Firearms as a Market-Driven Epidemic: Potential Pathways to Reduce Preventable Firearm-Related Harm in the United States

Context: The United States has among the highest firearm-related deaths in the world. In 2023, suicides accounted for 58% of firearm-related deaths and 38% of homicides. Firearms have become the leading cause of death among those under age 19. Nonfatal injuries, outnumbering deaths over two-to-one, often lead to lifelong physical and mental health sequelae. The firearms market, valued at around $40 billion per year, is one-tenth the estimated $500 billion cost of the epidemic due to medical costs, work loss, and quality-adjusted life years lost.

Methods: Peer-reviewed literature, government documents, and media reports were used to analyze the firearms epidemic according to the market-driven epidemics (MDE) definition and framework of five often overlapping phases: (1) market development; (2) evidence of harm; (3) corporate resistance; (4) mitigation; and (5) market adaptation. The MDE framework emerged from the analysis of efforts that reduced cigarette, sugar, and prescription opioid use. The central question for mitigating the firearm MDE is: What combination of interventions and actors will achieve large-scale, long-term reductions in firearm-related deaths and other harm?

Findings: The epidemic of firearm harm fits the MDE definition and is progressing through the five stages of an MDE. Phase 1. Firearms marketing accelerated rapidly when the focus shifted from marksmanship, sportsmanship, and hunting to themes of self-defense, home protection, patriotism, and masculinity. Phase 2. Evidence of harm at the population level has linked firearm ownership or possession to significant increases in suicide deaths, homicide, femicide, and gun-related injuries. Phase 3. Firearms industry resistance has used “corporate playbook” strategies to downplay the evidence of preventable harm, discredit public health, and influence the passage of favorable legislation. Phase 4. Decades of action by government, academia, and civil society have produced an array of mitigation interventions shown to reduce firearm-related suicides, homicides, and other harm. Jurisdictions that have implemented these measures have been able to achieve significant, sustained decreases in firearm-related deaths, while some high-burden areas that have declined to implement such measures and have enacted permission policies have experienced notable increases in firearm-related deaths. Phase 5. The firearms market has evolved through consumer demand for “non-lethal” alternatives (i.e., TASERs, rubber bullets) and through company expansion of overseas sales and pursuit of new technologies (i.e., “smart guns,” magazine safeties).

Conclusions: High rates of firearm-related deaths and injuries are not inevitable. By treating the firearm harm epidemic as the market-driven problem it is, drawing on insights from other MDEs strategies, substantial reductions in violence may be achievable across the United States. States and cities have significantly reduced gun violence without infringing Second Amendment rights. The greatest unmet challenge now is generating increased engagement in gun safety among states and communities still experiencing high levels of preventable firearm deaths and related harms.