The Robb Elementary massacre in Uvalde, Texas has resurfaced many disturbing facts about America’s exceptional propensity for gun violence. But perhaps one of the most worrisome is that guns are now the leading cause of death for Americans 24 and under.

While guns have long been an integral part of American life, the emergence of firearms as the leading killer of young people is a relatively new phenomenon.

For years, the cars have held this distinction. But over the past two decades, motor vehicle deaths involving Americans aged 1 to 24 fell, cutting the rate by nearly half. And in the late 2010s, those two lines — car and gun deaths — intersected on the chart of leading causes of youth death.

In 2020, the most recent year for which data was available, firearms killed 10,186 young people, the highest number in two decades.

Centers for Disaster Control and Prevention

(It should be noted that motor vehicle related fatalities have increased in 2020, the first year of the pandemic. That said, guns also surged and remained the leading cause of death among young people.)

Based on a recent analysis of Centers for Disease Control and Prevention (CDC) data published in the New England Journal of Medicine (NEJM), the single-level graphic tells a tragic story: lives taken too soon. But it also highlights how political action can get things done to save lives – and how political neglect can make preventable tragedy worse. The article received some attention when it was first published in April, but its findings resurfaced in various US media after the Uvalde massacre. It’s easy to see why the comparison strikes a chord: the youngest members of our society are dying from the most American of public health problems.

While the Uvalde massacre has prompted the latest round of national gun-watching, the American tragedy of gun violence goes well beyond such incidents. A die NEJM The paper’s co-authors, Lois Lee, a professor of pediatrics and emergency medicine at Harvard Medical School, told me that mass shootings with at least several deaths are sadly just the tip of the line. iceberg. “Mass shootings like [Uvalde] actually represent less than 1% of pediatric firearm deaths. … Most gun deaths are not from mass shootings, but from homicides (62%) and suicides (33%),” Lee said.

Although youth gun deaths have increased, motor vehicle deaths have fallen by about half since 2000. Although road rage continues to kill many children and has increased markedly during the pandemic, the decline that has lasted for decades is nevertheless a hard-fought public health problem. milestone based on research, safety measures and regulations. This included adopting harm reduction principles in road safety policy: people are going to drive cars anyway, it is thought, so why not focus on making it as safe as possible ?

The current rate of young Americans killed by firearms is not inevitable; it is a political choice. In their analysis of this CDC data, Lee and his co-authors argue that the same approach to reducing motor vehicle deaths among young people can and should be applied to firearms.

How America made cars safer but not guns

The decline in motor vehicle-related deaths in America over the past two decades is part of a larger trend that began in the 1960s. Ralph Nader’s seminal 1965 talk, Dangerous at any speedcatalyzed a car safety movement that resulted in the creation of the National Highway Traffic Safety Administration (NHTSA), which established the infrastructure for car safety.

Beginning in the 1970s, NHTSA would maintain a database of motor vehicle fatalities, invest in research, and provide safety certifications for cars on the market, prompting automakers to adopt safety procedures. The work of NHTSA and civil society groups like the Insurance Institute for Highway Safety has helped usher in a new era where safety devices such as seat belts and airbags have become standardized. All of this, along with measures such as universal state driver licensing and car registration, has resulted in lower deaths among young people and in American motor vehicles overall. The CDC would eventually tout this decline as one of the nation’s greatest public health achievements of the 20th century.

And as Lee tells it in the NEJM article, that progress has continued into the 21st century. In 1998, front airbags became mandatory in all cars and trucks sold in the United States. Other improvements such as automatic emergency braking, blind spot detection, side airbags and rear-facing cameras have also helped improve the automotive safety landscape. “What we’ve seen is more than half a century of efforts to make the automobile safer,” said Mitchell Moss, professor of urban policy and planning and director of the Rudin Center for Transportation at the ‘New York University.

If the cars went one way with safety, the weapons went the other. Firearms are one of the only consumer goods whose safety is not regulated by any government agency. Gun manufacturers are also very immune to lawsuits and therefore may have little incentive to design safer weapons, such as “smart guns” that would only be usable by users. with which they are registered. As Moss said, “We really have a Wild West approach to gun-making in this country.”

To top it off, federal research on firearms, gun violence, and gun safety has also been essentially frozen for more than 20 years through 2020 due to an NRA-backed measure known as the Dickey amendment name. “We don’t even have a real real-time, national database to understand what’s going on with firearm injuries and deaths,” Lee said. “We have a lack of infrastructure, a lack of researchers, and then a lack of knowledge to even know what are the things we can do to mitigate or certainly reduce firearm injuries and deaths.”

Compare that with cars. When it comes to public health achievements in reducing motor vehicle-related deaths, improvements in car safety and the introduction of driver-specific regulations have led the way, says Kerri Raissian, professor of public policy at the University of Connecticut. “The federal government has encouraged certain safety measures (tying interstate money to the legal driving age, for example) and the states are enforcing the rules of the road,” I was told. she writes in an email. “It’s a feat in terms of results and coordination that it took to get us here.”

Certainly, the number of car fatalities is still unacceptable – a recent report by the International Transport Forum, which is affiliated with the Organization for Economic Co-operation and Development (OECD), found that the United States in 2020 had more road deaths per 100,000 population than all other OECD countries.

In fact, road fatalities likely hit a 16-year high last year, with pedestrian fatalities in particular up 59% since 2009. This could partly be attributed to the way cars have become more safe for drivers and passengers, but not for others. The auto industry manufactures and promotes larger, more dangerous SUVs that are far more likely to kill pedestrians in crashes. SUV sales have also risen sharply over the past decade, now accounting for half of all car sales in the United States. Despite rising pedestrian fatalities, NHTSA has refused to adopt safety tests that other countries use to protect pedestrians.

That said, reducing overall deaths and mitigating injuries should be — and have been — the overriding policy goal, and it’s what has delivered results, Lee says. “It’s not realistic given the number of cars on the road and the vehicle-miles driven or traveled per person that we would ever reach zero,” she said. “And the mitigation of injuries or fatalities is just the tip of the iceberg. There are many more serious injuries that require hospitalizations.

For legal, cultural and political reasons, guns, like cars, are inseparable from American life. But if so, that’s all the more reason to try to implement all possible strategies to reduce the damage. Moss said it clearly: “We are not going to eliminate the car from American life,” and the same truism can be applied to guns. “I think what’s happened is we’ve normalized the number of child deaths. We’ve become too accepting of that.

As Vox’s Marin Cogan wrote, “To do nothing is to endorse an intolerable status quo.” And while federal action is not imminent, there are still many things that can and have been done at the state level to successfully reduce the rate of gun violence. Lee also pointed to a study she and her colleagues conducted that showed that enacting laws requiring the safe storage of firearms away from children led to reductions in homicides, suicides and unintentional child deaths. . Moreover, strong research, both at home and abroad, shows that regulations such as licensing can reduce gun deaths for everyone, not just young people.

“When a child is killed, you lose the rest of their life as a member of society, as a member of their family, as a member of their community,” Lee said. “And the repercussions of that, in a way, will never go away.”