It's an issue that has seen about 30,000 American deaths every year for the last decade, sparking heated debate, massive protests, and widespread concern.
But for two decades, the nation's leading public health organisation has been unable to even try to figure out how to stop it.
The 2017 federal budget, which is still under negotiation in advance of a December 9 deadline, will mark 20 years since Congress last approved federal funding for the Centers for Disease Control and Prevention (CDC) to conduct research into gun violence.
And that's a big problem, advocates for gun control say.
“When you don’t have good research and a shared set of facts, you will find it very hard to find consensus on how the world works, and how different, perhaps contradictory, sets of values should operate within it,” Ted Alcorn, the director of innovation at research and advocacy group Everytown for Gun Safety, said in an interview.
In 1996, Congress stripped the CDC’s allotted funding for gun violence prevention research, reallocating the money to other studies and simultaneously putting into place legal language that restricted future research. A CDC spokesperson told Refinery29 that in order for the public health organisation to resume meaningful research, Congress would have to approve the $10 million in funding the CDC requested in the 2017 presidential budget for gun violence prevention research. That hasn't happened in two decades.
In the meantime, the CDC's Injury Center is left with only what it can wrangle out of its discretionary funds — a "very limited" amount, according to a spokesperson — to devote to gun violence prevention.
The number of things we don’t know is pretty astounding.
With the biggest organisation in public health virtually out of the game, researchers and policymakers are left with huge gaps in knowledge. The absence left by the CDC is one that can't be filled by private institutions, says Garen Wintemute, MD, MPH, an emergency room physician and the director at the Violence Prevention Research Program at the University of California Davis, who has become an expert in the slowly shrinking field of gun violence prevention research.
"The CDC has a unique perspective on violence, as it does on other health problems," Dr. Wintemute said. "When CDC’s not in the game, then something is absolutely missing, that is not made up for by other agencies." On questions such as how to prevent accidental injuries, the psychological effects of gun violence, or whether or not the public policies in place are working, there are a lot of blanks to fill.
In many respects, gun violence amounts to a public health issue. The CDC's National Center for Injury Prevention and Control, which tracks rates of injury from various causes, has found that more than 30,000 Americans, on average, are killed with guns every year. According to Everytown for Gun Safety, more than 2,500 of them are teens or children.
The number of annual fatalities is comparable to the number of reported deaths from car accidents. In 2012, the CDC spent only about $100,000 to study gun violence prevention, according to a 2013 report from Everytown (then called Mayors Against Illegal Guns). The same year, the National Highway Traffic Safety Administration (NHTSA), the federal organisation devoted to limiting traffic fatalities, devoted more than $32 million to vehicle safety research and analysis, according to the organisation's 2014 budget overview. Over several decades, NHTSA’s publicly funded research into traffic and vehicle safety has identified a number of ways that driving fatalities can be reduced, suggesting strategies for the public and policymakers on ways to reduce drunk driving and increase car seat and seat belt use. The CDC's website does not offer any equivalent strategies to reduce gun violence.
“The number of things we don’t know is pretty astounding," Alice Chen, MD, executive director of public health advocacy group Doctors For America, said.
Many in the medical and public health community are increasingly unhappy about the lack of progress for gun violence prevention research. In recent months and years, Doctors For America and other organisations of medical professionals, such as the American Medical Association, the American Public Health Association, and the American College of Physicians, have all spoken out to call for reinstating funding for gun violence prevention research.
“Take a disease like cancer — we study it from every single perspective,” Dr. Chen said. “That’s why we’ve been able to make progress over the past 20 years, the same time that we haven’t been able to make a lot of progress on gun violence prevention.”
Congress' decision to strip the CDC’s funding for research into gun violence in the 1990s happened amid accusations that researchers were biased in favour of gun control. Led by former Arkansas Rep. Jay Dickey, who described himself after the fact as "the NRA’s point person in Congress," legislators passed a one-sentence rider in that year’s federal omnibus spending bill that added an additional hurdle for researchers. The eponymous Dickey amendment instructed that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” At the same time, Congress cut the $2.6 million allotted to study the issue, dedicating the money instead to investigating traumatic brain injury.
The NRA celebrated the decision. “There is no room in good government for bad practices like recklessly biased research and blatant political advocacy, especially at taxpayer’s expense,” Tanya Metaksa, then-director of the NRA’s Institute for Legislative Action, said in a release shared with The New York Times at the time.
The Committee continues the general provision to prevent any funds from being used to advocate or promote gun control. The Committee does not include funding for the proposed Gun Violence Prevention Research.
In the 20 years since, the CDC has repeatedly asked Congress to approve more funding to research gun violence prevention, to no avail.
The NRA, which currently spends about $3 million annually on political lobbying and advocacy, is one of the most prominent opponents of reinstating the CDC’s funding on gun issues. In December of 2015, shortly after the San Bernardino shooting, NRA Executive Director Chris Cox wrote an op-ed for Politico asserting that the CDC could not be trusted with gun research due to its alleged bias.
“It’s not objective data gun control advocates seek,” Cox wrote. “They have a pre-determined outcome. Now, they just need some government-sponsored, taxpayer-funded data points to validate their anti-gun agenda.” The NRA did not return multiple requests for comment on this story.
Dr. Wintemute doesn't buy the accusations of research bias. “Research is about discovering and reporting the truth,” he said. “The people who have been doing this work for a long time are not agenda-driven. We are scientists.”
Dr. Wintemute has spent the past 35 years researching gun violence. His centre operates on a yearly budget of about $1 million per year, and is currently researching issues, such as whether alcohol abuse affects gun violence, and how well the current system of background checks functions in California.
He said that even though institutions like his are doing what they can, nothing can replace the CDC’s capacity to conduct large-scale, in-depth research. “There’s nowhere near enough federal funding to meet the need, or even specifically to fund the really good projects that people propose,” Dr. Wintemute said.
For one state, that might be about to change. In mid-June, the California state Legislature voted to allot $5 million to create the country’s first centre dedicated solely to firearm research, becoming the first state to move to allot budgetary funds specifically to gun research, according to Everytown for Gun Safety. The timing is tragically appropriate — though the legislation had been in the works for months, it passed only a few days after the mass shooting in Orlando, FL.
Dr. Wintemute, who has since been tapped to lead the centre, says that better funding could be a game-changer regarding the type of information researchers are able to provide. “Currently, we work on a project-to-project basis. What [increased] funding would allow a center to do is to think long-term about what work is in the public’s best interest,” he said. According to Dr. Wintemute, the most important thing to figure out is how well — or even if — efforts to curb violence are working.
"In general, there’s no part of firearm violence and its prevention about which enough is known," he said. "But if I had to put something at the top, it would be the answer to the general question, 'What works?'"
Maybe this year will be his chance to find out.
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