The public health establishment, represented at the national level by the Centers for Disease Control and Prevention (CDC), believes that collecting comprehensive data on firearms injuries and deaths—such as who was shot, under what circumstances, and with what kind of weapon—is the first step in reducing those injuries and deaths. The next step, they believe, may be a campaign like those that eradicated polio and reduced traffic fatalities. The HELP Network, an international coalition of medical, public health, and allied organizations, described the form such a campaign might take ("The Public Health Approach to Firearm Injury Prevention," http://www.helpnetwork.org/frames/resources_factsheets_pubhealth.pdf [accessed September 23, 2004]):
Most firearm deaths in the U.S. are caused by handguns, yet handguns account for a minority of all firearms owned. The handgun can be recognized as a high-risk weapon, and perhaps even as the primary agent of the modern epidemic of gun death. One strategy to reduce these risks may be to restrict civilian access to certain kinds of handguns.
The CDC, in collaboration with the U.S. Product Safety Commission, administers the only national system that tracks firearm-related injuries—the National Electronic Injury Surveillance System (NEISS). Established in 1992, NEISS as of 2004 had collected data from ninety-one participating hospital emergency departments. Expansion of the surveillance system beyond the ninety-one hospitals is a CDC goal and is being researched.
State and local health departments report that they lack the funding to conduct a thorough surveillance of firearms injuries. To investigate how many health agencies conduct surveillance, Roger Hayes and colleagues carried out a survey of all fifty state health departments, as well as the city and county health departments of the fifty largest urban areas. The report is titled Missing in Action: Health Agencies Lack Critical Data Needed for Firearm Injury Prevention (Chicago: The HELP Network, 1999). The survey reports that thirty-one states (62%) maintain some type of firearm injury surveillance, but nineteen (38%) do not. More than one-half of the states (56%) track mortality data, 30% track hospital data, and 38% track the type of firearm. Twenty-six percent of the states track circumstances. Only 18% issue a report. According to the HELP report, the lack of funding and staffing were the main obstacles to adequate surveillance.
According to the survey, about one-half of the city and county health departments collected data on firearm injuries and deaths. Less than one-quarter collected information on firearm types involved in injuries or on the circumstances, and 35% issued a report. The lack of funding and staffing were the reasons cited by health departments for not collecting data.
Concerned about the lack of firearms injury data, the CDC in September 2002 awarded $7.5 million to six states (New Jersey, Maryland, Massachusetts, Oregon, South Carolina, and Virginia) to develop the nation's first comprehensive system for collecting data about violent deaths, the National Violent Death Reporting System. In 2004 the U.S. Congress granted $3.7 million to continue implementing the system. The CDC has identified four main objectives for the system:
- To link records from violent deaths that occurred in the same incident to help identify risk factors for multiple homicides or homicide-suicides;
TABLE 6.1
| Nonfatal gunshot injuries and firearm-related deaths, 1993–97 | ||||||
| Total | Assault or homicide | Legal intervention | Suicide attempts/Suicide | Unintentional | Undetermined | |
| *Annual estimates for legal intervention injuries are presented for completeness but may be statistically unreliable because they are based on a small number of cases. | ||||||
| **Injury deaths include firearm-related deaths. The total represents only the categories presented here. | ||||||
| SOURCE: Marianne W. Zawitz and Kevin J. Strom, "Appendix. Number of Nonfatal Gunshot Injuries and Firearm-Related Deaths," in Firearm Injury and Death from Crime, 1993–97, U.S. Bureau of Justice Statistics, 2000, http://www.ojp.usdoj.gov/bjs/pub/pdf/fidc9397.pdf (accessed October 9, 2004) | ||||||
| Nonfatal gunshot injury | ||||||
| 1993–97 | 411,800 | 257,200 | 5,100* | 23,400 | 70,900 | 55,200 |
| 1993 | 104,200 | 64,100 | 1,300* | 5,600 | 18,200 | 15,100 |
| 1994 | 89,600 | 61,200 | 1,100* | 5,700 | 13,600 | 8,000 |
| 1995 | 84,200 | 53,400 | 1,000* | 5,000 | 14,300 | 10,400 |
| 1996 | 69,600 | 39,200 | 700* | 4,000 | 13,600 | 12,000 |
| 1997 | 64,200 | 39,400 | 900* | 3,100 | 11,100 | 9,700 |
| Percent change |
−38% | −39% | −31%* | −45% | −39% | −36% |
| Firearm-related deaths | ||||||
| 1993–97 | 180,533 | 78,620 | 1,501 | 91,940 | 6,217 | 2,255 |
| 1993 | 39,595 | 18,253 | 318 | 18,940 | 1,521 | 563 |
| 1994 | 38,505 | 17,527 | 339 | 18,765 | 1,356 | 518 |
| 1995 | 35,957 | 15,551 | 284 | 18,503 | 1,225 | 394 |
| 1996 | 34,040 | 14,037 | 290 | 18,166 | 1,134 | 413 |
| 1997 | 32,436 | 13,252 | 270 | 17,566 | 981 | 367 |
| Percent change |
−18% | −27% | −15% | −7% | −36% | −35% |
| Injury deaths** | ||||||
| 1993–97 | 737,650 | 112,877 | 1,770 | 154,966 | 450,778 | 17,259 |
- To provide timely information through faster data retrieval. Currently, vital statistics data are not available until two years after the death;
- To describe, in some detail, the circumstances that might have contributed to the violent death; and
- To better characterize perpetrators, including their relationship to the victim(s).
The CDC aims to "illustrate a more comprehensive picture of violent incidents" in order to provide useful information to law enforcement personnel and death investigators in local areas. They hope to have all fifty states as part of the program within ten years. When data is released in 2005, more will be known about factors such as the involvement of alcohol or drugs in violent deaths, the type and source of the weapons used, and whether social-service agencies or the police had prior warning of domestic violence or child abuse.
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