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The Financial Costs of Gun Violence FREE

Linda Gunderson
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1999;131(6):483-484. doi:10.7326/0003-4819-131-6-199909210-00102
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As is widely known, the United States leads the world in death by firearms. The Centers for Disease Control and Prevention (CDC) reported that since 1972, more than 30 000 people have died of firearm injuries each year. Injuries from firearms are the second leading cause of death for Americans 15 to 34 years of age, and the number of nonfatal firearm injuries is estimated at 84 000 annually.

Less appreciated is the fact that firearms-related injury and death incur huge financial costs. These costs have been almost invisible for many reasons, but the need to define health care costs related to gun violence is imperative. Because many victims of gun violence have no medical insurance, taxpayers fund approximately 85% of their medical care costs.

The trend of large cities filing lawsuits against gun manufacturers is also increasing the need to determine the costs of gun violence. Until recently, the only expense tracked was the immediate cost of treatment of victims; however, insurance companies usually have no separate classification for gun injuries and view them simply as trauma. Understanding the full effect of firearm injury on health care costs involves more than accurate assessment of hospital bills. Two major factors contribute to the effect of gun violence on the overall costs of health care: the cost of long-term care for disabled victims and the cost of lost productivity.

The following statistics help to define gun violence as a national health epidemic:

Philadelphia

  • More than 1300 persons were hospitalized from gun injuries in 1996, and approximately 25% of these persons died in the hospital.

  • Hospital costs alone totaled $40 million in 1996; more than three fourths of these costs were paid by taxpayers and by the hospitals, without reimbursement.

Pennsylvania

  • Medicaid covered approximately 50% of gunshot victims' medical costs in 1996.

  • In 1996, the average hospital bill for a victim of gun violence was $29 500.

United States

  • The total cost (including lost productivity and medical treatment) for a fatally injured gunshot victim is estimated at $374 000.

  • Taxpayers bear approximately 85% of the medical costs of injuries related to gun violence.

  • In 1995, medical costs alone for firearm-related injuries were estimated at $4 billion.

In 1990, medical expenses and lost productivity related to gun violence were estimated at $20.4 billion. Of this amount, $1.4 billion was solely for expenses related to health care, $1.6 billion was for injury-related illness and disability (lost productivity), and $17.4 billion was for premature death (lost productivity). More recent statistics show that the costs of gun violence are on the rise. One recently published study in JAMA estimated that lifetime medical costs for gunshot injuries in 1994 were $2.3 billion—$1.1 billion of that was funded by taxpayers. The study further suggested that the victims themselves may be as much as six times more likely than others to default on medical debt. The obvious conclusion is that almost half a billion in costs is absorbed elsewhere.

Philadelphia's mayor Ed Rendell was one of the first mayors to consider filing suit against the gun industry. He said that gun violence cost the city $58.8 million in 1 year. To arrive at this figure, Mayor Rendell calculated the costs of police expenses (including overtime), paramedics, and even hosing blood from crime scenes. The legalities involved in his suit against gun manufacturers were strict liability, negligence, and public nuisance.

Although the suit never materialized (Rendell cited exorbitant legal costs), several other mayors have since filed suit, including Milton Milan, mayor of Camden, New Jersey. Although the crime rate in Camden is decreasing, in June 1999 Mayor Milan filed suit against gun manufacturers for an unspecified amount. Milan believes that easy access to guns contributes to the number of gun violence victims in Camden. Atlanta's mayor Bill Campbell has also filed suit but has said that it was difficult to calculate the total costs of gun violence because costs other than those related to medical care were difficult to determine. Mayor Richard Daley of Chicago cited a figure for damages resulting from gun violence: He is suing gun retailers, manufacturers, and distributors for $433 million in an attempt to offset taxpayers' contributions, which are estimated at more than 80% of the total costs. Other cities seeking damages against the gun industry include Cleveland and Cincinnati; Miami; New Orleans; Bridgeport, Connecticut; and Detroit.

Alcohol and drugs are related to violent crime, but the extent of that relation and its consequences may be grossly underestimated. The Office of Drug Policy and Violence Prevention (ODPVP) explains one less obvious connection between drugs and violence. It asserts that cognitive deficits and hyperactivity in children whose mothers abused substances during pregnancy can lead to violent behavior.

Other statistics support the connection between drugs, alcohol, and gun violence:

According to the ODPVP, alcohol use is involved in 54% to 79% of homicides (guns are the most common weapons used in homicide).

A 3-year study conducted at the University of California, Davis, Medical Center found that alcohol and drug use was a comorbid condition in more than 50% of the patients treated for firearm-related injuries for whom information was available.

The American Psychological Association cited early involvement with alcohol and drugs as one of four factors contributing to onset of youth violence.

Richard Montgomery, who is state director of drug and alcohol intervention for the Pennsylvania Department of Labor and Industry, says that alcohol and drug use may be as high as 90% in perpetrators of violent crimes against children. In fact, estimates from various studies suggest that alcohol is a factor in 30% to 84% of child abuse and neglect incidences. Montgomery also asserted that most violence in urban areas is directly related to the prevalence of drugs and alcohol. “Where you have drug markets, you have incredibly high violent crime,” he stated. One of the less obvious consequences of drug and alcohol abuse is its role as a cause of gun violence.

Detective Matthew McDonald, a Philadelphia police detective assigned to the high-intensity drug trafficking area taskforce at the Bureau of Alcohol, Tobacco, and Firearms, believes that the role of drugs and alcohol in gun violence is almost a constant. “I think it's [drug and alcohol use] always there in the overall scheme of things,” he contended. According to the Bureau of Justice Statistics, more than one third of convicted offenders were drinking at the time of the offense. Numerous other studies indicate that alcohol played a part in 31 % to 49% of assaults, 25 % to 80% of domestic violence, 28% to 50% of rapes and sexual assaults, and 54% to 79% of homicides. Detective McDonald commented, “Any statistics I see on this I always think are a little bit low.”

The cost of drug abuse alone, including lost productivity and criminal activity, was estimated at $76 billion in 1991. But, despite these impressive statistics, few studies have been conducted to determine the contribution of drugs and alcohol to gun violence-related health care costs.

Robert K. Musil, PhD, executive director and chief executive officer of Physicians for Social Responsibility, remarked that although gun violence has reached epidemic proportions, it is nonetheless preventable. Physicians for Social Responsibility, which has 20 000 physician members, points out that major changes are needed in the design, manufacture, and distribution of guns before physicians will see a decrease in victims of gun violence.

As a resident, Deborah B. Prothrow-Stith, MD, former Commissioner of Public Health for the Commonwealth of Massachusetts and current founder of the Office of Violence Prevention, has observed that physicians have two very different responses to patients with disease and patients injured by violence. She believes the disparity starts in medical school, where the curriculum emphasizes disease prevention but does not include violence prevention. Prothrow-Stith believes that policymakers fail to enact reforms to prevent gun violence because they are hesitant to provide the funding. However, these same policymakers routinely spend millions on health care-related costs after violence has occurred.

Although the recent trend of viewing gun violence as a health care problem—indeed, as a national epidemic—has resulted in a more accurate accounting of the costs related to health care, it is still almost impossible to gauge the enormous societal effect of firearm injuries. But it is becoming imperative. If outlining the enormous financial burdens is one of the few effective ways to draw attention to the issue of gun violence, so be it, but the monetary cost of gun violence is only one symptom of the disease. The social cost is the real affliction, and has taken on the aspect of many other diseases: It is insidious, infectious, and tragic, but it is also largely preventable.

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