This week’s JAMA released a comparison of major causes of injury death and how they contribute to the gap in life expectancy between the US and other high-income countries. Here are their findings:
Men in the comparison countries had a life expectancy advantage of 2.2 years over US men (78.6 years vs 76.4 years), as did women (83.4 years vs 81.2 years). The injury causes of death accounted for 48% (1.02 years) of the life expectancy gap among men. Firearm-related injuries accounted for 21% of the gap, drug poisonings 14%, and MVT [motor vehicle traffic] crashes 13%. Among women, these causes accounted for 19% (0.42 years) of the gap, with 4% from firearm-related injuries, 9% from drug poisonings, and 6% from MVT crashes. The 3 injury causes accounted for 6% of deaths among US men and 3% among US women.
These findings are also shown in tabular format here, in the paper’s Table 1:
What is simultaneously so hopeful and so frustrating about these findings is that all three causes of the mortality gap between the US and other high-income nations is that there are clear, proven public health answers to all three causes of injury (with thanks to Injury Epidemiologist Dr. Dawn Comstock for her scholarship and public health advocacy messages for all three).
- GUNS: I have written previously about prevention of gun violence deaths, including preventive technologies such as smart guns and required training for gun ownership (just as is required for vehicle licensure.
- OPIOIDS: I have also written about some local approaches to the opioid epidemic, including efforts to educate prescribers to prescribe carefully and efforts to improve prescription drug records as well as better packaging to prevent pill bottles and marijuana edibles from falling into the wrong hands and mouths.
- MOTOR VEHICLES: Finally, for motor vehicle related deaths, public health solutions include enforcing our existing laws (e.g., drunk driving laws, penalties for driving with suspended licenses) and improving technology (e.g., easier-installation car seats).
Findings of the JAMA study have also been covered in the media.
A New York Times opinion piece today gives another perspective on gun violence prevention. In an earlier post, I had focused on the public health approach to reducing gun violence through targeting mass shootings. Although mass shootings occur more than once daily in this country, the rate of gun-related suicide is far higher: about 20,000 suicides by gun per year, or about ⅔ of all people killed by guns.
A common argument about restricting access to firearms for people with suicide risk is that there’s no point to locking up a home’s firearms because people in crisis or with suicidal impulses will find some way to get a gun, or will just find another way to kill themselves. In reality, most suicides are often impulsive, meaning that there’s a very short time between the decision and the action, and 90 percent of people who survive suicide attempts do not eventually die by suicide.
Suicide is largely preventable through means restriction–the fewer guns there are at the time of a suicidal thought, the lower the rate of successful suicide.
I agree with the New York Times editorial board’s response to the most recent mass shootings, as well as Ronald Reagan–that these atrocities–atrocities that occur more than once daily in this country–are not beyond the power of government and politicians to stop. Times columnist Nicholas Kristof points out that we urgently need to develop public health policies that focus not on eliminating guns (an unrealistic goal given the current social and political milieu) but on reducing gun deaths. As a health care provider and researcher, I like that he goes beyond rhetoric, proposing a public health approach. Public health approaches to gun violence prevention are favored by a large majority of Americans from both parties:
- Assault weapon and large-capacity ammunition clip policies
- Prohibited person policies
- a 10-year prohibition on possessing guns for anyone convicted of domestic violence, assault or similar offenses
- Background check policies
- universal background checks
- tighter regulation of gun dealers
- allowing the information about which gun dealers sell the most guns used in crimes to be available to the police and the public so that those gun dealers can be prioritized for greater oversight
- other policies
- other technologies
- invest in “smart gun” technology, such as weapons that fire only with a PIN or fingerprint.
- adopt microstamping that allows a bullet casing to be traced back to a particular gun
Another impediment to using public health tools to approach policy prioritization in reducing gun violence is the Congressional ban on CDC and NIH research on firearm violence. A coalition of physician groups has urged the ban be lifted. Even the ex-Congressman who introduced this ban, former Rep. Jay Dickey (R-Ark.), has since called for the ban to be lifted.
Although this post focuses on gun violence involved in mass shootings, the leading cause of gun violence death is suicide. Suicide is largely preventable through means restriction–the fewer guns there are at the time of a suicidal thought, the lower the rate of successful suicide.
The Washington Post has also covered gun violence recently, pointing out the racial disparities in causes of gun related deaths. Among whites, 77 percent of gun deaths are suicides, but among black Americans, 82 percent of gun deaths are homicides.
Where do you begin to help the public health campaign against gun violence? One first stop is Organizing for Action’s gun violence prevention site. It contains several tools that you can use to take easy, online steps to reduce gun violence. It is a party affiliated web link. If you know of a good bipartisan or nonpartisan site for getting involved in doing more to prevent gun related violence, please share it in comments.