In the United States, more than 1 million people died because of firearm injuries (72, 78) between 1933 and 1987. In 1986, firearms were second only to motor vehicles as a cause of fatal injury and ranked seventh among all causes of death (28). During 1986 and 1987, the last two years for which data are available, the number of people who died from firearm injuries in the United States (50, 72) was greater than the number of casualties during the entire 8Y2-year Vietnam conflict. In a recent report on the cost of injury in the United States (57), investigators estimated that firearm injuries imposed a $14.4 billion economic burden in 1985. These statistics highlight the magnitude of what is one of the most serious public health problems facing the United States. Unfortunately, it is also one that has not yet received sufficient scientific attention.
Firearm injuries result from three general circumstances: interpersonal conflicts, suicidal behavior, and unintentional discharge of weapons. Traditionally, these types of firearm injury have been addressed separately. Criminal firearm injuries and gunshot injuries due to interpersonal violence are largely considered a “crime” problem; firearm suicides are considered a “mental health” problem. Unintentional firearm injuries, however, have long been dismissed as “accidents,” which creates the impression that these are random events resulting from misfortune or fate and are, therefore, not preventable. Fortunately, the 1985 report Injury in America (21) stimulated broad interest in viewing injuries, including firearm injuries, from a public health perspective.
In this article we summarize the epidemiology of firearm injuries and describe the magnitude of firearm injury as a public health problem in the United States. We also review the public health approach towards understanding the etiology of firearm injury and use this approach to suggest strategies for prevention. Finally, we identify a research agenda for establishing a scientific basis for prevention. The key to this approach is to view these injuries, regardless of their medicolegal circumstances, as having one common factor-the discharge of a firearm.
