hate-mongers who have become so common in recent years. But it was certainly a consequence of the culture of disrespect and violence they have fomented. With some luck this attack my cause all parties to be more circumspect and embrace civility.
But in a global context we have to ask as dispassionately as we can: What do these events say about America's culture, and what are their impact on America's ability to lead? Many will reflexively note that other societies also have similar shortcomings. That is no doubt the case. But no society that holds itself up as an example to the world should, as the United States does, brazenly shrug off what are clearly deep national character flaws when it comes to our love of guns or our celebration of hate politics. Tragedies like that which unfolded in Arizona this weekend not only wound the victims, but also America's ability to lead and to advance our interests and values worldwide. Think, to take just one example, how the shadow of events like this and the patterns and history they reveal impact America's ability to advance its human rights agenda internationally -- as it will no doubt attempt to do during the upcoming visit of China's president next week.
The problem is that we are not talking about the aberrant behavior of a lone gunman here. Instead we should see that what we are discussing are grossly uncivilized aspects of American society, aspects of ourselves that we ought to change not because we fall below international norms, but because we fall so short of doing what is right, moral, or sensible.
Dak
mentat
Honestly, after all the nitpicking you've been doing to in this thread - your chart should read gun or fire arms homicide, shouldn't it?
And if fork and spoon homicides where higher in the states than in japan, Canada or the EU, then yes, we should take away those things from you. If you can't handle sharp or hard objects, you can just suck your food thru a straw.
Start acting like adults already! Man up, grow a pair!!
If your gun is just a tool like any other, get rid of it, just in case.
Fucking weak - gun owners.
Einherjar86
Active Member
The clarion call for gun regulation always coincides with atrocities such as school shootings or other individuals "going postal" in some context or another. Other homicides, committed in connection with drug crime, police action, or other illegal activities, never seem to get recognized as good reasons for regulation reform. If people care more about shootings in schools, then perhaps we should be focusing more on education reform and how these students are treated and/or taken care of.
I'm not opposed to gun regulation, but I am opposed to blindly championing it.
I'm not opposed to gun regulation, but I am opposed to blindly championing it.
No, it does not.
But the cry "don't take my gun" sure does!
Just how many dead will it take?
viewerfromnihil
Vein-Marbled Tower
Einherjar86
Active Member
Dak
mentat
That would be nice if I had come across a chart like that. However, that is really irrelevant to the point. Homicides went up regardless of the weapon of choice after regulation increased (and not necessarily specifically gun regulation, in the cases of alcohol and drug prohibition). It also shows the current trend as it relates to CCW expansion in the US, and how this paranoia/hysteria over a "wave of gun violence" is founded on pure myth.
Do you realize how arrogant this whole statement is? Who is "we"? Who is "you"?
I know I've already posted the relevant statistics to show relation between the drug war and homicides involving a gun. It's not "NRA gun nuts" blowing people away in the US, or whatever other inaccurate stereotype you want to concoct.
Matt
Active Member
Not that I want this to happen at all, but I'd be interested to see what the response would be if a disgruntled NRA employee went berserk or something.
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848468/
Guns: Dangerous, Especially for Suicide, and Costly for America
Steven Lippmann, MD
Gun ownership is common in America. People report that they need them for safety and/or sport. However, having a firearm in the home actually increases the rate for suicide, homicide, domestic violence, and accidents. The presumed security is questioned, especially since owner and family suicide vastly outnumbers self-protective events. Gun-related suicide in America accounts for most of the violent death occurrences. This high suicide rate is shockingly under appreciated. The deaths, injuries, and disabilities significantly escalate healthcare costs, insurance premiums, criminal justice system expenses, and taxes. Nevertheless, regulation of firearms has neither been popular with the public nor legislatures; perhaps the degree of carnage might now kindle discussion about the way we control these weapons.
The Second Amendment to the Constitution states that, “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Despite current gun regulations, firearms can be bought at gun shows or privately from unlicensed dealers with no background checks.
In 2005, out of a total of 541 firearm-related deaths in Kentucky, 375 were gun-shot suicides (69%), homicides accounted for 143, accidents claimed 11, nine died in police shootings, and three fatalities were unspecified.1 During 2006 and 2007, again, approximately 70 percent of gun-shot deaths were suicides.1 Most Americans are unaware that gun-shot suicide occurs much more often than all other shooting deaths combined. Suicide by gun fire is the fastest growing and most common means of suicide regardless of age, gender, race, or educational level. It is the leading cause of death in those who purchase firearms for the first time.2 Despite being obtained for personal security, 83 percent of gun fatalities in a home are suicide.3 Among 395 shooting deaths in Seattle during one year, 333 were by suicide, 41 were domestic violence incidents, 12 were accidents, and only nine involved an intruder.3 Women commit suicide three times as often when firearms are present in a home than in domiciles without them.4 Despite mental illness being an important factor, most suicide attempts are impulsive and done under stress, when upset and/or intoxicated, but without psychopathology. Awareness about the frequency of such unplanned acts is limited. Having firearms readily available increases the lethality of such impulsivity.
Guns are the most frequently used means involved in deaths by domestic violence, increasing the rate of killing an intimate partner. Five times as many women are shot to death in homes where such weaponry is available in contrast to households without them.4 Family member homicide is much more likely than stopping a trespasser. Sadly, many American children are shot to death every day.
Gun violence has a negative impact on society. Beyond death and disability, survivors of a shooting endure psychological trauma and grief. Violence-exposed children experience developmental consequences and adults also evidence personal compromise. Living in communities where fear of getting shot is common has detrimental effects on people and teaches inappropriate role modeling about responsible behavior to future generations.
Hospitals, trauma centers, and rehabilitation or nursing home facilities are flooded with victims of shootings. Acute healthcare expenditures for injured individuals are enormous and most of these patients are uninsured. The economic impact extends well beyond emergency treatment and continues with chronic dysfunction, rehabilitation, and long-term disability. Medical expense outlays increase for everyone, covered largely by government and ultimately affecting tax-payers. These costs inflate the price of medical, disability, and life insurance; escalating premiums are paid by companies, governments, and private individuals. Acute care medical bills for gun violence in the United States reportedly is over $4 billion per year, and it exceeds $100 billion annually, when including follow up and long-term care.5 A serious attempt to reduce healthcare costs, would include consideration at limiting gun usage.
Firearm use also adds to the expenses of police work, court prosecutions, legal involvements, and incarcerations, again borne by tax-payers. Loss of productivity, disability payments, and emotional or physical dysfunction all add to the cost. Guns are so much a part of our culture, that Americans have become accustomed to the resulting bloodshed and huge expenses.
Firearms have a negative impact on our society, both emotionally and physically. They heighten expenditures for us all in taxes and insurance premiums, but gun regulation still remains socially and politically controversial.
Americans can make choices. We should decide whether to accept our current status or whether a reassessment of our gun-regulation system is a potential legal alternative.
With regards,
Rupinder Johal, MD
Steven Lippmann, MD
University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences
William Smock, MD
Cynthia Gosney, RN
University of Louisville School of Medicine, Department of Emergency Medicine
Guns: Dangerous, Especially for Suicide, and Costly for America
Steven Lippmann, MD
Gun ownership is common in America. People report that they need them for safety and/or sport. However, having a firearm in the home actually increases the rate for suicide, homicide, domestic violence, and accidents. The presumed security is questioned, especially since owner and family suicide vastly outnumbers self-protective events. Gun-related suicide in America accounts for most of the violent death occurrences. This high suicide rate is shockingly under appreciated. The deaths, injuries, and disabilities significantly escalate healthcare costs, insurance premiums, criminal justice system expenses, and taxes. Nevertheless, regulation of firearms has neither been popular with the public nor legislatures; perhaps the degree of carnage might now kindle discussion about the way we control these weapons.
The Second Amendment to the Constitution states that, “A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Despite current gun regulations, firearms can be bought at gun shows or privately from unlicensed dealers with no background checks.
In 2005, out of a total of 541 firearm-related deaths in Kentucky, 375 were gun-shot suicides (69%), homicides accounted for 143, accidents claimed 11, nine died in police shootings, and three fatalities were unspecified.1 During 2006 and 2007, again, approximately 70 percent of gun-shot deaths were suicides.1 Most Americans are unaware that gun-shot suicide occurs much more often than all other shooting deaths combined. Suicide by gun fire is the fastest growing and most common means of suicide regardless of age, gender, race, or educational level. It is the leading cause of death in those who purchase firearms for the first time.2 Despite being obtained for personal security, 83 percent of gun fatalities in a home are suicide.3 Among 395 shooting deaths in Seattle during one year, 333 were by suicide, 41 were domestic violence incidents, 12 were accidents, and only nine involved an intruder.3 Women commit suicide three times as often when firearms are present in a home than in domiciles without them.4 Despite mental illness being an important factor, most suicide attempts are impulsive and done under stress, when upset and/or intoxicated, but without psychopathology. Awareness about the frequency of such unplanned acts is limited. Having firearms readily available increases the lethality of such impulsivity.
Guns are the most frequently used means involved in deaths by domestic violence, increasing the rate of killing an intimate partner. Five times as many women are shot to death in homes where such weaponry is available in contrast to households without them.4 Family member homicide is much more likely than stopping a trespasser. Sadly, many American children are shot to death every day.
Gun violence has a negative impact on society. Beyond death and disability, survivors of a shooting endure psychological trauma and grief. Violence-exposed children experience developmental consequences and adults also evidence personal compromise. Living in communities where fear of getting shot is common has detrimental effects on people and teaches inappropriate role modeling about responsible behavior to future generations.
Hospitals, trauma centers, and rehabilitation or nursing home facilities are flooded with victims of shootings. Acute healthcare expenditures for injured individuals are enormous and most of these patients are uninsured. The economic impact extends well beyond emergency treatment and continues with chronic dysfunction, rehabilitation, and long-term disability. Medical expense outlays increase for everyone, covered largely by government and ultimately affecting tax-payers. These costs inflate the price of medical, disability, and life insurance; escalating premiums are paid by companies, governments, and private individuals. Acute care medical bills for gun violence in the United States reportedly is over $4 billion per year, and it exceeds $100 billion annually, when including follow up and long-term care.5 A serious attempt to reduce healthcare costs, would include consideration at limiting gun usage.
Firearm use also adds to the expenses of police work, court prosecutions, legal involvements, and incarcerations, again borne by tax-payers. Loss of productivity, disability payments, and emotional or physical dysfunction all add to the cost. Guns are so much a part of our culture, that Americans have become accustomed to the resulting bloodshed and huge expenses.
Firearms have a negative impact on our society, both emotionally and physically. They heighten expenditures for us all in taxes and insurance premiums, but gun regulation still remains socially and politically controversial.
Americans can make choices. We should decide whether to accept our current status or whether a reassessment of our gun-regulation system is a potential legal alternative.
With regards,
Rupinder Johal, MD
Steven Lippmann, MD
University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences
William Smock, MD
Cynthia Gosney, RN
University of Louisville School of Medicine, Department of Emergency Medicine
UltimateApathy
Infinite Idiocy
http://rothkopf.foreignpolicy.com/posts/2011/01/09/how_can_a_gun_crazed_society_lead_the_world
How can a gun-crazed society lead the world?
According to a 2007 survey, the United States leads the world in gun ownership: 90 guns per 100 people. We are a country with five percent of the world's people and between 35 and 50 percent of its civilian-owned guns. That's something like 270 million weapons.
Repeated studies have shown that the United States is far and away the leader among the world's developed countries in gun violence and gun deaths. There is no other developed country that is even close. Over 30,000 Americans die every year from gun violence. Most of these are suicides but in excess of 12,000 a year are homicides. Another 200,000 Americans are estimated to be injured each year due to guns.
In 2009, Bob Herbert of the New York Times wrote a compelling column noting that since 9/11 over 120,000 people have died in the United States as a result of gun violence. By now, the number is in excess of 140,000.
For those in the world who are mystified by this, the legal explanation associated with it by gun rights defenders is that the right to own guns is protected by the U.S. Constitution. The Second Amendment of the U.S. Constitution states: "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed."
This statement has taken on quasi-theological importance for many in the United States even though it is clearly being misinterpreted by those who believe it provides every individual the right to own such guns -- including advanced, highly-destructive automatic weapons. The misinterpretation begins with the deliberate ignoring of the first half of the sentence associating the right with the need for a "well-regulated militia." This is a clear qualifier associated with the so-called right to bear arms and had it not been important to the sentence, one can only conclude it would not have been included in the famously sparely written document. If militias don't exist, one can therefore conclude this "right" should be reconsidered if not eliminated.
Further, of course, there have been many elements of the Constitution that have required amending because the views, values, and circumstances of the nation have evolved since the country's founding. Strangely, many of those who consider the Second Amendment sacrosanct would vigorously support those subsequent adjustments to the document.
Congresswoman Giffords, the targeted victim of this attack, was a supporter of "Second Amendment rights." This is a tragic irony, but it does not suggest this case should not reopen the discussion on this important issue. Consider the case of the shooter, a drug-using, clearly unhinged loser who responded to a requirement from his community college to seek a mental evaluation due to troubling behavior not by seeking help but by going out and buying a weapon … legally.
The attack also rightfully raises a question about the tenor of political discourse in the United States. This was not an attack by the venom-tongued and reckless political extremists and hate-mongers who have become so common in recent years. But it was certainly a consequence of the culture of disrespect and violence they have fomented. With some luck this attack my cause all parties to be more circumspect and embrace civility.
But in a global context we have to ask as dispassionately as we can: What do these events say about America's culture, and what are their impact on America's ability to lead? Many will reflexively note that other societies also have similar shortcomings. That is no doubt the case. But no society that holds itself up as an example to the world should, as the United States does, brazenly shrug off what are clearly deep national character flaws when it comes to our love of guns or our celebration of hate politics. Tragedies like that which unfolded in Arizona this weekend not only wound the victims, but also America's ability to lead and to advance our interests and values worldwide. Think, to take just one example, how the shadow of events like this and the patterns and history they reveal impact America's ability to advance its human rights agenda internationally -- as it will no doubt attempt to do during the upcoming visit of China's president next week.
The problem is that we are not talking about the aberrant behavior of a lone gunman here. Instead we should see that what we are discussing are grossly uncivilized aspects of American society, aspects of ourselves that we ought to change not because we fall below international norms, but because we fall so short of doing what is right, moral, or sensible.
How can a gun-crazed society lead the world?
According to a 2007 survey, the United States leads the world in gun ownership: 90 guns per 100 people. We are a country with five percent of the world's people and between 35 and 50 percent of its civilian-owned guns. That's something like 270 million weapons.
Repeated studies have shown that the United States is far and away the leader among the world's developed countries in gun violence and gun deaths. There is no other developed country that is even close. Over 30,000 Americans die every year from gun violence. Most of these are suicides but in excess of 12,000 a year are homicides. Another 200,000 Americans are estimated to be injured each year due to guns.
In 2009, Bob Herbert of the New York Times wrote a compelling column noting that since 9/11 over 120,000 people have died in the United States as a result of gun violence. By now, the number is in excess of 140,000.
For those in the world who are mystified by this, the legal explanation associated with it by gun rights defenders is that the right to own guns is protected by the U.S. Constitution. The Second Amendment of the U.S. Constitution states: "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed."
This statement has taken on quasi-theological importance for many in the United States even though it is clearly being misinterpreted by those who believe it provides every individual the right to own such guns -- including advanced, highly-destructive automatic weapons. The misinterpretation begins with the deliberate ignoring of the first half of the sentence associating the right with the need for a "well-regulated militia." This is a clear qualifier associated with the so-called right to bear arms and had it not been important to the sentence, one can only conclude it would not have been included in the famously sparely written document. If militias don't exist, one can therefore conclude this "right" should be reconsidered if not eliminated.
Further, of course, there have been many elements of the Constitution that have required amending because the views, values, and circumstances of the nation have evolved since the country's founding. Strangely, many of those who consider the Second Amendment sacrosanct would vigorously support those subsequent adjustments to the document.
Congresswoman Giffords, the targeted victim of this attack, was a supporter of "Second Amendment rights." This is a tragic irony, but it does not suggest this case should not reopen the discussion on this important issue. Consider the case of the shooter, a drug-using, clearly unhinged loser who responded to a requirement from his community college to seek a mental evaluation due to troubling behavior not by seeking help but by going out and buying a weapon … legally.
The attack also rightfully raises a question about the tenor of political discourse in the United States. This was not an attack by the venom-tongued and reckless political extremists and hate-mongers who have become so common in recent years. But it was certainly a consequence of the culture of disrespect and violence they have fomented. With some luck this attack my cause all parties to be more circumspect and embrace civility.
But in a global context we have to ask as dispassionately as we can: What do these events say about America's culture, and what are their impact on America's ability to lead? Many will reflexively note that other societies also have similar shortcomings. That is no doubt the case. But no society that holds itself up as an example to the world should, as the United States does, brazenly shrug off what are clearly deep national character flaws when it comes to our love of guns or our celebration of hate politics. Tragedies like that which unfolded in Arizona this weekend not only wound the victims, but also America's ability to lead and to advance our interests and values worldwide. Think, to take just one example, how the shadow of events like this and the patterns and history they reveal impact America's ability to advance its human rights agenda internationally -- as it will no doubt attempt to do during the upcoming visit of China's president next week.
The problem is that we are not talking about the aberrant behavior of a lone gunman here. Instead we should see that what we are discussing are grossly uncivilized aspects of American society, aspects of ourselves that we ought to change not because we fall below international norms, but because we fall so short of doing what is right, moral, or sensible.
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pubmed/15522849
Guns in the home and risk of a violent death in the home: findings from a national study.
Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.
Guns in the home and risk of a violent death in the home: findings from a national study.
Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.
UltimateApathy
Infinite Idiocy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829336/
Firearm Injuries: Epidemic Then, Endemic Now
Katherine Kaufer Christoffel, MD, MPH
There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world.
The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.
IN THE UNITED STATES, firearm injuries are off the front pages, just a few years after they were identified as one of the leading problems facing the nation.1 Within the firearm injury prevention community, discussions about why have focused on the early-21st-century US political landscape. The factors discussed have included a shift in the focus of violence prevention to terrorism since September 11, 2001, and opposition by the Republican presidential administration to firearm regulation. Although these factors are surely relevant, it is necessary to consider whether the epidemiology of firearm injuries may have changed in ways that have promoted the shift in public attention.
I propose that there has been such a transition: firearm injury data in the United States has indicated a change from an epidemic phase (from the mid-1980s to the early 1990s) to an endemic one (since the mid- to late 1990s). My aim is not to prove a hypothesis but to begin a discussion about whether such a transition has occurred and its potential significance for efforts to prevent firearm injuries. To that end, I (1) present evidence suggesting that firearm injuries in the United States have passed from an epidemic to an endemic and (2) review what is known about links between endemic and epidemic conditions—including models of endemic disease management—and consider how this information might be applied to firearm injuries. I conclude with a call to open a wide-ranging conversation about endemic conditions.
For the purposes of this discussion, endemic conditions are ones that are always present in an area, and epidemic conditions are ones that are rising and are well above historic levels. Both condition counts and rates are relevant (the former perhaps more for public awareness, the latter for public health reckoning).
Go to:
HOW US FIREARM INJURY PATTERNS HAVE CHANGED.
There has been substantial stability in US firearm deaths since 1999 (range=27700–29200 annually; rate=9.8–10.2 per 100000 population).2 As seen in Figure 1 , which shows firearm death counts from 1910 to 2002, this stability is in sharp contrast to the rising tolls that were seen in epidemic periods (i.e., the 1920s–1930s, 1960s–1970s, and 1980s–1990s). The peak year of the most recent firearm injury epidemic was 1993, with a record 39595 gun deaths (15.4 per 100000). There was then a more than 25% decline in deaths to 28663 in 2000 (with a 34% fall in rates to 10.2 per 100000). Whereas gun deaths increased after 2000, reaching 30242 (10.5 per 100000) in 2002, the average 1% rise in rates from 1999 to 2002 was less than half the average 2.2% rise from 1987 to 1993; the largest single yearly rise was almost 7%, from 1989 to 1990. The death toll in 2003 was 30136 (10.3 per 100000).3
FIGURE 1—
Firearm deaths in the United States from 1910 to 2002.
Data on nonfatal firearm injuries are much less available than are data on fatalities. Figure 2 shows the available data for the period 2000 to 2004. After 2000, the annual number of medically attended injuries was 58 000–64 000 (20.4–21.9 per 100 000).2 This pattern is consistent with the recent pattern for deaths.
FIGURE 2—
Nonfatal firearm injuries in the United States from 2000 to 2004.
These flat trends mean that the current level of US firearm injuries has become routine to the general population, most of whom are not victims of gun violence. In this context, reduced public attention to firearm injuries is not difficult to understand.
In the 1990s, when US public health efforts to prevent firearm injuries began in earnest, the situation was different: US gun deaths and injuries had been rising for close to a decade,4 and young people were dying at unprecedented rates.5 Although this was especially true in inner cities, suburban areas were also beginning to feel the lap of the rising tide of injuries.
Prevention strategies were dictated by the understanding that public health and government officials were dealing with an emergency. The factors guiding prevention work were therefore those that were most salient under epidemic conditions: meeting the immediate burden on the health system related to recent and looming deaths and injuries, dealing with the near-term social consequences of this burden (e.g., fear, grief, anger, short-term lost income), and creating opportunities for immediate benefits (even ones that might not be long lasting).
With these priorities in mind, the largest coalition of medical and allied groups working to prevent gun deaths and injuries, the HELP Network (1993–2006), originally named the Handgun Epidemic Lowering Plan, was formed. Prevention work focused on death counts, public and clinical education aimed at immediate change,6–13 experiments with removing guns quickly from communities through buy-back programs,14,15 and policy initiatives designed to bring quick and measurable changes (e.g., reducing rogue gun dealing by stiffening requirements for gun dealer licenses and taking tougher criminal justice approaches to areas with outbreaks of gun crime16–18). These efforts presumably contributed to falling rates of gun ownership,19 more focus on safe gun storage,20–24 and the development of improved approaches to collecting data on gun deaths.25–28
If it is true that firearm injuries have entered an endemic phase, prevention work may need to adapt to this altered situation. Experience with endemic health problems of other types may offer useful information about the differences between endemic and epidemic contexts.
Go to:
ENDEMIC VERSUS EPIDEMIC CONDITIONS.
Public health work is characterized by adaptation to ever-changing conditions—for example, the changing antibiotic resistance of pathogens, lifestyle changes that alter disease and injury patterns, and natural and man-made disasters. How public health work adapts depends, in part, on whether the target condition is in an epidemic or endemic phase. The following are 3 salient dangers associated with endemic conditions.
First, a disease may be imported from an endemic area into an area where the disease is unknown, resulting in an epidemic. This is illustrated by the iconic introduction of smallpox into native populations in North America.
Second, endemic diseases always pose a risk of “epidemic flare”—that is, a sudden epidemic outbreak of the disease. Such concerns were evident after the 2004 tsunami and 2005 hurricane disasters. The immediate concern of disaster relief organizations is always rescue, followed by the establishment of vital services (food, water, and shelter). Quickly thereafter comes suppression of endemic disease to prevent epidemic outbreaks.
Third, endemic conditions exact an ongoing toll. Over years, total deaths in a region from endemic disease may well exceed those seen during an epidemic outbreak.29 The public health community therefore focuses resources on endemic diseases through immunization and other health promotion efforts intended to maintain low rates and to lower rates over time. Examples of noninfectious endemic conditions addressed in this way in the United States include adolescent pregnancy and injury from motor vehicles.
There is an extensive body of public health literature on the burdens associated with and management of epidemic and endemic conditions, and on the relationships between the two.30–41 The best-developed approaches for handling endemic and epidemic phases in an integrated way relate to influenza.
The US Department of Health and Human Services has an extensive program of influenza surveillance,42 as does the Communicable Disease Surveillance and Response program of the World Health Organization (WHO).43 These programs include designated preparedness phases and phase levels, which are based on objectively defined conditions and warrant specified actions. WHO’s plan recommends that national pandemic planning committees generate and implement control strategies, strengthen surveillance systems, engage scientific and medical experts, ensure the availability of needed supplies, address legal issues that may arise, and ensure effective communications with health professionals and the general public. The planning explicitly takes into account resource allocation based on pressing health needs and long-term, potentially disastrous health problems (e.g., for pandemic flu).44
Go to:
FIREARM INJURIES AS AN ENDEMIC CONDITION.
All 3 of the major risks associated with endemic conditions apply to firearm injuries.
•
Endemic conditions are mobile. As the world’s leading gun producer and exporter, the United States needs to consider its role in preventing the adverse health consequences of gun injury from spreading. The spread of gun deaths and injuries to countries that have low rates of both—such as England (0.3 deaths per 100 000 population in 1999) and Japan (0.1 deaths per 100 000 population in 1995)—should be prevented.45
•
Endemic conditions can flare up as epidemics. We have learned much over the past 20 years about the factors that promote gun injury. These include easy access to guns (especially handguns),46,47 the introduction of new weapon models,48 gang and drug turf wars,49,50 domestic violence without escape options,51,52 and depression in adolescents53 and elderly men.54,55 It is likely that if several of these factors again surge, rates of gun injury will again rise. In addition, there are probably “unknown” factors that could drive a rise in gun injuries (such as the introduction of semiautomatic pistols, which was a wild card in the last epidemic outbreak). Development of a repertoire to monitor and respond to known risk factors is all the more important given the likelihood of such an unknown factor.
•
Endemic conditions cause much suffering. Gun deaths and injuries continue to afflict families and communities in the United States, where there were 147 488 shooting deaths from 1999 to 2003. The burden is particularly heavy for families that suffer from depression, communities wracked by drugs and gangs, and states and rural areas with high gun ownership rates.56,57
To further reduce ongoing firearm deaths and prevent or mitigate the next epidemic outbreak, an approach similar to that used for influenza might be considered. The approach would entail assessment and monitoring of local risk factors over time and the application of proven measures to reduce these factors. The approach would include the development of new means to address changing circumstances and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday lives.
During the current endemic period, a challenging agenda could be undertaken without the visibility and sense of urgency present in an epidemic context. Such an agenda could include the creation of structures to establish firearm injury management phases predetermined and tied to local risk factors and conditions (such as gang violence; many isolated, elderly farmers; and high adolescent drug use), changing incidence rates (fluctuations in shootings per time interval or per population group), and similar activities to foster the creation of prevention planning committees (national, regional, and local). During the peak of the last epidemic outbreak of firearm injuries, those structures and procedures were needed but were not available. The evolving National Violent Death Reporting System58 can facilitate the needed work by providing data at state levels.
Over the next few years, efforts to prevent US firearm injuries might include the following initiatives.
•
Health departments could strengthen their monitoring of deaths and nonfatal injuries to guide prevention planning and ensure that an outbreak is recognized.
•
Health departments could begin to monitor risk factors that are likely to contribute to future epidemic outbreaks of firearm injuries and to develop response repertoires for those factors to prevent outbreaks from occurring.
•
Public health and medicine could begin to institutionalize firearm injury prevention methods, including initiating processes to act on changes in injury patterns and educating health professionals on how to include gun injury prevention in routine history-taking and health-promotion counseling. This would be a change from epidemic-born prioritization of assessing and reducing immediate danger.
•
US injury prevention professionals could become more involved in international public health work aimed at reducing violence from small arms. This work is led by the International Action Network on Small Arms59 and International Physicians for Prevention of Nuclear War (through its Aiming for Prevention campaign, which addresses small arms by fostering public education, medical education, and health-sector advocacy).60 This move would be a change from the exclusively domestic focus on US public health work related to firearm injuries.
Firearm Injuries: Epidemic Then, Endemic Now
Katherine Kaufer Christoffel, MD, MPH
There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world.
The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.
IN THE UNITED STATES, firearm injuries are off the front pages, just a few years after they were identified as one of the leading problems facing the nation.1 Within the firearm injury prevention community, discussions about why have focused on the early-21st-century US political landscape. The factors discussed have included a shift in the focus of violence prevention to terrorism since September 11, 2001, and opposition by the Republican presidential administration to firearm regulation. Although these factors are surely relevant, it is necessary to consider whether the epidemiology of firearm injuries may have changed in ways that have promoted the shift in public attention.
I propose that there has been such a transition: firearm injury data in the United States has indicated a change from an epidemic phase (from the mid-1980s to the early 1990s) to an endemic one (since the mid- to late 1990s). My aim is not to prove a hypothesis but to begin a discussion about whether such a transition has occurred and its potential significance for efforts to prevent firearm injuries. To that end, I (1) present evidence suggesting that firearm injuries in the United States have passed from an epidemic to an endemic and (2) review what is known about links between endemic and epidemic conditions—including models of endemic disease management—and consider how this information might be applied to firearm injuries. I conclude with a call to open a wide-ranging conversation about endemic conditions.
For the purposes of this discussion, endemic conditions are ones that are always present in an area, and epidemic conditions are ones that are rising and are well above historic levels. Both condition counts and rates are relevant (the former perhaps more for public awareness, the latter for public health reckoning).
Go to:
HOW US FIREARM INJURY PATTERNS HAVE CHANGED.
There has been substantial stability in US firearm deaths since 1999 (range=27700–29200 annually; rate=9.8–10.2 per 100000 population).2 As seen in Figure 1 , which shows firearm death counts from 1910 to 2002, this stability is in sharp contrast to the rising tolls that were seen in epidemic periods (i.e., the 1920s–1930s, 1960s–1970s, and 1980s–1990s). The peak year of the most recent firearm injury epidemic was 1993, with a record 39595 gun deaths (15.4 per 100000). There was then a more than 25% decline in deaths to 28663 in 2000 (with a 34% fall in rates to 10.2 per 100000). Whereas gun deaths increased after 2000, reaching 30242 (10.5 per 100000) in 2002, the average 1% rise in rates from 1999 to 2002 was less than half the average 2.2% rise from 1987 to 1993; the largest single yearly rise was almost 7%, from 1989 to 1990. The death toll in 2003 was 30136 (10.3 per 100000).3
FIGURE 1—
Firearm deaths in the United States from 1910 to 2002.
Data on nonfatal firearm injuries are much less available than are data on fatalities. Figure 2 shows the available data for the period 2000 to 2004. After 2000, the annual number of medically attended injuries was 58 000–64 000 (20.4–21.9 per 100 000).2 This pattern is consistent with the recent pattern for deaths.
FIGURE 2—
Nonfatal firearm injuries in the United States from 2000 to 2004.
These flat trends mean that the current level of US firearm injuries has become routine to the general population, most of whom are not victims of gun violence. In this context, reduced public attention to firearm injuries is not difficult to understand.
In the 1990s, when US public health efforts to prevent firearm injuries began in earnest, the situation was different: US gun deaths and injuries had been rising for close to a decade,4 and young people were dying at unprecedented rates.5 Although this was especially true in inner cities, suburban areas were also beginning to feel the lap of the rising tide of injuries.
Prevention strategies were dictated by the understanding that public health and government officials were dealing with an emergency. The factors guiding prevention work were therefore those that were most salient under epidemic conditions: meeting the immediate burden on the health system related to recent and looming deaths and injuries, dealing with the near-term social consequences of this burden (e.g., fear, grief, anger, short-term lost income), and creating opportunities for immediate benefits (even ones that might not be long lasting).
With these priorities in mind, the largest coalition of medical and allied groups working to prevent gun deaths and injuries, the HELP Network (1993–2006), originally named the Handgun Epidemic Lowering Plan, was formed. Prevention work focused on death counts, public and clinical education aimed at immediate change,6–13 experiments with removing guns quickly from communities through buy-back programs,14,15 and policy initiatives designed to bring quick and measurable changes (e.g., reducing rogue gun dealing by stiffening requirements for gun dealer licenses and taking tougher criminal justice approaches to areas with outbreaks of gun crime16–18). These efforts presumably contributed to falling rates of gun ownership,19 more focus on safe gun storage,20–24 and the development of improved approaches to collecting data on gun deaths.25–28
If it is true that firearm injuries have entered an endemic phase, prevention work may need to adapt to this altered situation. Experience with endemic health problems of other types may offer useful information about the differences between endemic and epidemic contexts.
Go to:
ENDEMIC VERSUS EPIDEMIC CONDITIONS.
Public health work is characterized by adaptation to ever-changing conditions—for example, the changing antibiotic resistance of pathogens, lifestyle changes that alter disease and injury patterns, and natural and man-made disasters. How public health work adapts depends, in part, on whether the target condition is in an epidemic or endemic phase. The following are 3 salient dangers associated with endemic conditions.
First, a disease may be imported from an endemic area into an area where the disease is unknown, resulting in an epidemic. This is illustrated by the iconic introduction of smallpox into native populations in North America.
Second, endemic diseases always pose a risk of “epidemic flare”—that is, a sudden epidemic outbreak of the disease. Such concerns were evident after the 2004 tsunami and 2005 hurricane disasters. The immediate concern of disaster relief organizations is always rescue, followed by the establishment of vital services (food, water, and shelter). Quickly thereafter comes suppression of endemic disease to prevent epidemic outbreaks.
Third, endemic conditions exact an ongoing toll. Over years, total deaths in a region from endemic disease may well exceed those seen during an epidemic outbreak.29 The public health community therefore focuses resources on endemic diseases through immunization and other health promotion efforts intended to maintain low rates and to lower rates over time. Examples of noninfectious endemic conditions addressed in this way in the United States include adolescent pregnancy and injury from motor vehicles.
There is an extensive body of public health literature on the burdens associated with and management of epidemic and endemic conditions, and on the relationships between the two.30–41 The best-developed approaches for handling endemic and epidemic phases in an integrated way relate to influenza.
The US Department of Health and Human Services has an extensive program of influenza surveillance,42 as does the Communicable Disease Surveillance and Response program of the World Health Organization (WHO).43 These programs include designated preparedness phases and phase levels, which are based on objectively defined conditions and warrant specified actions. WHO’s plan recommends that national pandemic planning committees generate and implement control strategies, strengthen surveillance systems, engage scientific and medical experts, ensure the availability of needed supplies, address legal issues that may arise, and ensure effective communications with health professionals and the general public. The planning explicitly takes into account resource allocation based on pressing health needs and long-term, potentially disastrous health problems (e.g., for pandemic flu).44
Go to:
FIREARM INJURIES AS AN ENDEMIC CONDITION.
All 3 of the major risks associated with endemic conditions apply to firearm injuries.
•
Endemic conditions are mobile. As the world’s leading gun producer and exporter, the United States needs to consider its role in preventing the adverse health consequences of gun injury from spreading. The spread of gun deaths and injuries to countries that have low rates of both—such as England (0.3 deaths per 100 000 population in 1999) and Japan (0.1 deaths per 100 000 population in 1995)—should be prevented.45
•
Endemic conditions can flare up as epidemics. We have learned much over the past 20 years about the factors that promote gun injury. These include easy access to guns (especially handguns),46,47 the introduction of new weapon models,48 gang and drug turf wars,49,50 domestic violence without escape options,51,52 and depression in adolescents53 and elderly men.54,55 It is likely that if several of these factors again surge, rates of gun injury will again rise. In addition, there are probably “unknown” factors that could drive a rise in gun injuries (such as the introduction of semiautomatic pistols, which was a wild card in the last epidemic outbreak). Development of a repertoire to monitor and respond to known risk factors is all the more important given the likelihood of such an unknown factor.
•
Endemic conditions cause much suffering. Gun deaths and injuries continue to afflict families and communities in the United States, where there were 147 488 shooting deaths from 1999 to 2003. The burden is particularly heavy for families that suffer from depression, communities wracked by drugs and gangs, and states and rural areas with high gun ownership rates.56,57
To further reduce ongoing firearm deaths and prevent or mitigate the next epidemic outbreak, an approach similar to that used for influenza might be considered. The approach would entail assessment and monitoring of local risk factors over time and the application of proven measures to reduce these factors. The approach would include the development of new means to address changing circumstances and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday lives.
During the current endemic period, a challenging agenda could be undertaken without the visibility and sense of urgency present in an epidemic context. Such an agenda could include the creation of structures to establish firearm injury management phases predetermined and tied to local risk factors and conditions (such as gang violence; many isolated, elderly farmers; and high adolescent drug use), changing incidence rates (fluctuations in shootings per time interval or per population group), and similar activities to foster the creation of prevention planning committees (national, regional, and local). During the peak of the last epidemic outbreak of firearm injuries, those structures and procedures were needed but were not available. The evolving National Violent Death Reporting System58 can facilitate the needed work by providing data at state levels.
Over the next few years, efforts to prevent US firearm injuries might include the following initiatives.
•
Health departments could strengthen their monitoring of deaths and nonfatal injuries to guide prevention planning and ensure that an outbreak is recognized.
•
Health departments could begin to monitor risk factors that are likely to contribute to future epidemic outbreaks of firearm injuries and to develop response repertoires for those factors to prevent outbreaks from occurring.
•
Public health and medicine could begin to institutionalize firearm injury prevention methods, including initiating processes to act on changes in injury patterns and educating health professionals on how to include gun injury prevention in routine history-taking and health-promotion counseling. This would be a change from epidemic-born prioritization of assessing and reducing immediate danger.
•
US injury prevention professionals could become more involved in international public health work aimed at reducing violence from small arms. This work is led by the International Action Network on Small Arms59 and International Physicians for Prevention of Nuclear War (through its Aiming for Prevention campaign, which addresses small arms by fostering public education, medical education, and health-sector advocacy).60 This move would be a change from the exclusively domestic focus on US public health work related to firearm injuries.
Krigloch the Furious
Pants full of poo
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