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Sandro Galea

5 dead, but hundreds more suffering

Law enforcement personnel shield civilians outside a garage after gunfire erupted at the Fort Lauderdale-Hollywood International Airport.AP PHOTO

In some ways, mass shootings like the tragedy Friday at the Fort Lauderdale-Hollywood International Airport in Florida have become a numbers game.

“Five dead,” the headlines proclaim. An average of 91 Americans killed by guns per day. Thirty-thousand gun deaths per year in the past decade. A gun murder rate that is 25 times the average of comparable countries.

But as we rightly focus on those who are killed by firearms, we risk underestimating the full health hazard of guns in this country. It is time to include the number of gun injuries — 13 in this latest shooting — in the national conversation.


The number of people killed is dwarfed by the number of those who are shot, either by others or by themselves, and then go on to live with the consequences. Between 70,000 and 80,000 people are physically injured by firearms each year, and this number is rising, as more people survive gunshot wounds through better hospital care. The effects of gunshot injuries are pernicious and last for decades. Gun injuries have more profound ramifications for long-term health and disability than, for example, motor vehicle injuries.

Simply put: Being shot hurts, and it hurts for a long time.

The burden of physical injury due to guns is likely exceeded by the mental health consequences of violence. While there are still very little data about the direct mental health effects of gun violence (a real limitation in our understanding, driven largely by federal limits on gun research funding), we know that between 40 percent and 50 percent of those who are injured in a traumatic event will experience a trauma-induced mental health disorder. These disorders can include depression, post-traumatic stress disorder (PTSD), and substance use. The psychological aftermath of violence can be lifelong; undergoing a traumatic event has been shown to increase an individual’s vulnerability to PTSD following any subsequent traumatic experience.


But the consequences of gun injury extend beyond individual harm. A full 99 percent of Americans know someone who has been shot by a gun, recent research shows. When a family member or loved one is unexpectedly killed by a firearm, the survivors inherit the effects of this violence. The sudden death of a loved one is well-recognized as one of life’s most potentially traumatic events. Devastating as this loss can be, sudden, unexpected death is known to be associated with a range of hazards, including substance use, PTSD, anxiety, and major depressive disorders. These conditions can undermine health throughout life for both children and adults.

If we assume that at least two family members of each of the 30,000 Americans killed annually will encounter mental health difficulties — and factoring in the tens of thousands of people who are shot but survive — the true number of those injured by guns approaches an appalling 120,000 per year. This is about the same number of Americans who die each year from stroke.

Finally, the damage of gun violence is not limited to survivors and their loved ones. It touches whole populations. A recent systematic review summarizing the current evidence on the transmission of gun violence within social networks found that the risk of violence can spread through communities like an infectious disease, with peer networks, family ties, intimate partner relationships, and other ties to people victimized by violence among its primary transmission routes. Living in a neighborhood characterized by violence also increases the risk of perpetrating violence, either as a result of learned behavior, self-defense, or retaliation. This creates a cycle of violence in communities that can be hard to break.


The problem of gun violence is therefore much bigger than 30,000 deaths per year. In numbers alone, it qualifies as a significant public health problem, affecting hundreds of thousands of lives. And importantly, unlike other health ills, this particular malady is one we can do something about, through state and federal policy changes.

Tackling the health consequences of gun violence requires us first to acknowledge their true scope. That means not only focusing on those who have been killed, but also accounting for the mental and physical scars of the many injured in this epidemic.

“Five dead” — in an instant Friday.

But hundreds more suffering.

Sandro Galea is dean and Robert A. Knox professor at the Boston University School of Public Health.