In 1996, Congress approved a budget restriction, known as the Dickey Amendment, that dramatically curtailed the ability of the Centers for Disease Control and Prevention (CDC) to conduct firearms research. This restriction prevented the agency from spending funds to “advocate or promote gun control” and effectively zeroed out the $2.6 million the CDC had previously used for firearms research.1Omnibus Consolidated Appropriations Act, Public Law 104-208 (1996). In December 2011, exactly one year before the tragedy at Sandy Hook, Congress moved to extend these funding prohibitions to the National Institutes of Health (NIH).2Consolidated Appropriations Act, 2012, Public Law 112-74 (2011). Although these amendments did not explicitly change existing law, they had a profound chilling effect on federal efforts to develop research on guns and gun violence.3Federal agencies do not traditionally advocate for legislation and research into gun violence and its causes does not constitute advocacy.
Both the CDC and NIH budget restrictions were deliberate efforts by the gun lobby to suppress gun research following landmark studies examining the impact of firearms on public health and safety.4Jamieson C. American Psychological Association Science Directorate. Gun violence research: History of the federal funding freeze. Psychological Science Agenda. February 2013. https://bit.ly/2SDVXxB. In the spring of 2018, Congress took an important step by clarifying that the CDC has the authority to examine gun violence.5Greenfieldboyce N. Spending bill lets CDC study gun violence; but researchers are skeptical it will help. National Public Radio. March 23, 2018. https://n.pr/2GkoIsc. However, the spending bill that accompanied that report language lacked funding for any research and researchers remain skeptical that federal support for their work will increase.6Ibid.
Since the passage of the Dickey Amendment, the CDC and NIH have severely underfunded gun violence research.7National Institute of Justice, Awards Funded by NIJ: Gun Violence, https://bit.ly/2GzPUnb; National Institute of Justice, Awards Funded by NIJ: Gun Technology, https://bit.ly/2T9zO9G. Funding from the National Institute of Justice (NIJ) has been similarly impacted, with less than one percent of research over the past decade committed to studying gun violence or technologies to make firearms safer. From FY 2004 to FY 2017, the NIJ funded a total of 6,278 projects related to criminal justice research, totaling over $2.9 billion in awards. Out of those projects, only 43 addressed guns, receiving only $22.8 million in total.
The Centers for Disease Control and Prevention: CDC funding for gun injury prevention fell by 94 percent between 1996 and 2018.8Everytown for Gun Safety original analysis. Data obtained directly from Centers for Disease Control and Prevention, Firearm Injury Prevention Activities at the National Center for Injury Prevention and Control, Budget Expenditures: Fiscal Years 1992-2018. Between 1996 and 2018, the amount of funding dedicated to firearm injury prevention fell from $3,152,788 to $199,184. Funding amounts in previous years are controlled for inflation by adjusting to their worth in 2018 dollars. In 2018, out of a total budget of more than $8.2 billion, the CDC devoted merely $199,000 to firearm-related research.9Everytown for Gun Safety original analysis. Data obtained directly from Centers for Disease Control and Prevention, Firearm Injury Prevention Activities at the National Center for Injury Prevention and Control, Budget Expenditures: Fiscal Years 1992-2018.
The National Institutes of Health: For nearly two decades, NIH funding for gun violence research has remained below 1 percent of its total budget for research project grants.10Everytown for Gun Safety original analysis. Funding data were accessed through NIH RePORT (Research Portfolio Online Reporting Tools) for the years 2001 to 2018. NIH RePORT database was queried for projects awarded by the NIH (including institutes under the NIH, e.g. National Institute on Alcohol Abuse and Alcoholism) containing project titles and abstracts with the keywords ”gun,” ”firearm,” ”gunshot,” and ”rifle.” https://bit.ly/2hvlSAM. In 2018, out of approximately $21 billion in support for research grants,11While the total NIH budget for FY 2018 was $36.4 billion, more than half of the total agency budget is directed towards research grant projects (approximately $20.9 billion). Total NIH Budget Authority: FY 2018 Operating Plan. National Institutes of Health. https://bit.ly/2tI6WXX. the NIH awarded less than $9 million — approximately 0.04 percent of the total — to projects addressing gun violence.12Everytown for Gun Safety original analysis. Funding data were accessed through NIH RePORT (Research Portfolio Online Reporting Tools) fiscal year 2018. NIH RePORT database was queried for projects awarded by the NIH (including institutes under the NIH, e.g. National Institute on Alcohol Abuse and Alcoholism) containing project titles and abstracts with the keywords ”gun,” ”firearm,” ”gunshot,” and “rifle.” In 2018, research grants for gun violence funded by the NIH amounted to approximately $8,531,117. https://bit.ly/2hvlSAM.
The CDC and NIH grant less funding for gun violence research than for nearly every other leading cause of death in America.
Among the 30 leading causes of death, gun violence ranks 13th in terms of mortality, but 29th in terms of research funding.13Everytown for Gun Safety original analysis. Funding data were accessed through FedREPORTER for the years 2008 to 2017. Mortality data for the 30 leading causes of death were accessed through Centers for Disease Control and Prevention, Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death reports for the years 2008 to 2017. For each cause of death, Federal RePORTER was queried for the total funding awarded by the CDC and NIH to projects containing project terms corresponding to MeSH terms, including descendant MeSH terms. Methodology derived in large part from: Stark DE, Shah NH. Funding and publication of research on gun violence and other leading causes of death. Journal of the American Medical Association. 2017; 317(1): 84–85. The only leading cause of death to receive less research funding than gun violence is accidental falls.14Ibid.
From 2008 to 2017, gun violence killed nearly 342,500 people in the U.S. but received only $150 per life lost in research funding from the CDC and NIH.15Ibid. This figure is an approximation and is derived from a search of FedREPORTER for projects with “firearm” or “gunshot wound” listed among the project terms. Also note that gun violence may have received funding from other agencies included in FedREPORTER that were not reported here.
By contrast, motor vehicle accidents killed roughly the same number of people as gun violence from 2008 to 2017, but received approximately five times the amount of funding per life lost.16Ibid. Motor vehicle accidents received approximately $801 per life lost between 2008 and 2017. This figure is an approximation and is derived from a search of FedREPORTER for projects with “motor vehicle” or “traffic accident” listed among the project terms. Also note that motor vehicle accident research may have received funding from other agencies included in FedREPORTER that were not reported here.
Unlike with the issue of gun violence, sustained government investments in research on motor vehicle accidents and HIV/AIDS led to scientific innovations and policies that have saved countless lives.
Motor Vehicle Accidents:
Advocates for motor vehicle safety persuaded Congress to enact new legislative standards and support research, despite mounting pressure from the automobile industry.17Mashsaw JL, Harfst DL. The struggle for auto safety. Harvard Journal of Law Technology. 1991; 4(1); 307-312. As a result, for nearly 60 years, the U.S. Department of Transportation
(DOT) has invested significantly in highway and vehicle safety research through the National Highway Traffic Safety Administration (NHTSA).
Each year, the DOT directs approximately $320 million to studying road safety,18U.S. Department of Transportation. Budget estimates Fiscal Year 2017: National Highway Traffic Safety Administration. https://bit.ly/2GAS2uS. A yearly average was developed using three years of most recent available data: FY 2015 (actual), FY 2016 (enacted), and FY 2017 (requested). and it has tracked all motor vehicle deaths since 1975 through the Fatality Analysis Reporting System (FARS).19National Highway Traffic Safety Administration. Fatality Analysis Reporting Systems (FARS). https://bit.ly/2V5EzOY.This research led to new motor vehicle technologies, safer highways equipped with guardrails and barriers,20United States Department of Transportation Federal Highway Administration. Roadway Safety. https://bit.ly/2Sw9MsM. Published August 2018. and laws requiring seat belts and criminalizing unsafe driving.21Canis B. Congressional Research Service. Issues with federal motor vehicle safety standards. CRS Report. https://bit.ly/2NhQEhx. Published March 24, 2017. 22Department of Transportation. Understanding the National Highway Traffic Safety Administration (NHTSA). https://bit.ly/2Xf7XUJ. Published January 31, 2017.
Together, these measures helped reduce the fatality rate of motor vehicle accidents by 81 percent from 1956 to 2017.23National Highway Traffic Safety Administration. Traffic safety facts annual report tables: Motor vehicle traffic fatalities and fatality rates, 1899-2016. https://bit.ly/2H4ntgP. Published January 24, 2018. 24Department of Transportation. 2017 fatal motor vehicle crashes: Overview. Traffic Safety Facts: Research Note. https://bit.ly/2P6GhNn. Published October 2018. In 2017, firearms killed more people than did motor vehicles for the first time in modern history.25Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Reports. Data include gun deaths and motor vehicle deaths from 1968 to 2017.
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS):
The HIV/AIDS epidemic first emerged in the U.S. in the late 1970s and early 1980s. Despite the devastating impact of the disease, particularly among the LGBTQ community, the government refused to acknowledge the issue for many years.26Curran JW, Jaffe HW. Centers for Disease Control and Prevention. AIDS: the Early Years and CDC’s Response. Morbidity and Mortality Weekly Report. 2011; 60(04); 64-69. It wasn’t until thousands of lives were lost that the U.S. Department of Health and Human Services received congressional support for funding to study the epidemic in 1983.27Institute of Medicine (US) Committee to Study the AIDS Research Program of the National Institutes of Health. The AIDS Research Program of the National Institutes of Health, Section 4. Published 1999.
Today, the CDC dedicates an average of $758 million to domestic HIV/AIDS prevention and research each year, including nearly $120 million for surveillance data tracking the transmission of HIV.28Centers for Disease Control and Prevention. Congressional Justification. https://bit.ly/2SVSYAC. A yearly average was developed using five years of most recent available data: FY 2014 to FY 2018. Surveillance data led to the identification of HIV as the causal agent of AIDS, a better understanding of transmission modes, and studies examining the efficacy of treatment and prevention methods.29Surveillance overview. Centers for Disease Control and Prevention. https://bit.ly/2A3GZ7k.
Prevention and treatment efforts must continue to expand,30Despite these scientific gains, disparities persist in access to prevention, treatment, and testing among communities with disproportionately high risks of HIV infection, including Black women, Black men who have sex with men (MSM), and transgender women. Centers for Disease Control and Prevention. Today’s HIV/AIDS epidemic. CDC Fact Sheet.https://bit.ly/2eextT6. Published August 2016. but today, more Americans than ever before are living with HIV as a manageable chronic condition,31Centers for Disease Control and Prevention. Today’s HIV/AIDS epidemic. CDC Fact Sheet. https://bit.ly/2eextT6. Published August 2016. and the death rate has decreased by nearly 90 percent since the height of the epidemic in 1995.32Centers for Disease Control and Prevention. National Center for Health Statistics. Wide-ranging ONline Data for Epidemiologic Research (WONDER) Underlying Cause of Death. Detailed Mortality File 1999 to 2017 and Compressed Mortality File 1979 to 1998. Note that this may be an undercount as AIDS-related illnesses may not have been identified as the cause of death.
Underfunded and censored federal data collection systems leave considerable gaps in our ability to study gun violence. Good research requires good data, but unlike the database of motor vehicle fatalities or the surveillance system for HIV, the systems tracking firearm casualties are incomplete. As a result, researchers lack much of the data necessary to rigorously measure the causes and effects of gun violence, including the following:
Nonfatal firearm injuries: The CDC derives the estimates of nonfatal firearm injuries treated in hospitals from a survey of hospitals known as the National Electronic Injury Surveillance System (NEISS).33Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Data Sources. NEISS collects data about all types and external causes of non-fatal injuries and poisonings treated in U.S. hospital emergency departments. https://bit.ly/2EBNxOI. According to the CDC, these estimates, particularly at a granular level, are unreliable and limit the data for greater specificity.34Definitions for Nonfatal Injury Reports: Advanced Statistics. Centers for Disease Control and Prevention. https://bit.ly/2IpG7li.
Shootings by law enforcement and unintentional shootings: The CDC’s counts of two fatal injury intents – shootings by law enforcement and unintentional shootings – are believed to be greatly underreported due to missing information on death certificates resulting in misclassification of intent.35Foley RJ. New CDC data understate accidental shooting deaths of kids. USA Today. December 9, 2016. https://bit.ly/2tkVHTN. 36Loftin C, Wiersema B, McDowall D, Dobrin A. Underreporting of justifiable homicides committed by police officers in the United States, 1976-1998. American Journal of Public Health. 2003; 93(7): 1117-1121. 37Barber C, Azrael D, Cohen A, et al. Homicides by police: Comparing counts from the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports. American Journal of Public Health. 2016; 106(5): 922-927. The widely cited Washington Post database estimates that 986 civilians are fatally shot by police in an average year – nearly twice as many as recorded by the CDC.38Fatal Force. Washington Post. https://wapo.st/2KN8DNS. Data reflects a 4-year average (2015 to 2018) of fatal shootings by law enforcement.
Gun ownership: In 2001, 2002, and 2004, the CDC measured the prevalence of gun ownership through its anonymized Behavioral Risk Factor Surveillance System (BRFSS) surveys. The CDC removed items on gun ownership from the list of questions following the 2004 survey.39Siegel M, Ross CS, King C. The relationship between gun ownership and firearm homicide rates in the United States, 1981–2010. American Journal of Public Health. 2013; 103(11): 2098–2105.
Gun violence is a public health crisis in America and it demands a robust response from the federal government.
Research is integral to prevention, but Congress has failed to stand up to the gun lobby and properly fund scientists examining the epidemic. It is past time for Congress to remove barriers and fully support gun violence research by taking the following actions:
Congress should appropriate $50 million annually to the CDC for gun violence research.
With this new funding, the CDC could direct funding to researchers to conduct a broad range of gun violence research projects.
1) To improve understanding of gun violence and gun violence prevention, the CDC can support research examining the effects of gun policies and prevention strategies on a broad range of outcomes, including, but not limited to, suicide and self-harm, homicide and nonfatal assaults, unintentional shootings, shootings by law enforcement, firearm theft and trafficking, and domestic violence.
2) To complement this investment, Congress should direct the CDC to convene experts annually to recommend ongoing funding levels commensurate with gun violence mortality and injury rates.
The CDC could also fill existing gaps in public health surveillance data on firearms at national and state levels.
Data collection and open data sharing are integral to the study of public health burdens, including gun violence. If provided on an annual basis, this funding could support the CDC to make the following critical improvements to its data systems:
1)Improve the collection of data on nonfatal firearm injuries by increasing the number of hospitals included in the NEISS and compel representation from all 50 states in the sample.
2) Improve CDC data collection on deaths, including the rigorous examination of gun deaths disaggregated by different intents.
3) Release full funding for the National Violent Death Reporting System (NVDRS) to support expansion to all 50 states,4The CDC’s National Violent Death Reporting System (NVDRS), which would vastly improve research on violent injury, has never been fully funded and has yet to reach all 50 Centers for Disease Control and Prevention. National Violent Death Reporting System. https://bit.ly/2BN5NCW. which will provide comprehensive counts of fatal injuries and detailed circumstantial information about these deaths, including deaths resulting from shootings by law enforcement.5Conner A, Azrael D, Lyons VH, Barber C, Miller, M. Validating the National Violent Death Reporting System as a Source of Data on Fatal Shootings of Civilians by Law Enforcement Officers. American Journal of Public Health. https://bit.ly/2IFxW4B. Published online ahead of print February 21, 2019.
4) Require that the BRFSS surveys once again include questions to anonymously measure gun ownership at the state level.