Elevating the conversation by grounding it in factual evidence: How landmark studies on firearm-related injuries led to policy change in Canada
When it comes to the complex issue of firearm-related injuries in Canada, a series of groundbreaking studies using ICES data have been pivotal in shedding light on the incidence and risk for young people—including the hidden dangers of non-powdered firearms, such as pellet and BB guns. The research paved the way for advocacy and a historic shift in Canadian firearm policy, aligning legislative priorities with public health needs.
The first study in the series explored sociodemographic risk factors for firearm injury in Ontario, revealing key trends that shaped the conversation on gun safety. The findings were stark: most injuries involving firearms in children and youth were unintentional and non-powdered firearms accounted for a large proportion of these incidents. Further, this study showed that the vast majority of people survived their initial injury, and older reports that measured only firearm fatalities had grossly underestimated the magnitude of the issue.
“These findings were really a wake-up call for public health advocates, highlighting the urgent need to address firearm safety,” says Dr. Natasha Saunders, an ICES senior adjunct scientist and a paediatrician at the Hospital for Sick Children (SickKids).
Patterns of injuries differ by the intent of a firearm discharge
Dr. Saunders’ research program built on this first study to show how risk for firearm-related injuries varied according to the type of firearm used and the intent behind why the firearm was discharged.
The next study in the series found that young men who lived in lower-income urban areas were most likely to be injured by firearm-related assaults, which accounted for 40% of nonfatal injuries. In contrast, more than two-thirds of self-harm related injuries occurred in older rural-dwelling men and were almost always fatal.
Another study among children and youth found that most firearm injuries were unintentional, and half were to the head and neck region. Importantly, half of the injuries in children and youth were from non-powdered firearms, with many causing traumatic brain or eye injuries. Incidents involving both traditional powdered and non-powdered firearms also led to a significant increase in healthcare encounters and expenses, underscoring the widespread impact on the healthcare system.
Discovery that changed the conversation around “toy” guns
“Non-powdered firearms such as BB or pellet guns can be almost as dangerous as regular guns when unsupervised or in the wrong hands,” says Dr. Saunders. “Pellets or BBs can break through the skin and cause serious injury inside the body, yet these firearms can be easily purchased and accessed by children.”
Because these firearms are unregulated and marketed as “toys,” their inherent dangers are hidden. Dr. Saunders has changed the narrative around these seemingly benign weapons, pushing forward critical policy changes to safeguard Canadian youth using rigorous data analysis and community health perspectives.
Improving community safety
Dr. Saunders leveraged these insights to advocate for policy change. Her research program has consistently produced evidence-based recommendations aimed at protecting children and youth from firearm-related harm. Working at the intersection of injury prevention and public policy, Dr. Saunders has collaborated extensively with firearm injury prevention groups, helping build a coalition of advocates working toward improving public safety.
Her contributions, backed by ICES data, were instrumental in guiding the passage of two key Canadian federal bills: Bill C-71 and Bill C-21. Bill C-71 introduced more robust background checks, particularly focusing on personal history, to ensure that firearms don’t end up in the wrong hands. The original Bill C-21 marked a turning point by recognizing the real threat of non-powered firearms, which were debated for the first time in the House of Commons. Dr. Saunders’s expertise was sought by the Canadian Paediatric Society (CPS) to testify before the Senate Committee in 2019 and 2023, where she highlighted the urgent need to amend gun control legislation to better protect Canada’s most vulnerable populations.
“The issue of firearms control is highly politicized, with limited high-quality national data to inform and assess injury prevention strategies. This body of work elevated the conversation by grounding it in factual evidence,” says Dr. Saunders.
The ICES research on both powdered and non-powdered firearm injuries has not only informed policy but has also sparked a national conversation, positioning ICES as a leader in public health research with real, lasting impacts on community safety.
Acknowledgements
Many researchers and trainees have advanced the work and advocacy on firearm-related injuries in children and youth, including:
- Dr. Charlotte Moore Hepburn, paediatrician at the Hospital for Sick Children (SickKids)
- Dr. David Gomez, acute care and trauma surgeon at St. Michael’s Hospital and a scientist at the Li Ka Shing Knowledge Institute and ICES
- Dr. Claire de Oliveira, health economist at the Centre for Addiction and Mental Health, an assistant professor at the Institute of Health Policy, Management and Evaluation, University of Toronto, and an adjunct scientist at ICES
- Dr. Alison Macpherson, a professor in the School of Kinesiology and Health Sciences at York University and an adjunct scientist at ICES
- Ms. Rachel Strauss, a medical student at the University of Toronto