Firearm deaths remain a significant public health problem in the United States, with no signs of abatement. Although school mass shootings dominate media coverage, most gun deaths are suicides.1 Strong evidence indicates that firearm-related harm, as with other harmful products such as tobacco or alcohol, is linked to firearm availability.2
Leaving aside issues of constitutionality and debates about American gun culture, there is little question that, at the core, gun-related injury and death are directly linked to the use of a category of consumer products—guns, produced and marketed by commercial actors. Therefore, it seems logical that as we consider the determinants of gun-related morbidity and mortality, we regard the firearm industry as one of these determinants worthy of study.
In recent years, an emerging scholarship has begun to link corporate practices to their effects on health, collectively termed the “commercial determinants of health.” These commercial determinants, which often have remained absent from public health frameworks,3 can have profound health consequences through not only the direct effects of harmful products but also the influence on policymaking, the effects on scientific evidence and research agendas, and the influence on public discourse. Direct effects on health include the sale of harmful products such as in the ongoing marketing of cigarettes or promoting the overuse of opioids. Efforts to influence policymaking include attempts to prevent marketing restrictions, as the alcohol industry has done through emphasizing personal responsibility and self-regulation while disputing evidence.4 Commercial actors also can affect scientific evidence and research agendas, as in the soft drink industry funding of physical activity research consortia.5 Finally, public discourse itself can be shaped by these commercial forces through attempts to generate doubt around a product’s role in harm, as has been observed in the context of disputing anthropogenic climate change.6 As our understanding grows of how commercial factors influence health, it is becoming apparent that such practices are not aberrations resulting from uniquely malign intent but rather a consequence of large economic actors reacting to incentives that are fundamentally misaligned with population health, often with significant public health consequences.
To date, research on the role of the firearms industry as a vector of firearm violence remains limited. Public debate and academic commentary have focused on opposition to policies regulating firearms, particularly by the National Rifle Association (NRA). However, researchers have yet to examine organizations like the NRA, the evidence they cite, the ecosystem that this and other such groups operate in, or the funding underpinning them, as part of a set of broader firearm industry strategies.
This lack of research is an important limitation of the current evidence base around determinants of gun morbidity and mortality, particularly because such evidence can help public health efforts to mitigate the consequences of firearms. For example, the evidence of the tobacco industry’s intent in shaping research, policy, and social norms helped unite public opinion around potential policy options despite these well-funded efforts. We propose four areas of immediate scholarly relevance, based on the aforementioned commercial determinants of health framework, that remain unaddressed by the current public health literature on firearms.
First, there is a clear need to examine the nature of the firearms market. Often, improving product characteristics—including lethality in the case of firearms—is essential for industry revenue growth and marketing efforts. In fact, emerging evidence shows a trend toward greater lethality in gun manufacturing, purchases, and traced crime guns.7 It is thus important to understand the extent to which the industry revenue is dependent on the types of firearms that cause the most population health harm and how marketing is used to drive that revenue. A greater understanding of the sources of revenue and growth for the industry and the level of industry reliance on components of the market such as gun shows, imports, accessories, and targeting of particular consumer segments are likely to be predictive of future corporate political activity. Such understanding can help identify areas in which the interests of public health and elements of the firearm industry most diverge or align.
Second, there have been highly publicized restrictions on federal research funding for the study of health consequences of firearms in the United States, but less is known about the ways in which firearms manufacturers may have sought to support alternative lines of research or whether corporate sponsorship of third-party organizations has been used to promote scholarship agendas that favor industry.
Third, current evidence on how or whether the firearm industry has sought to frame evidence and solutions of firearm-related harm in political debates and legal challenges is very limited, although guns are becoming a greater feature in political advertising. Access to internal industry documentation is limited; however, public policy submissions, freedom of information requests, and court filings offer data sources that allow for thematic analysis and identification of common corporate tactics such as the obfuscation of evidence relevant to policy, lobbying, or threatening litigation.
Finally, currently little evidence is available on how or whether the firearm industry has sought to shape public discourse of firearms. This can be studied in multiple ways, including analysis of attempts to use traditional and social media to create favorable narratives regarding the role of guns in society and culture. It also may involve describing the ecosystem of third-party organizations involved in such efforts, including, for example, the NRA, for which more evidence does exist. By way of illustration, in the early days of tobacco control, an understanding of these networks of influence helped to determine the extent to which opposition to evidence-based legislation supported by most of the public was being manufactured by industry and associated legal and public relations firms. Identification of such networks could help underpin future research on the firearm industry across a range of issues, including the relation between industry activities and changes in US gun culture over time.
As distant as it may seem now from memory, the tobacco industry once held sway over American politics and culture. It resisted overwhelming evidence of harm to the user and to others, while framing public health researchers as “anti-tobacco” and fanning fears of black markets, while relying on those same markets as an important component of their overall commercial strategy. Ultimately, the unification of a variety of powerful advocates, congressional investigational attention, and the explosion of internal documentation that followed from internal leaks and high-profile lawsuits led to even stronger tobacco control measures and reductions in smoking rates.
An understanding of the extent to which the firearm industry drives gun injury and death, directly and indirectly, is within the capacity of public health research and remains largely missing from current discourse. With tobacco, some evidence would emerge only in the face of congressional investigation, whereas research on other harmful product manufacturers has indicated that the data to develop such strands of evidence may hang in plain sight. A concerted research agenda tackling firearms as a commercial determinant of health may contribute to efforts to mitigate the negative consequences of firearms in the United States.
ACKNOWLEDGMENTS
N. Maani is supported through a Harkness Fellowship funded by the Commonwealth Fund.
Note. The views presented here are those of the authors and should not be attributed to the Commonwealth Fund or its directors, officers, or staff.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to disclose.
