Between 1990 and 2016, firearm deaths were more common outside war settings
than within in all but one year.
In 2016 alone, there were 251?000 such deaths.
When a quarter million people die per year by use of firearms,
that is an enormous public health problem and crisis that we should really address
and of course acknowledge that the risks vary tremendously across nations.
Global Burden of Disease Investigators from the University of Washington's Institute
for Health Metrics and Evaluation have estimated trends in global mortality
from firearms between 1990 and 2016.
The researchers measured cause-specific deaths by age, sex, location,
and year for 195 countries, and evaluated the relationship between gun ownership
and access and gun injury deaths.
Overall, there was good news: during the 27 years,
the global rate of firearm deaths decreased at an annual rate of 0.9%,
primarily driven by a decrease of 1.6% in suicide rates.
But trends differed by country, age group, and other variables.
Two patterns were especially noteworthy.
First, gun deaths were highly concentrated.
In 2016, six countries in the Americas accounted for more than half of all firearm deaths.
These countries hold only 10% of the world's population.
And there was another notable example of geographic concentration.
If you look at the countries with the highest rates of firearm homicide in 2016,
they're concentrated in Latin America and the Caribbean.
These countries have something in common: many have been identified as drug producing
or transporting by the US Department of State.
And this has repercussions beyond firearm deaths.
Having criminal organizations heavily armed and often far better armed than law enforcement,
it really, really leads to a set of conditions that not only elevate violence
but generally make it hard for a country to move forward in ways
that advance public health and safety.
In these countries, firearm deaths were driven by homicides, in line with a global pattern
where homicides exceeded suicides, and unintentional deaths.
But in 67 countries in 2016, mostly in Europe, high-income North America and Australasia,
suicides dwarfed homicides, which is the second important pattern.
Take the United States: Much of our discussion about gun violence in the United States and what
to do about it does not recognize that for every homicide with a firearm, there are two suicides
with a firearm, and, importantly, as public health professionals,
we recognize that these are preventable deaths.
And preventing these deaths could have a big impact globally.
In 2016, the US had only 4% of the global population, but in that same year,
it had 35% of global firearm suicides.
While some of our policies connect to both of those kinds of risks, both for homicides
and suicides, there are other strategies that may be very specific and unique
to suicide reduction that we have not fully examined and invested in.
One thing that many people in public health are beginning to talk about is ways
to change a culture, in essence, about holding firearms from individuals when they're going
through some crisis that might elevate their risk for suicide.
So just as a friend or a family member, as a caring thing to do about someone's safety,
would say, let me get you, let me drive you home because you've had too much
to drink, you do the same thing with saying,
let me hold your guns while you're going through this divorce.
Let me keep your guns after you just lost your job and are very distraught.
We also talk about this as what physicians can do in their role in counseling patients
and their families to reduce access to firearms to lower suicide risk.
But, in my opinion, it's a much bigger public health challenge to really change a culture
about firearm access and suicide.
It is the thing that is leading to the greatest number of firearm deaths in our country.
Whenever we've had big breakthroughs in public health,
it's always been a combination of policy and cultural change.
And this global data set is a lens through which researchers can better compare nations
and examine how the interaction between policies and culture affect firearm death rates.
A final takeaway is about gun ownership.
How does access to firearms influence patterns of homicide and suicide?
The study in question here is consistent with other studies
that look at other units of analysis.
Sometimes those units of analysis are household, sometimes they are communities,
sometimes they're cities, states, and now across countries.
We see a fairly consistent relationship, when you control for other factors,
the more firearms there are, the greater the risk for both firearm homicide and suicide.
But this finding doesn't address the complex set of factors
that affect whether owning a firearm might result in a lethal outcome.
People in public health and people who study epidemiology and risk as it relates
to firearms mostly think about it in terms of relative risk: the more guns,
the more deaths there are with respect to homicides and suicides in particular.
But I think what's lost in that, however, is absolute risk.
In the United States, for example, roughly one in three homes will have at least one firearm,
and the vast majority of those homes with firearms, nothing bad will happen.
It's when other risk factors are coupled
with firearm ownership that the excess risk is formed.
And these risk factors can be found in any country.
Each population has some people who are more impulsive, have more anger problems,
have more mental health problems, a variety of other things,
that could otherwise make them more impulsive to harm themselves or someone else.
And sometimes it has to do more with context.
Infrequently do we acknowledge the substance abuse component of this,
and specifically alcohol, that comes into play, that elevates both homicide risk
and suicide risk, and you mix a firearm into that mix of alcohol abuse,
any violence that's directed at others or oneself becomes highly lethal.
So the more firearms there are, the more likely it is
that they will end up in high-risk contexts.
But these contexts vary globally.
And this variation underpins both the global disparities in firearm deaths
and effective ways to reduce them.