why gun violence is a problem?

Gun violence is a national public health epidemic that exacts a substantial toll on the U.S. society. Gun violence includes homicide, violent crime, attempted suicide, suicide, and unintentional death and injury. According to the Centers for Disease Control and Prevention (CDC), more than 38,000 deaths from firearms (including suicides) occurred in the United States in 2016,1 and nearly 85,000 injuries from firearms occurred in 2015.2 That’s an average of 105 deaths and more than 230 injuries from firearms each day.1,2

In addition to the thousands killed or injured, myriad families must also cope with the consequences of this violence. In terms of the financial toll, although the estimates vary, it’s generally held that gun violence expenses—medical charges, loss of income, daily care/support, and criminal justice expenditures—cost the U.S. economy approximately $229 billion annually.3

Gun violence should be considered a public health issue, not a political one—an epidemic that needs to be addressed with research and evidence-based strategies that can reduce morbidity and mortality. Gun violence affects people of all ages and races. Family physicians care for victims of gun violence and their families every day. These physicians, who witness the substantial impact firearm-related violence has on the health of their patients, families, and communities, have the power to help improve the safety and wellbeing of those groups.

The complexity and frequency of firearm violence, combined with its impact on the health and safety of Americans, suggest that a public health approach should be a key strategy used to prevent future harm and injuries. This approach focuses on three elements: scientific methodology to identify risk and patterns, preventive measures, and multidisciplinary collaboration.4 The AAFP encourages this public health approach and supports research that identifies which policies and interventions effectively reduce morbidity and mortality, while also respects the Constitutional right to bear arms.

Call to Action The American Academy of Family Physicians joined the American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, and the American Psychiatric Association urging the president and Congress to take the following three concrete steps to address gun violence:

This call to action from physician groups emphasizes the need to treat gun violence as a public health epidemic.

Family physicians can further address gun violence in their practices and communities by following these office- and community-based steps.

Office-based:

o   Patients who screen positive should undergo additional assessment that considers severity of depression and comorbid psychological problems, alternate diagnoses, and medical conditions. Patients with depression should be treated with antidepressant medication and/or psychotherapy.

o   The presence of guns in the home increases the risk that a woman will die due to an IPV-related homicide eight-fold.9

Community-based:

o   Funding research to identify effective measures to increase the safety of firearms; o   Gun safety legislation; o   Strict enforcement of current gun laws; o   Constitutionally-appropriate restrictions on the manufacture and sale, for civilian use, of large-capacity magazines and firearms; and o   Appropriate funding for mental health services.

Gun Violence: A Public Health Epidemic Gun violence is a public health epidemic and should be treated accordingly. While mass shootings are horrific and capture the attention of the media, they are only part of the gun-violence picture—more than half of all suicides are firearm-related,10 and firearms are used in more than 50% of female homicides.3,11

Similarly to females, firearm-related deaths are a particular threat to children in the U.S. They are the third-leading cause of death in children overall,1 and the U.S. accounts for more than 90% of all firearm deaths among children in developed, high-income nations.12

Public health professionals are trained to create and test interventions to reduce death and injury. However, limited federal funding is available to research this leading cause of death. Introduced in 1996, the Dickey Amendment prohibits federal funding allocated to the Centers for Disease Control and Prevention (CDC) be used to advocate for or promote gun control, which essentially ended all CDC funding research on gun violence or gun control measures.13

Appropriate research funding is the first step to understand gun violence and is essential to develop programs to prevent premature death from guns. An inconsistent collection of epidemiologic data is another impediment to this research. Currently, not all U.S. states report surveillance data to the National Violent Death Reporting System.14International Classification of Disease (ICD) codes are often used to collect data on a national scale, but do not provide the same level of detail. Creating a comprehensive data collection surveillance system will provide public health researchers with comprehensive and consistent information to study gun violence.

An example of such a system in place with data to study a public health issue is research on motor vehicle accidents. The number of deaths caused by motor vehicle accidents is comparable to gun violence, but motor vehicle deaths have declined significantly over the past decade despite more motorists on the road. Extensive research has improved motor vehicle safety with multiple evidence-based interventions contributing to decreased mortality. Implementation of vehicle safety features, stricter enforcement of traffic laws, and public awareness campaigns effectively addressed high morbidity and mortality associated with motor vehicles.

The National Highway Traffic Safety Administration (NHTSA) operates with a budget of more than $1 billion annually, and is committed to the continued improvement of the safety of motor vehicles and motorists.15 Research and development for the agency alone had a budget of nearly $146 million in 2017.15

Similarly, almost all other leading causes of death, whether accident or disease, receive substantially more funding for research than gun violence.16 One study found that, “in relation to mortality, gun violence research was the least-researched cause of death and the second-least funded cause of death after falls.”16 When a similar approach to research on motor vehicle accidents is suggested for gun violence, it is often considered political, instead of an evidence-based, data-driven approach to prevent morbidity and mortality.

As whole-person health care providers, family physicians see the effect of gun violence on their patients and in their communities. Using a public health perspective, family physicians can incorporate evidence-based strategies to treat their patients and guide their communities on this important issue. With that in mind, the AAFP:

Suicide In 2016, almost 45,000 individuals committed suicide in the U.S.1 Suicide accounts for nearly 60% of all firearm-related deaths in the U.S., with men overwhelmingly choosing firearms as their primary method to commit suicide.1Alarmingly, suicide was the second-leading cause of death for adolescents ages 15-19, with firearms as the leading method of suicide (50.7%) in this age group.1

Firearms are the most lethal method of attempting suicide. Between 85 to 91% of firearm suicide attempts result in death, compared to 3% or less for other common ways of attempting suicide.17 Suicide is often an impulsive decision. The majority of those who survived a suicide attempt reported that less than one hour had passed between the time they decided to commit suicide and when they took action.18 The use of a firearm to commit suicide rarely allows for intervention or reconsideration, so increased access to firearms is associated with increased rates of completed suicide.19 Evidence suggests unsafe gun storage may also pose a higher risk for committing suicide using a firearm.19 The impulsive nature of suicide, in combination with often times easy access to guns, can result in a completed suicide—one that might have been preventable if another method had been attempted.

Opportunities for Prevention Reducing the availability of firearms is one of the most effective mechanisms for suicide prevention. Waiting periods for purchasing handguns, mandatory background checks, gun locks, and restrictions on open-carry policies are also associated with a reduction in suicide by firearm.20

Waiting periods may allow for a “cooling off” time for individuals to reconsider suicide.17 Background checks limit access by creating a second barrier at the point of purchase.20 Safely securing guns places a barrier on immediate access and open-carry regulations decreases exposure to firearms.20 These mechanisms have been shown not only to decrease suicide by firearm, but also to decrease overall rates of suicide (by any method).20

In addition to decreasing access to firearms, increased access to mental health services is associated with a decrease in overall rates of suicide.19 The majority of patients with mental health issues access the health care system through primary care physicians.21 Appropriate access to primary care and payment for mental health services are critical to care for individuals with depression, substance abuse, and other mental illnesses, and can ultimately prevent attempted suicide through firearms and other means.

Domestic Violence Among developed nations, the U.S. has the most gun violence against women. Women are nearly 16 times more likely to die by firearm when compared to other developed nations.12 The majority of these deaths are the result of intimate partner violence (IPV). For example, in 2015, more than 3,500 women and girls were victims of homicide. More than half of those deaths were related to IPV.11 These rates are even greater in subgroups defined by race. Non-Hispanic black and American Indian/Alaskan Native women have the highest rates of IPV-related homicide.11

Compared to homes without guns, households with guns are associated with a nearly three-fold increase for the risk of homicide occurring in the home.22 There is a nearly eight-fold increased risk associated with gun ownership and homicide when the perpetrator is the intimate partner or a relative of the victim.22 If the gun owner has a history of domestic violence, the risk of homicide is 20 times higher.22 Women who are physically abused by current or former partners are seven times more likely to be murdered if the partner owned a handgun compared to women whose partner does not own a handgun.9

Opportunities for Prevention A proven strategy to protect women from IPV-related homicides includes reducing the availability of firearms. The AAFP recommends screening all women of childbearing age for IPV, and referring women who screen positive for IPV to intervention services.8 A step that family physicians can take after a positive assessment for IPV is to refer female patients to organizations which have resources for crisis intervention and counseling, and finding safe housing, medical care, and legal advocacy.11

Intimate partner violence is higher in communities experiencing severe disadvantage, such as poverty and low-social cohesion.23 System-level changes to reinvest in communities of poverty can reduce violence of many forms, including IPV-related homicide. Legislative policy change is an essential component to the reduction of IPV-related homicide.

Restricting firearm purchases for individuals convicted of domestic violence-related crimes or under a domestic violence-related restraining order is an effective way to prevent IPV-related homicide.24 States with systems to screen for restraining orders prior to firearm purchases have an 8-19% reduction in all IPV homicides and a 9-25% reduction in the rate of IPV homicide with a firearm.25 However, these safeguards must apply to all purchases to be effective. Currently, federal law only requires background checks for firearm purchases with licensed dealers.19Firearms purchased through unlicensed sellers and at gun shows, commonly referred to as the “gun-show loophole,” do not require a background check, allowing for individuals with a history of domestic violence unfettered access to guns. States requiring universal background checks on handgun sales from all sources experienced a 47% reduction in victims of IPV-related firearm homicide.26

Homicide and Violent Crime with a Firearm In 2016, there were more than 14,400 homicides with a firearm, accounting for nearly three-quarters of all homicides.1 In contrast to IPV, the majority (80%) of homicide victims are men.1

In the U.S., individuals are 25 times more likely to be killed by a firearm than in other high-income nations.12Disparities exist across racial and ethnic lines, as well. Non-white individuals are more likely to die by homicide than whites. For individuals 10-29 years, homicide is the leading cause of death in non-Hispanic blacks and Hispanics.27This is substantially higher than non-Hispanic whites, where homicide is the fifth-leading cause of death.27

Opportunities for Prevention Not surprising, a lack of research has resulted in a scarcity of evidence regarding prevention of homicide and violent crime. Limited evidence suggests that reducing access to illegal guns through programs that have demonstrated success can reduce homicide and violent crime rates. One program implemented in Baltimore used a system of “hot-spotting,” where detectives were placed in areas at high risk for gun violence. Between 2007 and 2012, areas of “hot spotting” experienced a 12-13% reduction in homicides and an 18-20% reduction in shootings.28

Background checks may also contribute to decreased rates of both homicide and overall violent crime.19 Moderate evidence suggests a decrease in violent crime with mental health background checks.19 However, much of this data is reported voluntarily by states and may vary depending on which conditions prohibit gun ownership.19 It is important to note that there is evidence that certain policies may actually increase violent crime. There is moderate evidence that stand your ground laws increase rates of homicide, and some evidence that states with concealed carry laws see increased rates of violent crime.19

Mass Shootings Given no standard definition of “mass shooting,” data on the subject, as well as mass murder is inconsistent. After the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, the U.S. Congress defined “mass killing” as “3 or more killings in a single incident.”29 This definition does not include information about the weapon(s) used, the number of perpetrator(s), or the location of the shooting. Mass murder is defined by the Federal Bureau of Investigation (FBI) as a “multiple homicide in which four or more victims are murdered, within one event, and in one or more locations in close geographical proximity.”29 This does not include injuries, nor is this a formal definition used for data collection purposes. Developing standard definitions through consensus among researchers will be crucial for quality, consistent research regarding gun violence.

Mass shootings account for only a small portion of gun violence deaths, but generally garner media attention due to the public and horrific nature of the incidents. In recent years, mass shootings have, by and large, been perpetrated by men using assault-style, semi-automatic weapons, often modified to mimic fully-automatic versions via high-capacity magazines and “bump stock” technology. These shootings have occurred in public places, such as schools, nightclubs, churches, and music venues.

Opportunities for Prevention While a lack of research hinders the development of evidence-based strategies to prevent mass shootings, even small changes—banning modification devices, such as bump stocks and high-capacity magazines—could potentially reduce the number of injuries and deaths that occur.

Congress’s 1994 assault weapons ban, which included 18 types of assault weapons, weapons with military-style features, and weapons with high-capacity magazines (10 or more bullets), lapsed in 2004. In that 10-year period, “gun massacres” (six or more gun deaths) declined compared to the decade prior.

From 2004-2014, after the assault weapons ban lapsed, the number of gun massacre deaths during the ban (89) increased more than three times (302). Also, the number of gun massacre incidents during the ban (12) nearly tripled (34) during the same 10-year period.30

Unintentional Death and Injury by Firearm Unintentional deaths and injuries by firearms are largely preventable. In 2016, 495 people died from unintentional firearm incidents.1 Of those, 127 (25.7%) were children and adolescents (0-19 years).1 Most of those deaths were among two age groups: 15-19 years (53 deaths) followed by 0-4 years (23 deaths).1 Young adults (20-24 years) had the most deaths by age group, with 68 unintentional firearm deaths.1

Unintentional injury by firearm also disproportionately affects adolescents and young adults. Of the 17,311 unintentional injuries by firearm in 2015, nearly 8,000 (50%) occurred in individuals between 15-29 years.2 The rate of unintentional injury by firearm was the highest among individuals between 20-24 years (21.9).2

Opportunities for Prevention Research suggests clinical interventions and public health campaigns focused on safe storage are effective at preventing unintentional injuries and deaths by firearms.19 One study found that family physicians and pediatricians who ask patients (mostly those with children) about access to firearms, and are counseled on safe storage and provided a free safe storage device, it results in increased safe storage behaviors.19 Another study, following the same protocol without a providing a free safe storage device, also found improvements in safe storage of firearms. Safe storage of firearms decreases immediate access to guns, especially for children.19 Child access prevention (CAP) laws are designed to protect children by legally prosecuting adults who intentionally or carelessly create situations in which children have unsafe and negligent access to guns.19

These laws often mandate safe storage of firearms, and some states stipulate that firearms must be unloaded when stored.19 CAP laws also prohibit providing children with unsupervised, reckless access to firearms.19 Strong evidence suggests CAP laws decrease firearm-related self-injuries (intentional and unintentional) among all ages, and decrease unintentional firearm injuries and death among children.19,31 Evidence also suggests that classifying violations of CAP law as felonies may further reduce unintentional death and injuries by firearms among children.19

Policy Strategies to Address Gun Violence Other potential avenues to address gun violence are consistent with common prevention strategies employed in other public health interventions. Two of the most effective public health strategies employed to reduce tobacco use—price increases and taxation—have proven effective deterrents to initiating tobacco use and encouraging the decline and cessation of tobacco use.32 Applying this economic strategy to the purchase of firearms could potentially reduce gun ownership, and as a result, decrease gun violence.

For example, background checks for ammunition purchases, limits on ammunition purchases, and identification requirements for firearms, have been shown to reduce firearm deaths.33 Reinstating the 1994 federal assault weapons ban could decrease access to dangerous semi-automatic weapons. Requiring microstamping—microscopic, laser-generated engravings on guns and ballistic materials—contribute to a higher solve rate for homicides and other violent crimes.34

Call for Research The AAFP calls for increased research funding on gun violence, and identifying key areas that must be addressed. These areas could begin to be addressed by answering the following questions:

AAFP Efforts to Address Firearm Safety and Violence Family physicians frequently find themselves on the frontlines on public health issues and discussions. This role provides them an opportunity to address and guide conversations about public health issues, such as gun violence, in both the exam room and their communities. By advancing policies that promote safety and discourage violence, family physicians are instrumental in the gun violence debate.

To assist family physicians in this effort, the AAFP has policies and advocacy efforts relating to violence to help equip family physicians as they serve the needs of their patients. The AAFP recognizes violence as a public health concern, and the impact of violence has on immediate and long-term health outcomes. The AAFP acknowledges that violence occurs in the context of a broad range of human relationships and complex interactions. These encompass social, cultural, and economic risk factors, including but not limited to, the influence of the media, substance abuse, interpersonal violence, fragmentation of family life, and the increased availability of weapons.

Moreover, the AAFP recognizes that violence disproportionately affects vulnerable populations, such as women, children, lesbian, gay, bisexual, transgender, questioning, and intersex individuals, as well as those living in poverty, among other populations. The AAFP has outlined multi-faceted issues surrounding violence in position papers, and describes both the challenges and opportunities for family physicians to address the health consequences, as well as to help prevent a continued cycle of violence.

Guns are deeply ingrained in American society and the nation’s political debates.

The Second Amendment to the U.S. Constitution gives Americans the right to bear arms, and about a third of U.S. adults say they personally own a gun. At the same time, President Joe Biden and other policymakers earlier this year proposed new restrictions on firearm access in an effort to address gun violence ranging from rising murder rates in some major cities to mass shootings.

Here are some key findings about Americans’ attitudes about gun violence, gun policy and other subjects, drawn from recent surveys by Pew Research Center and Gallup.

Four-in-ten U.S. adults say they live in a household with a gun, including 30% who say they personally own one, according to a Pew Research Center survey conducted in June 2021.

There are differences in gun ownership rates by political party affiliation, gender, geography and other factors. For instance, 44% of Republicans and Republican-leaning independents say they personally own a gun, compared with 20% of Democrats and Democratic leaners.

Men are more likely than women to say they own a gun (39% vs. 22%). And 41% of adults living in rural areas report owning a firearm, compared with about 29% of those living in the suburbs and two-in-ten living in cities.

Federal data suggests that gun sales have risen in recent years, particularly during the coronavirus pandemic. In 2020, the number of monthly federal background checks for gun purchases was consistently at least 20% higher than in the same month in 2019, according to the FBI’s National Instant Criminal Background Check System. The largest comparative percentage point difference occurred in July 2020 – when about 3.6 million background checks were completed, 44% more than were conducted in July 2019.

Personal protection tops the list of reasons why gun owners say they own a firearm. In a Gallup survey conducted in August 2019, gun owners were most likely to cite personal safety or protection as the reason they own a firearm. Roughly six-in-ten (63%) said this in an open-ended question. Considerably smaller shares gave other reasons, including hunting (40%), nonspecific recreation or sport (11%), that their gun was an antique or a family heirloom (6%) or that the gun was related to their line of work (5%).

A Pew Research Center survey conducted in 2017 found similar patterns in firearm owners’ stated reasons for owning a gun.

Around half of Americans (48%) see gun violence as a very big problem in the country today, according to a Pew Research Center survey conducted in April 2021. That’s comparable to the share who say the same about the federal budget deficit (49%), violent crime (48%), illegal immigration (48%) and the coronavirus outbreak (47%). Only one issue is viewed as a very big problem by a majority of Americans: the affordability of health care (56%).

Another 24% of adults say gun violence is a moderately big problem. About three-in-ten say it is either a small problem (22%) or not a problem at all (6%).

Attitudes about gun violence differ widely by race, ethnicity, party and community type. About eight-in-ten Black adults (82%) say gun violence is a very big problem – by far the largest share of any racial or ethnic group. By comparison, about six-in-ten Hispanic adults (58%) and 39% of White adults view gun violence this way. (Due to sample size limitations, data for Asian Americans is not available.)

Democrats and Democratic-leaning independents are far more likely than Republicans and GOP leaners to see gun violence as a major problem (73% vs. 18%). And nearly two-thirds of Americans who describe their community as urban (65%) say the same, compared with 47% of suburbanites and 35% of those who live in rural areas.

Roughly half of Americans (53%) favor stricter gun laws, a decline since 2019, according to the Center’s April 2021 survey. Smaller shares say these laws are about right (32%) or should be less strict (14%). The share of Americans who say gun laws should be stricter has decreased from 60% in September 2019. Current opinions are in line with what they were in March 2017.

Among Republicans and Republican-leaning independents, views have shifted. Republicans are currently more likely to say gun laws should be less strict (27%) than stricter (20%). In 2019, by comparison, a larger share of Republicans favored stricter gun laws than less strict laws (31% vs. 20%). Both years, roughly half of Republicans said current gun laws were about right.

Today, a large majority of Democrats and Democratic leaners (81%) say gun laws should be stricter, though this share has declined slightly since 2019 (down from 86%).

Americans are divided over whether restricting legal gun ownership would lead to fewer mass shootings. Debates over the nation’s gun laws have often followed recent mass shootings. But Americans are split over whether legal changes would lead to fewer mass shootings, according to the same spring 2021 poll. About half of adults (49%) say there would be fewer mass shootings if it was harder for people to obtain guns legally, while about as many either say this would make no difference (42%) or that there would be more mass shootings (9%).

The public is even more divided about the effects of gun ownership on crime overall. Around a third (34%) say that if more people owned guns, there would be more crime. The same percentage (34%) say there would be no difference in crime, while 31% say there would be less crime.

There is broad partisan agreement on some gun policy proposals, but most are politically divisive, the April 2021 survey found. Majorities in both partisan coalitions favor two policies that would restrict gun access: preventing those with mental illnesses from purchasing guns (85% of Republicans and 90% of Democrats support this) and subjecting private gun sales and gun show sales to background checks (70% of Republicans, 92% of Democrats). Majorities in both parties also oppose allowing people to carry concealed firearms without a permit.

Other proposals bring out stark partisan rifts. While 80% or more Democrats favor creating a federal database to track all gun sales and banning both assault-style weapons and high-capacity ammunition magazines that hold more than 10 rounds, majorities of Republicans oppose these proposals.

Most Republicans, on the other hand, support allowing people to carry concealed guns in more places (72%) and allowing teachers and school officials to carry guns in K-12 schools (66%). These proposals are supported by just 20% and 24% of Democrats, respectively.

Gun ownership is closely linked with views on gun policies. This is true even among gun owners and non-owners within the same political party, according to the April 2021 Center survey.

Among Republicans, gun owners are generally less likely than non-owners to favor policies that restrict access to guns. Democratic non-gun owners are generally the most likely to favor restrictions.

For example, a majority of Republicans who don’t own a gun (57%) say they favor creating a federal government database to track all gun sales, while 30% of Republican gun owners say the same. There are similar-sized gaps among Republicans who own guns and those who do not on banning assault-style weapons and high-capacity magazines.

Among Democrats, there are modest gaps on gun policies by gun ownership. For instance, while majorities of Democratic gun owners and non-owners both favor banning assault-style weapons and banning high-capacity magazines, Democratic gun owners are about 20 percentage points less likely to say this.

Americans in rural areas typically favor more expansive gun access, while Americans in urban places prefer more restrictive policies, according to the April 2021 survey. Even though rural areas tend to be more Republican and urban communities more Democratic, this pattern holds true even within each political party. For example, 71% of rural Republicans favor allowing teachers and other school officials to carry guns in K-12 schools, compared with 56% of Republicans living in urban places. Conversely, about half of Republicans who live in urban communities (51%) favor bans on assault-style weapons, compared with 31% of those living in rural areas.

Democrats favor more gun restrictions regardless of where they live, but there are still some differences by community type. A third of rural Democrats (33%), for instance, support allowing teachers and other school officials to carry guns in K-12 schools, compared with 21% of those in urban areas.

The issue of gun violence is complex and deeply rooted in our culture, which is why we must take a public health approach to ensuring our families and communities are safe. We must place a renewed emphasis on improving gun injury and violence research.

If you are interested in a sample op-ed, letter to the editor or technical support to help reach your local media, please contact APHA Media Relations.

“As our nation has this very intense debate over how best to make our communities safer and reduce the carnage that occurs from firearms, we’ve given you some policies that will work and how we can move this nation forward.” -- APHA Executive Director Georges Benjamin, MD

Policies that Work to Reduce Gun Violence forum: Video Presentation slides (PDF) Introduction and Overview, Panel 1, Panel 2

Read about the forum in this article from The Nation's Health

APHA webinar: Gun Violence Prevention through the Public Health Lens: History, Intersectionality and Interventions

From The Nation's Health: Federal funding for gun violence prevention research sparks hope

APHA President Pam Aaltonen: Progress on gun violence prevention constrained by unanswered questions (The Nation's Health)

Webinar for APHA members: Gun Violence as a Public Health Issue

Fact sheet: Who Gets Killed in America? The National Violent Death Reporting System is Keeping Track (PDF)

Troisi, Williams: Public health approach can stem gun violence (PDF, Houston Chronicle)

"Gun Violence is an epidemic. It is time for a public health response" (editorial in The Guardian by APHA's Georges Benjamin)

Diagnosis: gun deaths and injuries are a public health issue (editorial by APHA Executive Director Georges Benjamin, MD, and Brady Campaign and Center to Prevent Gun Violence President Dan Gross)

Contents

Introduction

I. The Surge of Gun Violence in the United States

II. Gun Control: An Uphill Battle in the United States

III. Gun Violence Lays Bare the Decline of U.S. Governance Capacity

Conclusion

Introduction

Gun violence is a chronic disease in the United States. With its interplay with gun culture, individual rights, interest groups and partisan politics, it has long plagued American society and gravely violated people's right to life, leaving an indelible stain on the country's human rights record.

Through facts and figures, this report sheds light on the alarming state of gun violence in the United States and the political and social causes of this entrenched problem.

I.The Surge of Gun Violence in the United States

Gun violence is one of the acutest social problems in the United States, with ramifications not only for the victims and their families, but also for the entire society and country. In addition to the casualties caused and the threat to public security, it has also resulted in enormous economic losses and social trauma for the nation.

◆ The United States is the country with the most civilian-held firearms. With less than 5 percent of the world's population, it accounts for 46 percent of global civilian gun ownership. As estimated by the Small Arms Survey in Switzerland, the global stockpile of civilian-held firearms has increased from 650 million in 2006 to 857 million in 2017, largely attributable to soaring figures in the United States. In 2017, about 393.3 million guns were privately owned in the United States at a time when its population was less than 326.5 million. This amounts to 120.5 firearms for every 100 people. The second-ranked country was war-torn Yemen, with 52.8 guns per 100 people. While the United States ranks first in the world in terms of both individual gun ownership and the number of guns per capita, only about 1.07 million civilian guns are registered, indicating that the vast majority of firearms owned by civilians are left unregistered and uncounted.

◆A latest study by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) reveals that the United States is in the midst of a massive gun-buying boom that shows no signs of abating. From 2000 to 2020, annual production of firearms in the country almost tripled, with a dramatic increase in the past three years in particular. Since 2020, the COVID-19 pandemic has brought about more social problems. The "Black Lives Matter (BLM)" movement sparked a series of looting and riots, aggravating social insecurity. As a result, demand for semi-automatic pistols for self-protection surged and gun sales soared at a record pace. According to the U.S. National Shooting Sports Foundation (NSSF), the United States conducted 21 million background checks for gun purchases in 2020, a 60 percent increase from 2019 and a record high, surpassing the previous record in 2016 by 5.3 million. The sudden first-time gun ownership by millions of Americans has inevitably given rise to considerable security threats.

◆Individual ownership of a large number of guns has triggered incessant violence, putting social security in the United States at greater risk. As pointed out by some American scholars, gun-related deaths in the United States in one week may exceed those in the whole Western Europe in one year. Amid the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994. According to a survey by the Giffords Law Center, 32 of the country's 50 largest cities witnessed a prominent increase in firearm homicides in 2021. The Guardian reported in October 2021 that every 16 hours, a woman is fatally shot by her partner in the United States. According to data from the U.S. Centers for Disease Control and Prevention (CDC), from 2018 to 2021, the proliferation of guns not only resulted in a spike in homicides across the country, but also led to more suicides by people with mental illnesses. According to the Gun Violence Archive (GVA), gun-related casualties surged to 85,584 in 2021 from 34,231 in 2014. Among the nearly 95,000 homicides between 2015 and 2019, about 74 percent were committed with firearms. In 2020, firearm-related deaths reached 45,222, an average of 124 per day. Firearm injuries are one of the top five causes of death for people aged 1 to 44 in the country.

◆Recent years have witnessed frequent mass shootings in the United States, causing alarmingly high casualties. By American standards, a mass shooting is defined as an incident of gun violence in which four or more people are injured or killed, excluding the suspect or the gunman. According to GVA data, both mass shootings and deaths in the United States have surged about fourfold since 2013. There were 417 mass shootings in the country in 2019, 611 in 2020, and 692 in 2021. In 2022, there were 213 mass shootings reported in 34 states and the capital Washington, D.C. by the end of May, with 242 killed and 912 wounded, a 50 percent increase over the same period in 2017 and a 150 percent increase over the same period in 2013. On July 4, 2022, Independence Day of the United States, a 21-year-old white man fired more than 50 shots from a rooftop at a parade in Highland Park, a suburb north of Chicago, killing at least seven people and injuring more than 30. On Jan. 21 and 23, 2023, tragic shootings occurred in Monterey Park of Los Angeles County, California and Half Moon Bay in northern California, killing 17 and injuring 11.

◆The United States has seen repeated mass school shootings for many years, causing serious trauma to the American society. The mass shooting at the Columbine High School in Colorado in April 1999 killed 13 people and left more than 20 injured. In April 2007, the shooting at Virginia Tech resulted in the death of 32 students and faculty members. GVA data show that, over the past decade, 27 mass school shootings took place in the United States. The deadliest shootings among them are: December 2012, Connecticut, Sandy Hook Elementary School shooting, 26 killed including 20 children aged six to seven; October 2015, Roseburg, Oregon, Umpqua Community College shooting, 10 killed; February 2018, Parkland, Florida, Marjory Stoneman Douglas High School shooting, 17 killed (14 students and 3 faculty members) and 17 injured; May 2018, Houston, Santa Fe High School shooting, 10 killed. In May 2022, an 18-year-old gunman entered the Robb Elementary School in Uvalde, Texas, and killed 21 people including 19 children. This last incident was the 27th school shooting in the United States in 2022. It was also one of the worst in recent years.

◆Gun violence also inflicts huge economic losses. According to Brady, an organization that advocates gun control, gun violence costs the U.S. economy at least 229 billion U.S. dollars each year. In May 2022, in the wake of the shooting at the Robb Elementary School in Uvalde County, Texas, over 200 CEOs co-signed a letter urging the U.S. Senate to take immediate actions to address gun violence. In the letter, it was stated that "gun violence costs American taxpayers, employers and communities a staggering 280 billion U.S. dollars per year".

◆Gun violence has also taken a toll on the everyday life of the American people. A poll conducted by the University of Chicago Harris School of Public Policy and the Associated Press-NORC Center for Public Affairs Research found that 21 percent of American adults have experienced gun violence in which their relatives, friends or themselves have been threatened with a gun or have fallen victim to a shooting. As many as 54 percent of black and hispanic Americans say that they have had similar experience. The Associated Press reported a survey by the American Psychological Association (APA), which shows that one-third of American adults feel they cannot go anywhere without worrying about being a victim of a mass shooting, and nearly a quarter of them admit that they have changed their behavior due to fear of mass shootings.

II.Gun Control: An Uphill Battle in the United States

Since the end of the 19th century, U.S. state and local governments have made various attempts to introduce legislation on gun control, but such efforts all ended up either long in words but short on action, or flip-flopped. No real progress was made on gun control.

◆The second amendment to the U.S. Constitution provides for the right of individuals to keep and bear arms. In recent years, as gun-related issues have become increasingly prominent, pro-gun and pro-control advocates have engaged in heated debates on the interpretation of the second amendment. Organizations that support gun rights claim that individual rights should not be arbitrarily modified and gun control is illegal. Organizations that support gun control argue that the second amendment establishes a collective right, rather than an individual right to possess guns, and the government has the right to control guns. Such debates have resulted in stalled efforts on gun control legislation, and Supreme Court rulings based on the second amendment are often not in favor of gun control.

◆In the United States, there is significant disparity in gun control from state to state, and relevant legislation efforts at the federal level are often slow, inconsistent and contradictory. In 1927, an act passed by Congress banned mail shipment of firearms such as pistols and revolvers to individuals, but did not prohibit the delivery of such firearms through private delivery firms. Under this act, individuals are allowed to buy guns across state lines. In 1968, the Gun Control Act passed by Congress did not include registration and licensing requirements for all firearms and their carriers, nor did it ban the import of firearm components. In 1969, the lobbying power of the U.S. National Rifle Association (NRA) propelled Congress to waive requirement for registration of buyers' information by sellers of shotgun and rifle cartridges. In 1986, the Firearms Owners' Protection Act signed by President Ronald Reagan made it easier for unlicensed individuals to sell firearms. It also allowed firearms to be sold at gun shows, and banned the establishment of any comprehensive system of firearm registration.

◆In 2005, Congress passed the Protection of Lawful Commerce in Arms Act, which protects firearm manufacturers from civil liability for crimes committed with their products. Pro-gun groups have also used legislation and federal courts to resist gun control efforts. In June 2008, the U.S. Supreme Court ruled 5-4 in the case of District of Columbia v. Heller. With this ruling, the District of Columbia lifted the ban on handguns and allowed individuals to keep guns at home. Justice Antonin Scalia, who presided over the case, noted that the second amendment protects an individual's right to keep and bear firearms, and that the District of Columbia's ban on handgun possession in the home violated that right. The Supreme Court's ruling and its opinion on this case have directly affected gun control legislation across the United States. In 2012, in the wake of a mass shooting at Sandy Hook Elementary school, Senators Joe Manchin and Patrick Toomey drafted a compromise bill to expand background checks on gun buyers. The bill fell short of the 60 votes required to move forward and was thus defeated. In the ensuing decade, all congressional efforts to pass bills to enhance background checks on gun buyers ended up in failure.

◆In March 2021, the House passed the "Bipartisan Background Checks Act of 2021", which requires background checks on all gun sales. In May 2022, two mass shootings in Buffalo, New York and Uvalde, Texas sparked hundreds of anti-gun violence demonstrations, and calls for gun control re-surged. The Senate and the House adopted new gun control legislation, only after Democrats significantly weakened the control measures. At the same time, however, the Supreme Court issued a ruling striking down New York State's 1911 law which restricts carrying a concealed firearm in public. This directly undermined the ability of state and local governments to monitor firearms in New York, California, Hawaii, Maryland, Massachusetts and New Jersey, among others.

◆Due to the difficulty of Congress to act on gun control, the U.S. administration could only regulate certain types of firearms and firearm modifications through presidential executive orders. In June 2022, Congress passed a gun-related bill called the Bipartisan Safer Communities Act. According to a Pew poll, most people are not optimistic about the bill's effect in reducing gun violence in the United States. Seventy-eight percent think it will do little, of which 36 percent think it will do nothing at all.

◆The American public is deeply divided on gun control. Public opinion polls in recent years have shown that women, urban residents, non-native borns, liberal-leaning people and non-gun owners are more likely to support gun control, while men, rural residents, native-born Americans, political conservatives, hunters and gun owners oppose it. The gap between Americans' stance on gun control is still widening.

III.Gun Violence Lays Bare the Decline of U.S. Governance Capacity

Given a political system where different sides hold each other back, an increasingly polarized political ecosystem, pervasive interest groups and ineradicable racial discrimination, gun control in the United States is in stalemate, and a total ban on guns is effectively a mission impossible.

◆How the U.S. political system is designed and operates constitutes the root cause of ineffective gun control. Gun control intensity varies across different states, making it increasingly difficult to regulate guns and perform interstate enforcement. Everytown for Gun Safety, a gun control group, compared gun policies across the country, rating every state on the strength of its gun laws and comparing it with its gun violence occurrence. A positive correlation was found between ineffective gun control and gun violence rate. Eight states, including California and Hawaii, with comparatively well-established gun laws saw relatively low gun violence rates, while the 13 states with the weakest gun control, including Texas, Alaska and Missouri, have nearly three times as many gun deaths as the eight states mentioned above.

◆Positions of Democrats and Republicans on gun control are becoming increasingly polarized. In 1968, the House voted 305-118 and the Senate 70-17 to pass the Gun Control Act. Since then, the two parties have been increasingly divergent over gun control. Republicans have always supported gun ownership, while Democrats have unequivocally supported gun control. Given the polarized U.S. political landscape at present, it is even more difficult for either party to compromise. The New York Times reported that since the mass shooting at Sandy Hook, despite a Democratic push for gun control, 14 Republican-controlled states have gone the opposite way, passing laws allowing their citizens to carry guns without any licensing process. The Washington Post reported that in recent years, the Republican Party has posted a myriad of pictures and videos containing guns in newspapers, billboards and social media to appeal to voters who oppose gun control for campaigning purposes.

◆Interest group lobbying is rampant. Group politics and electoral politics in the United States have provided legalized channels for gun groups to conduct money politics and influence the stance of Congress members on guns. According to OpenSecrets statistics, from 1990 to 2022, gun ownership groups contributed 69.3 million U.S. dollars to federal and state candidates, while gun control groups contributed 51.6 million U.S. dollars. From 1998 to 2022, gun ownership groups spent 190.4 million U.S. dollars on lobbying, while gun control groups spent 28.9 million U.S. dollars. In the 117th Congress, 262 members have been sponsored by the NRA, among which 19 have each received more than 1 million U.S. dollars cumulatively. The vast majority of them are Republicans. Meanwhile, the NRA has spent handsomely against pro-gun control lawmakers. All five of the lawmakers whom the association has paid millions of dollars to oppose are Democrats.