I am a cardiologist and epidemiologist. For 40 years, I thought I was addressing America’s biggest health problem. I’ve changed my mind. I now believe that the greatest burden on the health and well-being of Americans is gun violence.
Right now, you’re probably thinking, “What? Doesn’t he know that heart disease caused nearly 700,000 deaths in 2024 while there were less than 50,000 firearm-related deaths in 2022?”
Yes, I know those stats very well. What creates most of the burden of gun violence is the pervasive stress and anxiety it causes. I came to that conclusion using the methods of the Global Burden of Disease (GBD) Study and would be happy to share my calculations offline.
Back to the comparison: If you learned that a man living one street over from you died of a heart attack, you may feel sorry for him and his family, but I doubt that you will avoid that street as a result. So, stress and anxiety contribute little to the burden of heart disease. However, I suspect even a rumor that a young man living on the next street over has purchased an assault rifle or has been given one for his birthday would trigger your anxiety. I think this because nearly 90% of American adults report experiencing some level of stress or anxiety at the thought of gun violence.
If you are also like many Americans, fear of gun violence affects your day-to-day life: We have found that levels of physical activity are lower in regions of the country with higher levels of gun violence. Between one-quarter and one-third of Americans report that, as a result of gun violence and/or terrorism incidents, they have increased anxiety when they go to sporting events, concerts, bars and nightclubs, movie theaters, or malls. Almost a quarter report that they have increased anxiety when they go to the grocery store. A few even skip going to their doctor. In the hypothetical I described above, you might avoid driving or walking by that young man’s house.
Related: Health care workers are the overlooked victims of gun violence
This response is apparently not unfounded: In one of the surveys my research team obtained, 29% of respondents reported that they had been in a location where someone unexpectedly opened fire with a gun. Most frequently it was in a bar or nightclub, but 10% reported that it was in a grocery store.
Direct experience with gun violence can generate extreme stress and anxiety. Not infrequently, survivors of gun violence suffer PTSD and poor long-term physical health. Death of a child more than doubles the probability that a parent will suffer psychiatric disorders. Parents of adolescent and child survivors have been found to have a 30% increase in psychiatric disorders.
If a shooting occurs in a school, the impact extends into adulthood. Student mental health suffers and antidepressant use increases. An analysis by the National Bureau of Economic Research found that a school shooting increases absenteeism and grade repetition; reduces high school graduation, college enrollment, and college completion rates; reduces employment and earnings among young adults; and increases turnover among teachers and teaching support staff.
Active shooter drills in schools are not the answer. They increase fear, inflate perceptions of risk, and decrease perceptions of school safety among the students.
There is an aphorism spoken by gun rights advocates that the only way to stop a bad guy with a gun is a good guy with a gun. Jillian Petersen and her associates at the Violence Prevention Project at Hamline University have analyzed the effectiveness of armed guards in schools and found they are not associated with a reduction in school shootings.
A ban assault weapons, a ban high-capacity magazines and other bills are now being debated at the Minnesota Legislature. These bans can be expected to reduce death and injury. Banning assault weapons and large capacity magazines will also likely reduce the stress and anxiety of Minnesotans, particularly students, parents, grandparents.
To reduce what is perhaps the greatest burden on the health and well-being of Minnesotans— gun violence and the associated stress and anxiety — the time to ban assault weapons and large-capacity magazines is now.
Dr. Thomas E. Kottke lives in St. Paul. He can be reached at tkottke@comcast.net.
