The United States suffers far more violent deaths than any other wealthy nation, due in part to the widespread possession of firearms and the practice of storing them at home in a place that is often unlocked, a report released amid a fierce debate over gun control in the country has found.
The findings, released Wednesday by two leading US health research institutions, took on urgency because the report comes less than a month after the shooting deaths of 20 children and six adults at an elementary school in Newtown, Connecticut.
The tragedy has fired up both sides of the gun control debate in a way that other recent mass shootings in the US could not. President Barack Obama promised swift action to curb gun violence and vowed his administration would not shy away from an issue that is one of the most divisive in the country.
Trying to keep up the momentum before the shock over the massacre fades, Vice President Joe Biden heard Wednesday from representatives of victims groups and gun-safety organizations. The talks were part of a series of meetings the vice president is holding this week in an effort to build consensus around proposals to curb arms violence. He will meet Thursday with the powerful National Rifle Association and other gun-owner groups, who are digging in against tighter gun restrictions.
Obama, after remaining largely silent on gun control after previous mass shootings, demanded change and tasked Biden with heading a commission to come up with recommendations on gun policy by the end of this month.
"Every once in a while, there's something that awakens the conscience of the country, and that tragic event did it in a way like nothing I've seen in my career," Biden said at the White House, referring to the Newtown shootings. "The president and I are determined to take action."
Against that backdrop, the report from the National Research Council and the Institute of Medicine found that gun violence was a contributing factor to lower US life expectancy compared to other wealthy countries.
The NRA, the country's most powerful gun lobby, did not immediately return calls seeking comment about the report, but in the past gun-rights advocates have fought any suggestion that firearms ownership has public health implications, and they have won cuts in the government's budget for such research.
The United States has about six violent deaths per 100,000 residents. None of the 16 other countries included in the review came anywhere close to that ratio. Finland was closest to the US ranking with slightly more than two violent deaths per 100,000 residents.
For many years, Americans have been dying at younger ages that people in almost all other wealthy countries. In addition to the impact of gun violence, Americans consume the most calories among peer countries and get involved in more accidents that involve alcohol. The US also suffers higher rates of drug-related deaths, infant mortality and AIDS.
The result is that the life expectancy for men in the United States ranked the lowest among the 17 countries reviewed, at 75.6 years, while the life expectancy for US women ranked second lowest at 80.7 years. The countries reviewed included Canada, Japan, Australia and much of Western Europe.
The nation's health disadvantages have economic consequences. They lead to higher costs for consumers and taxpayers as well as a workforce that remains less healthy than that of other high-income countries.
"With lives and dollars at stake, the United States cannot afford to ignore this problem," the report said.
The researchers reviewed an array of studies over the years. They estimated that homicide and suicide together account for about a quarter of the years of life lost for US men compared to those in those peer countries. Homicide, they noted, is the second leading cause of death among adolescents and young adults aged 15-24. The large majority of those homicides involve firearms.
The researchers said there is little evidence that violent acts occur more frequently in the United States than elsewhere. It's the lethality of those attacks that stands out.
"One behavior that probably explains the excess lethality of violence and unintentional injuries in the United States is the widespread possession of firearms and the common practice of storing them (often unlocked) at home. The statistics are dramatic," the report said.
For example, the United States has the highest rate of firearm ownership among peer countries 89 civilian-owned firearms for every 100 Americans, and the US is home to about 35 to 50 per cent of the world's civilian-owned firearms, the report noted.
In attempting to explain why Americans are so unhealthy, the researchers looked at three categories: the US health care system, harmful behaviors and social and economic conditions.
Researchers noted that the US has a large uninsured population compared to other countries with comparable economies, and more limited access to primary care. And although the income of Americans is higher on average than that of other wealthy countries, the United States also has a higher level of poverty, especially among children.
Researchers said American culture probably plays an important role in the life expectancy rates falling short of other wealthy countries.
"We have a culture in our country that, among many Americans, cherishes personal autonomy and wants to limit intrusion of government and other entities on our personal lives," said Dr. Steven H. Woolf of Virginia Commonwealth University, who served as chairman for the study panel.
Those values are frequently cited among gun advocates, who consider arms ownership a basic right enshrined in the Second Amendment of the US Constitution.
Many argue that the crimes of some should not force law-abiding citizens to give up guns, and fear that attempts to restrict ownership of even the most high-powered weapons could be a stepping stone to eventually banning all arms. The NRA insisted after the Connecticut shooting that the answer to gun violence was arming more "good guys" and putting an armed security officer in every school.
A coalition of conservative and gun-rights groups is organizing a "Gun Appreciation Day" to coincide with the weekend of Obama's inauguration, calling on people to visit gun stores, gun ranges and gun shows with US flags and "Hands off my gun" signs.
Obama hopes to announce his administration's next steps to tackle gun violence shortly after he is sworn in for a second term on Jan. 21.
Obama wants Congress to reinstate a ban on military-style assault weapons, close loopholes that allow gun buyers to avoid background checks and restrict high-capacity magazines.
A day ahead of a meeting with the NRA, Biden signaled that the administration is mindful of political realities that could imperil sweeping gun control legislation, and is willing to settle for something less. He said the administration is considering its own executive action as well as measures by Congress.
"I want to make it clear that we are not going to get caught up in the notion that unless we can do everything, we're going to do nothing," Biden said at the White House.
Connecticut, a relatively liberal Northeastern state that nevertheless has a strong gun culture and is home to some of the nation's best-known firearm makers, is moving cautiously on gun control.
Connecticut Gov. Dannel P. Malloy, a Democrat, became choked up in his State of the State Address on Wednesday, vowing to do "everything in our power to ensure that Connecticut never again suffers such a loss." He offered no specific proposals, instead noting that an advisory panel he set up last week will issue recommendations in March on gun control.
Gov. Andrew Cuomo in neighboring New York proposed a wide-ranging package of restrictions on Wednesday, including closing loopholes in a New York ban on assault weapons and ammunition magazines that carry more than 10 bullets.
Cuomo, who owns a shotgun and has hunted, sought to balance his call for action with a note of respect for gun owners.
"Guns have both a noble and a tragic tradition in America and in New York state," Cuomo said. "They are a sign of our nation's fiercely defended independence and self-reliance ... (but) in the wrong hands, guns are also weapons of untold destruction and heartbreak."