For nearly three decades, the World Health Organization (WHO) has recognised violence as a major public health concern. Since the landmark World Health Assembly (WHA) resolution of 1996, violence has been framed not only as a cause of injury and death, but as a driver of long-term physical, psychological, and social harm, as well as a significant burden on public-health systems. 

Over this period, WHO has issued technical guidance, developed prevention frameworks, and supported countries to strengthen health-system responses to violence against women and children, youth violence, and other forms of interpersonal harm.

Yet one of the most lethal drivers of violence globally, firearms, remains largely absent from the WHO’s governance architecture.

A multi-method analysis, Tracking WHO Attention to Firearm Violence, 2000–2025, co-published on Tuesday (10 February) by a consortium of Global North and Global South academic institutions and NGOs working on public health and violence prevention, examined WHA resolutions, WHO violence-prevention frameworks, and key institutional trends over 25 years. 

The finding is straightforward. Violence appears repeatedly in WHO resolutions, strategies, and technical documents. Firearm-related harms do not.

This absence shows up across WHA resolutions, flagship prevention frameworks, and the national policies that rely on them. It is a governance blind spot with practical consequences.

Silence at the World Health Assembly

Since the WHA first met in 1948, more than 3,200 resolutions have been adopted. Only a small fraction address violence and none explicitly mention firearms, small arms, or gun violence.

Yet firearm-related harm has accounted for over a million deaths over the past five years, with millions more injuries, many leaving permanent disabilities, each year, most of them occurring outside armed conflict.

The downstream effects of this omission extend well beyond injury and death. Exposure to firearm violence, whether direct or indirect, is associated with anxiety, depression, post-traumatic stress, and substance use, particularly among children and adolescents. 

In high-violence settings, the effects are cumulative. Teachers, caregivers, and health workers absorb the strain. Schools struggle with attendance and concentration. Academic performance suffers, and dropout rates rise. These impacts shape life chances long after the violence itself.

Because firearm-related harm is largely absent from WHO’s violence-prevention frameworks, these mental-health, substance-use, and educational harms are weakly integrated into prevention strategies, if they appear at all.

This is not because the evidence is missing. WHO produced substantial work in the early 2000s explicitly addressing small arms as a public-health concern, including analysis of firearm injury, disability, and trauma.

Tracking WHO Attention to Firearm Violence shows how that early engagement steadily narrowed, with firearms increasingly folded into broader violence agendas or dropped altogether.

Interviews with global-health experts point to familiar constraints. Firearm-related harm is politically sensitive. Some member states resist explicit attention. WHO is donor-dependent. New resolutions carry costs. In that environment, firearm violence repeatedly falls below the line of what is considered feasible.

Global policy omission

INSPIRE, the WHO-led framework guiding global action to end violence against children, is widely used by governments, UN agencies, and donors.

RESPECT, developed to prevent violence against women, plays a similar role in the gender-based violence (GBV) field. Both focus on social norms, family-level interventions, and service responses.

But neither meaningfully addresses firearm-related harms.

In INSPIRE, guns appear only in passing, despite being a leading cause of death among adolescents in many countries. 

RESPECT does not engage with firearm access as a risk factor in intimate-partner homicide, even though the link between gun availability and lethality in domestic violence is well established.

These omissions matter. INSPIRE and RESPECT shape donor priorities, technical assistance, indicators, and national action plans.

The pattern was visible at the 2024 Interministerial Meeting on Ending Violence Against Children in Bogota. Nearly 100 governments made pledges aligned with INSPIRE to address violence against children.

None mentioned firearms or firearm-related harm. This was not because gun violence is irrelevant to children and adolescents in those countries. It reflects how global frameworks define what counts as legitimate prevention policy.

Men at risk

A similar narrowing appears in the growing number of national men’s health strategies.

In many regions, men, particularly young and marginalised men, account for the majority of firearm homicide victims and survivors. 

Gun violence drives premature mortality, disability, and long-term psychological harm. Yet emerging national men’s health policies tend to emphasise non-communicable diseases, mental health, encouraging norms’ changes to increase health-seeking behaviour, while neglecting firearm violence entirely.

Most international NGOs working on men’s health mirror this framing. The focus is on norms, behaviours and services, not on structural drivers of injury, death and chronic mental health challenges. This reflects prevailing policy architectures rather than intent. Nonetheless, the result is men’s health policies and programmes that do not correspond to epidemiological realities in high-violence contexts.

Taken together, these patterns point to a broader governance problem. Firearm violence sits in a policy no-go-zone, too political for violence-prevention frameworks, too securitised for health, and too structural for the prevailing approach to men’s health.

Commercial determinants contradiction

This fragmentation stands out given WHO’s expanding work on the commercial determinants of health.

WHO has been explicit about the role of tobacco, alcohol, ultra-processed foods, and other industries in driving ill-health. It has documented how corporate practices shape exposure, risk, and inequity. It has also excluded both the tobacco and arms industries from engagement under its Framework of Engagement with Non-State Actors.

Yet firearms remain largely absent from the commercial-determinants agenda.

Guns are plainly commercial products. They are manufactured, marketed, and distributed by powerful global industries. Marketing, increasingly online and often gender-exploitative, shapes norms around risk and protection. Availability is shaped by regulation, trade, and enforcement choices.

WHO’s leadership on tobacco did not emerge because the issue was politically easy. It emerged because the health burden was undeniable and the commercial drivers clear. Firearms and the ammunition they carry, present a similarly preventable source of injury and death.

Beyond agenda-setting, the WHO has a well-established role in generating and consolidating the types of health data that inform national regulatory decision-making.

Evidence from international reviews of firearm legislation consistently indicates that more comprehensive and effectively implemented firearm regulations are associated with lower firearm mortality, while permissive regulatory environments correlate with higher rates of lethal violence. 

WHO leadership in improving surveillance, harmonising indicators, and translating this evidence into technical guidance could strengthen member states’ capacity to assess where and how firearms contribute to preventable death and injury.

Such an approach would also support more informed policy responses in contexts such as intimate-partner and gender-based violence, where the presence of a firearm markedly increases lethality.

Why this matters now

WHO is under acute financial pressure following funding withdrawals and delayed contributions. At the same time, it is reasserting its role on social and commercial determinants of health and revisiting questions of mandate and prioritisation.

A growing group of research institutions, public-health bodies, and civil-society organisations has responded by forming the Global Coalition for WHO Action on Firearm Violence. WHO Action, as its name suggests, is calling on the WHO to recognise firearm violence as a preventable public-health harm that warrants clearer better data, clearer technical guidelines to health ministries and coordinated prevention strategies.

At this point, the continued exclusion of firearms from WHO’s core health frameworks is hard to justify. Addressing firearm violence as a public-health issue would not expand WHO’s mandate. It would clarify it by bringing violence prevention, gender-based violence, child protection, men’s health, and commercial determinants into closer alignment.

The WHO has done this before with other health issues. The question now is whether the organisation can afford to keep treating one of the world’s leading drivers of violent death and disability and one of the most disruptive and costly health matters as though it isn’t a public health problem.

Dean Peacock is affiliated with the School of Public Health at the University of Cape Town and the Gender Centre at the Geneva Graduate Institute. 

Dr Stephen Hargarten is Professor of Emergency Medicine at the Medical College of Wisconsin, (MCW) and the Founding Director of the Comprehensive Injury Center at MCW, where he currently serves as the senior injury and policy advisor. 

They are Co-Commissioners of the Lancet Commission on Global Gun Violence and Health and serve as Founding Directors of the Global Coalition for WHO Action on Firearm Violence

 

Image Credits: Maria Lysenko/ Unsplash, Max Kleinen/ Unsplash.