Epidemiology of gun related violence might seem odd, but violent deaths, including those associated with guns, should be considered a disease. We should therefore use a similar methodology used in treating disease, to identify potential interventions for gun related homicides. Gun control laws are one proposed intervention, or class of interventions. Like with all proposed interventions, we need to test for efficacy and safety. Efficacy requires defining an outcome, and that outcome must be reasonable. We must also take into account what is known as all-cause mortality.
All-cause mortality is an interesting concept and an important one. Consider the case of the health consequences of smoking. We could look at the cancer risk associated with smoking, the relationship between COPD or heart attacks and smoking, and so on. Or we can look at the total estimated impact of smoking on the risk of death. One advantage that this approach has is that it can capture causes of death associated with the exposure (or intervention in the case where you’re testing the efficacy and safety of a new treatment), even ones that may not yet have been considered.
Similarly, when we’re considering whether or not to implement a policy like gun control, which is targeted at reducing homicide rates, we need to consider all-cause mortality here as well. By doing so, we can capture the effects of substitutes for guns in violent deaths, police deaths and shootings, which may result from an increase in people trying to purchase guns on the black market, and even other effects of gun control laws on mortality, whether we have thought of what they might be or not.
This practice may seem like common sense, as it is used so often in health sciences, but a quick look at a major systematic review published in 2016 shows that all-cause mortality is being ignored. In fact, the study actively removed any study which looked at all-cause mortality (Systematic Review on Gun Control). The study did indicate that there seemed to be some evidence that there was a reduction in gun related deaths caused by increased gun control, but ignored what other potential impacts it could have. That is not acceptable. Any research conducted on gun control must include all-cause mortality. We must treat gun related deaths and proposed interventions in the same way that we would study any public health concern.
Finally there is the topic of cost-effectiveness. If we had unlimited resources, we could work on treating every problem, but we have limited resources, and therefore public health professionals evaluate whether or not a proposed intervention is “worth” taking. While placing a monetary value on a life seems horrible, it is actually quite important. If we have enough resources, we should implement all beneficial policies, but if we do not, then we should select the policies which result in the greatest benefit. This presentation does a fair job of explaining such an analysis.
- Second Amendment: History and Purpose
- The Myth of Australia’s Gun Control Success
- An in House Analysis of the Efficacy of Gun Control Laws