Gun violence research at standstill due to lack of federal funding

A year has passed since Congress clarified that the Centers for Disease Control and Prevention was allowed to conduct gun violence research, but the agency has yet to receive a significant increase in funding to support that effort.

The past 12 months simply reflect a dearth of funding over two decades that experts feel has left the country no closer to answering some of the most important questions about the nature of gun violence, limiting progress in reducing the number of deaths and injuries that occur each year due to firearms. 

That puts hospitals, a major stakeholder in the epidemic of gun violence, in an even greater bind as they try to tackle the social determinants of health with little guidance in that area.

“I cannot overstate the impact of lack of funding from Congress,” said Dr. Megan Ranney, director of the Emergency Digital Health Innovation program at Brown University and chief research officer at the American Foundation for Firearm Injury Reduction in Medicine, or AFFIRM. The nonpartisan, not-for-profit organization provides funding for firearm injury research that will focus on creating best practices on firearm injury for healthcare providers. 

Ranney said much of what she called the “low-hanging fruit” in terms of research questions—where some preliminary evidence already existed—still needs to be investigated more thoroughly. 

There has been a slight uptick in the effort to fill the research gap in recent years driven largely by healthcare providers. A small number of stakeholders have attempted to fund their efforts either by personally investing in research initiatives or by seeking private donations.

Either way, researchers would acknowledge that the lack of federal funding for gun violence research over the past two decades has all but halted progress in finding effective strategies to address one of the country’s deadliest public health issues.

“We have a generation of researchers who were unable to address this problem, and it will take time to get our science to where it needs to be,” Ranney said.

One area needing further research involves developing a more in-depth surveillance data system around firearm injury and mortality.

“You need to understand what’s happening in terms of what are the circumstances around injuries, what are the rates of nonfatal injury, and where are they happening,” said Dr. Eileen Bulger, chair of the American College of Surgeons Committee on Trauma. “From the research side, obviously there are huge gaps.”

Bulger envisioned a national commitment toward researching gun violence that would resemble the work that’s been conducted since the 1960s to address motor vehicle fatalities. In 1966, Congress passed legislation that set new safety regulations for motor vehicles and roads that eventually led to a stark decline in deaths, cutting the rate of mortality by 54% from 1972 to 2017, according to figures from the National Safety Council. 

The laws that led to such progress began as a public health initiative, one that first identified the various underlying factors involved in crashes, from driver behavior to the design of both the car and the roads. 

Bulger said similar progress could be achieved in addressing gun violence, but it would take substantially more funding than has ever been made available before, with estimates of around $50 million a year to start. 

By contrast, a 2017 study published in JAMA found an estimated sum total of $22 million was spent on gun violence research between 2004 and 2015, with 1,738 research publications written over that period, compared with the hundreds of thousands of publications on liver disease, heart disease and diabetes produced over the same period.

Study authors estimated that the amount spent on gun violence research over the years was 1.6% of the total funding expected to have been committed to address a leading cause of death of similar magnitude. In 2016 more than 38,000 people died from firearm-related injuries.

Firearm deaths are currently tracked by the FBI through its Uniform Crime Reporting Program, as well as by the CDC through the National Violent Death Reporting System. But many feel that reporting system does not contain enough data since up until last year the system only provided information from 40 states. Also, the system does not include data on nonfatal shooting injuries and does not have the ability to trace the origins of guns used in violent incidents. Bulger said having such additional surveillance data would provide a fuller picture of the problem’s scope.

“Really trying to understand the epidemiology is important,” Bulger said.

Bulger said several strategies have been shown to be effective in reducing the risk of gun violence. For instance, laws that require homeowners to safely lock away their firearms have been shown to reduce gun-related suicides as well as accidental shootings by children. 

But the problem lies in both identifying the risk factors that could lead to violence while knowing the most effective ways of communicating strategies to mitigate those risks. Talking with high-risk patients means finding the right messaging that will convince them to make the changes needed to reduce the risk.

“But we don’t know how to get people to do it,” Bulger said. “We need to study different ways of messaging to firearm owners about safe storage and firearm safety. We need to engage firearm owners in creating those solutions, but those are research projects that need to be done to understand what’s the best strategy for that.”

Many of the interventions that have been launched and much of the research that has been conducted remain in early stages of development and have yet to produce enough data that could better inform providers on best practices for such strategies. 

Perhaps more importantly, the lack of empirical evidence has left lawmakers with little information to help make policy decisions on guns, making it more likely any action taken is based in bias from both supporters and opponents of more restrictive firearm laws. 

A 2017 RAND Corp. analysis of the effects of gun policies found scant evidence for many of the most common actions taken around guns, including background checks, gun-free zones and concealed-carry laws, in terms of their impact on issues such as mass shootings, violent crime or accidental shooting deaths.

“There is a lot to draw from available research to guide current prevention efforts,” said Daniel Webster, professor of American health at the Johns Hopkins Bloomberg School of Public Health’s Center for Gun Policy and Research, speaking at a House Appropriations committee hearing on gun violence research held in March. “Most studies designed to estimate the effects of firearm policies and firearm-focused interventions have important weaknesses. I believe these weaknesses are often due to modest levels of funding that limit the amount and type of data that are collected and analyzed.”

Overall, Ranney remained hopeful that the renewed interest by House lawmakers in gun violence may represent a turning point that will finally lead to federal funding on research, but the urgent need for answers has made it too difficult to wait. Ranney said she’s still committed to advocating for federal funding but admits she’s running out of patience. “Our whole country has been waiting for too long. We need to get going now.”

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