Firearms as a Market‐Driven Epidemic: Potential Pathways to Reduce Preventable Firearm‐Related Harm in the United States
本文提出枪支伤害是一种市场驱动的流行病，借鉴烟草和处方阿片类药物的防控经验，分析了美国枪支行业如何通过营销策略推动伤害，并总结了已有证据支持的减少枪支伤害的干预措施。
Policy Points For half a century, firearm-related deaths and injuries have been endemic in the United States, with COVID-19 contributing to a record high of 48,830 deaths in 2021, an epidemic rate increase. By 2023, national trends masked a significant 10-fold difference in firearm-related death rates among states. Over decades, some states have experienced large, sustained reductions in firearm-related death rates, while others have experienced increases. Firearms are a consumer product that fit the definition of a market-driven epidemic (MDE), with the firearms industry having successfully marketed gun ownership through strategies that include fear, predatory tactics, and emphasis on lethality; stalling public health research for decades; and employing strategies used in other industries to promote potentially harmful products. Evidence from classic MDEs, such as tobacco and prescription opioids, demonstrates that large-scale, long-term reductions in harmful use can be achieved through a combination of focused, effective interventions and engaged governments, nongovernmental organizations, academia, media outlets, and, at times, companies themselves. The United States has developed a robust array of evidence-based mitigation strategies to reduce firearm-related harm, including gun safety laws, focused hospital and mental health programs, community and environmental programs, and social and economic policies. Applying insights from classic MDEs, building on what has worked, and increased active engagement among stakeholders are needed to reduce preventable firearm harm. CONTEXT: The United States has among the highest firearm-related deaths in the world. In 2023, suicides accounted for 58% of firearm-related deaths and 38% of homicides. Firearms have become the leading cause of death among those under age 19. Nonfatal injuries, outnumbering deaths over two-to-one, often lead to lifelong physical and mental health sequelae. The firearms market, valued at around $40 billion per year, is one-tenth the estimated $500 billion cost of the epidemic due to medical costs, work loss, and quality-adjusted life years lost. METHODS: Peer-reviewed literature, government documents, and media reports were used to analyze the firearms epidemic according to the market-driven epidemics (MDE) definition and framework of five often overlapping phases: (1) market development; (2) evidence of harm; (3) corporate resistance; (4) mitigation; and (5) market adaptation. The MDE framework emerged from the analysis of efforts that reduced cigarette, sugar, and prescription opioid use. The central question for mitigating the firearm MDE is: What combination of interventions and actors will achieve large-scale, long-term reductions in firearm-related deaths and other harm? FINDINGS: The epidemic of firearm harm fits the MDE definition and is progressing through the five stages of an MDE. Phase 1. Firearms marketing accelerated rapidly when the focus shifted from marksmanship, sportsmanship, and hunting to themes of self-defense, home protection, patriotism, and masculinity. Phase 2. Evidence of harm at the population level has linked firearm ownership or possession to significant increases in suicide deaths, homicide, femicide, and gun-related injuries. Phase 3. Firearms industry resistance has used "corporate playbook" strategies to downplay the evidence of preventable harm, discredit public health, and influence the passage of favorable legislation. Phase 4. Decades of action by government, academia, and civil society have produced an array of mitigation interventions shown to reduce firearm-related suicides, homicides, and other harm. Jurisdictions that have implemented these measures have been able to achieve significant, sustained decreases in firearm-related deaths, while some high-burden areas that have declined to implement such measures and have enacted permission policies have experienced notable increases in firearm-related deaths. Phase 5. The firearms market has evolved through consumer demand for "non-lethal" alternatives (i.e., TASERs, rubber bullets) and through company expansion of overseas sales and pursuit of new technologies (i.e., "smart guns," magazine safeties). CONCLUSIONS: High rates of firearm-related deaths and injuries are not inevitable. By treating the firearm harm epidemic as the market-driven problem it is, drawing on insights from other MDEs strategies, substantial reductions in violence may be achievable across the United States. States and cities have significantly reduced gun violence without infringing Second Amendment rights. The greatest unmet challenge now is generating increased engagement in gun safety among states and communities still experiencing high levels of preventable firearm deaths and related harms.