They are killing us: guns and public health


“When a country with less than five percent of the world’s population has nearly half of the world’s privately owned guns and makes up nearly a third of the world’s mass shootings, it’s time to stop saying guns make us safer.”

― DaShanne Stokes

MSR News Online Dr. Andrew Kiragu

Firearm-related injuries remain a significant public health crisis here in the United States. While we constitute less than 5% of the world’s population, Americans collectively own about 45% of all privately held firearms. There are more guns than people in this country. For every 100 people, there are more than 120 guns.

There are multiple reasons for gun ownership, including sport, hunting, self-protection and collection. However, guns in the home pose a clear threat to individuals living in that household despite protection being the most common reason individuals own guns. For every self-defense or justifiable homicide, 43 individuals in the home die due to firearms, primarily by suicide.

According to the American Academy of Pediatrics (AAP), almost a third of U.S. homes with children have guns, and nearly two million children live in homes with unlocked, loaded guns. Not surprisingly, this increases the risk for unintentional injuries and death in younger children and suicide in adolescents.

Data on firearm-related injuries is alarming. According to the Centers for Disease Control and Prevention (CDC), 39,707 Americans died due to injuries sustained from a firearm in 2019. This included 3,390 children under the age of 19.

Despite the ongoing COVID pandemic, recently published data point to a spike in deaths and injuries from firearms in 2020. The reasons for this spike in firearm-related injuries and deaths are unclear. Mass shootings also continue to be a concern. According to the Gun Violence Archive, there have been 191 mass shootings thus far in 2021.

Blacks most at risk

Unfortunately, African American children bear a disproportionate brunt of firearm-related deaths from unintentional injuries, homicide, and police-related shootings. Indeed, African American teens aged 15-19 are over four times more likely to die from homicide than White youth.

Why is this? The reasons are complex and myriad but are rooted in poverty and environmental and systemic racism. These limit the opportunities for children to grow up in healthy, violence-free environments. Addressing these conditions is essential to help limit our youth’s exposure to violence.

An all-hands-on-deck approach is necessary to tackle this issue. This will mean collaboration between different groups that may not always work together, including public health experts, legislators, law enforcement, youth services, schools, churches, and neighborhood groups.

In the Twin Cities, there are several community organizations involved in these efforts, including MADDADS, A Mothers Love Initiative, The Man Up Club, and Guns Down Love Up, among others. Establishing trust, providing clear communication, ensuring transparency and true commitment are key to this work.

These efforts will also need more than lip service from our politicians. The environmental and systematic racism that have led to the significant disparities in firearm-related deaths and injuries in our communities will require a true financial commitment from local, state and federal governments. Approaches to strengthen household financial security, including tax credits for families with children, safe and affordable housing, paid parental leave, livable wages, and economic support for developmentally appropriate childcare will go a long way in reducing poverty in our communities.

True investment in the communities in which we live, including through the provision of green spaces, playgrounds, schools and after-school programs, and investments in the infrastructure in poor neighborhoods are also important. Sensible gun legislation that expands background checks and extreme risk protection order laws to protect those at risk to themselves and others is a necessary step.

A major concern in the African American community is the strained relationship with the police. In 2019, about 20 children under the age of 19 were killed by the police. A recent study in the journal Pediatrics showed that Black children were six times more likely to be shot and killed by the police than White children. This data, as well as the recent deaths of George Floyd, Daunte Wright, Breonna Taylor, and countless others makes it clear that a fundamental change in the policing of our communities is needed.

The large number of guns in our society means that care is needed to prevent unintentional injuries in children and to reduce the chances for self-harm in adolescents. The AAP maintains that the safest home for a child is one without guns. However, if there is a gun in the home, then it important to remember the “5 L’s”:

  • Is it Locked? Guns should be securely locked in a gun safe separate from ammunition.
  • Is it Loaded? Guns should be ideally secured unloaded with ammunition locked in a separate location.\
  • Are there Little children? Special attention is needed to keep guns out of the curious hands of little children.
  • Is anyone in the house feeling Low? Given the significant risk of suicide, it is vital to ensure that family members at risk of self-harm have no access to a firearm.
  • Is the owner Learned? All gun owners and anyone in the home who will be handling a firearm must take the required firearm safety courses.

The U.S. is grappling with several current public health crises like the COVID pandemic and the continued consequences of the opioid crisis. However, it’s far past time that we treated the threat of firearm-related injuries with the same urgency and alarm.

Dr. Andrew Kiragu is an associate professor of pediatrics at the University of Minnesota and the co-medical director of the Pediatric Brain Injury Program at Hennepin Healthcare in Minneapolis. He is an associate of the Children’s Respiratory and Critical Care Specialist’s group and provides pediatric critical care at Children’s of Minnesota and Gillette Children’s. He is a fellow of the American College of Critical Care Medicine and the American Academy of Pediatrics. Dr. Kiragu is also engaged in injury prevention efforts nationally and statewide. He serves on the boards of Safe Kids Minnesota, the Midwest Injury Prevention Alliance, and the Injury Free Coalition for Kids. Dr. Kiragu is also a strong advocate on behalf of Minnesota’s children and is a past president of the Minnesota Chapter of the American Academy of Pediatrics. He is also a past president of the Minnesota Association of African American Physicians.