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Globally, up to 270 000 people are killed by firearms in non-conflict related situations each year. The total number of people who are shot is surely larger, probably substantially so, making firearm injuries a leading public health problem around the world. The Americas contend with the highest rates of firearm death in the world and the United States, even with its advanced economic standing, is a major contributor to these high rates.1 It is thus not surprising that much of the research on firearm injury has been conducted by US investigators.
As a recent example, the US National Academies’ National Research Council report, Firearms and violence: a critical review, reminds us that firearm injury is indeed a substantial public health problem.2 Yet this report, along with another recent report from the US Centers for Disease Control (CDC),3 similarly reminds us that firearm injury also suffers from a less than substantial program of public health research.
Historically, public health research on firearm injury has been hampered in the US. Since 1997 the CDC have not been legally permitted to fund “activities designed to affect the passage of specific Federal, State, or local legislation intended to restrict or control the purchase or use of firearms”.4 As predicted, federal public health support of firearm injury research has been in short supply relative to the magnitude of the problem.5
With limited resources at the CDC, now is the time for public health scientists to consider the US National Institutes of Health (NIH) as an alternative, and potentially more robust, source of support for firearm injury research. The NIH is, after all, the largest public health research agency in the US with a 2005 budget that is projected to be seven times that of the CDC and a charge to reduce the burdens of illness and disability, of which firearm injury is a marked contributor. Scientists from outside the US also qualify for funding given that the mission of the NIH is also global.6
However, the same experts who recognize the importance of federal funding for firearm research do not apparently recognize the NIH as a potential source of that funding.7 Firearm injury is likewise a biomedical disease that has been a trivial part of the NIH research agenda. A one year review of NIH research awards for select conditions in the US, including firearm injuries, found dramatic imbalances in funding.8 A 30 year update of this review using the NIH’s CRISP database9 showed similarly dramatic results (table 1).
One major NIH research award per million cases per decade is unacceptable. Despite this, the three firearm injury awards to date are an important precedent and a handful of new NIH program announcements have recently included the “f” word, firearms. Interested scientists should seek NIH funding if we are to better assure that future firearm injury research reviews are less ambiguous and that the crisis of firearm injury is less devastating.
From the Department of Biostatistics and Epidemiology, School of Medicine (CCB and DJW), Division of Biobehavioral and Health Systems, School of Nursing (TSR), Division of Traumatology and Surgical Critical Care (CWS), School of Medicine, and the Firearm & Injury Center at Penn, University of Pennsylvania (CCB, DJW, TSR, CWS), Philadelphia, Pennsylvania.
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