Changing the Narrative on Gun Violence

More than 800,000 people have died from firearms in the U.S. since the start of the 21st century, contributing to an ongoing public health crisis that shows no signs of slowing. In March 2025, the Journal of the American Medical Association (JAMA) convened more than 60 experts from across medicine, law and social sciences to study what actually works to reduce firearms-related injries and deaths. Their report, published Nov. 3. Synthesizes a broad range of evidence-based responses, including tighter firearms ownership laws, domestic violence intervention, community policing, and environmental changes to improve neighborhood safety. 

Jonathan Quick, M.D., an adjunct professor with the Duke Global Health Institute, was among the scholars tapped for the JAMA summit. A global health expert who has written extensively about pandemic policy and response, Quick might seem like an unlikely choice to weigh in on prevention of gun violence. In recent years, however, Quick has explored how consumer products can create harmful patterns of use that mimic infectious disease outbreaks, a concept he has called “market-driven epidemics,” or MDEs.

With support from DGHI’s Center for Policy Impact in Global Health, Quick has launched an initiative to study how lessons from past MDEs can help inform public health responses to gun violence and other health crises. We talked with Quick about what’s in the JAMA report and how the MDE concept influenced its recommendations. Responses have been edited for length and clarity.

How did you become involved in the JAMA summit?

We introduced the concept of market-driven epidemics in a 2024 PLOS Global Public Health article in which we analyzed the dynamics of three examples of MDEs in the U.S. -- cigarette smoking, sugar and prescription opioids. In each of these cases, millions of people became sick or lost their lives due to aggressive marketing of products with proven harms, but ultimately public health responses succeeded in reducing unhealthy behaviors, in some cases by as much as 65 percent. 

Following the PLOS article, a prominent firearms researcher, who served on the organizing committee for the upcoming JAMA Firearms Summit, invited us to present the market-driven epidemics concept at the Summit. He understood that the MDE approach provides a new pathway to address the core question: What combination of interventions and stakeholders is needed to achieve large-scale, long-term reductions in firearm-related deaths, injuries and other harms?

How do firearms fit the concept of a market-driven epidemic?

Market-driven epidemics occur when companies aggressively market products with proven harms, deny these harms, and make an active effort to reduce preventable injuries and deaths. The firearms epidemic has followed the same basic pattern as that of tobacco, sugar, prescription opioids and other MDEs. The industry has used fear and predatory tactics to market firearms, taken action to thwart public health research; and vigorously fought measures shown to reduce preventable firearm-related harms. 

What does the JAMA report hope to achieve?

The summit report sets out a pathway of five major steps to reverse the significant increase in firearm-related deaths and address the changing nature of the U.S. firearms epidemic. This is a problem that goes well beyond the rise in mass shootings. Firearm-related deaths are now the leading cause of death among children and among pregnant women in the U.S.  More than half of U.S. adults or a family member has been affected by a firearm-related incident. And for every person that is killed by firearms, two more suffer non-fatal injuries that can have life-long  impacts on physical and mental health. 

How did the MDE concept influence the report? Are there specific responses that are suggested by your research?

The report reflects our MDE insights in at least two of the five areas for action. The first relates to changing the narrative on the preventability of firearm harms. In each of the MDEs we studied, there was a critical moment that shifted the way the public thought about the issue. For tobacco, it was the watershed 1964 Surgeon General’s report, which reframed cigarette Smoking from a harmless pleasure to a serious health risk. For sugar, it was the 1999 “America is Drowning in Sugar” campaign, which helped catalyze a reduction in sugar use by linking it to obesity. For prescription opioids, a 2011 CDC report shifted the focus from blaming “negligent” users to overprescription driven by aggressive marketing. While changing attitudes and beliefs about firearm ownership, risks and gun safety measures provides a different set of challenges, it is a vital step forward.   

The second area of action is taking a whole-government and whole society approach to reducing firearms harms. This reflects an important lesson from our study of MDEs, which is that changing the behavior of millions of people requires a combination of stakeholders: including federal, state and local governments, professional associations, researchers and the private sector. 

Given the constitutional protection on gun ownership in the U.S. and strong advocacy from the gun lobby, how achievable are the JAMA recommendations in this political environment? 

Framing gun ownership as a matter of gun rights vs gun safety is a false choice. The report summarizes the effectiveness of two dozen interventions that reduce firearm suicide deaths, homicides and other harms without infringing the “right to bear arms”. These measures include federal and state gun safety laws, community interventions, healthcare programs, community environment changes and socio-economic policies.

While support for firearm safety and violence-prevention has waned at the Federal level, individual states have achieved large-scale, sustained reductions in firearm harm. Over the last three decades, for example, California, New York and Washington, D.C. have decreased per capita gun deaths by a range of 44 percent to 65 percent. They’ve done that while other states have seen significant increases in per capita gun deaths. That’s one area we’re hoping to understand in our research – the dynamics of those rising and falling gun violence rates.