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Volume 14, Number 4

Perhaps there is no more politically contentious topic in the realm of behavior and health in the United States than gun ownership and firearm-related violence. The most recent advocacy for changes in gun control legislation took the form of student-led “March for our Lives” in many cities. Whether this movement affects the political needle on the topic of gun control remains to be seen.

Gun ownership and gun control receive much attention in the wake of mass shootings, but factually these tragedies represent just a fraction of firearm-related injuries and death. In the United States in 2016, there were over 38,000 deaths attributable to firearms, a number that translates to over 100 per day. Approximately two thirds of these deaths were suicides while the others are homicides or accidental shootings. In addition, there are twice as many nonfatal firearm injuries each year as there are deaths, resulting in hundreds of millions of dollars in health care costs and lingering disability for many. Gun violence is disproportionately found in certain demographic groups. These morbidity and mortality numbers make gun-related injury and death a significant public health issue.

There are numerous psychological factors that impact the gun debate. Positions are affected by whether the issue is framed as a health matter or one of constitutional rights. The intense emotions around the issue mean that persons’ attentional focus tends to be narrowed, making it more difficult to understand and/or appreciate other persons’ perspectives. The confirmation bias serves to reinforce currently held beliefs. Differing parties cite statistical data that is consistent with established points of view. Perceptions of vulnerability to crime or violence are affected more by stories than by factual data, and the same is true for perceptions of the role of firearms in keeping people safe. Perspectives are affected by whether one places greater premium on individual rights or those of groups. All of these factors are contributing impediments to rational discussion about how to address firearm-related injuries and deaths.

The issue has certainly affected both the provision of health care and health-related research. Just over a year ago, courts overruled a law in Florida that had prohibited physicians from asking patients about guns in the home as part of discussions of safety. In the federal budget passed last month, a clause is present that allows the Centers for Disease Control and Prevention (CDC) to conduct research on the causes of gun violence, although there are questions about whether federal funding will be available for such research

Indeed there are many other areas where the role of government in health-related matters is intensely debated. Examples include the use of helmets for motorcycle riders, mandated immunizations, and taxes on cigarettes. In such matters, some want to uphold the freedom of individuals to make choices that are (or can be) harmful to health, while others support mandating choices that research indicates to be better for the overall health of the population.

Perceptions of what is good for the population and what is good for oneself aren’t always aligned. An individual patient may understand that antibiotic misuse contributes to antibiotic resistance (a problem for society), but that same patient may beg a physician to prescribe an antibiotic (perceived to be in one’s self interest) if a sore throat is very painful. Striking a balance between the freedom of individuals and the well-being of the population is an ongoing challenge for a democratic society, including decisions that are made that pertain to health.


Paul J. Hershberger, Ph.D.

… is a clinical health psychologist. He is Professor and Director of the Division of Behavioral Health, Department of Family Medicine, Wright State University Boonshoft School of Medicine.




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