This latest mass shooting, in which 59 people were killed and 500 wounded in Las Vegas, is distressing—and it won’t be the last. Again we find it incredible that this can be allowed to happen.

And again we are reminded of the unique position of the United States compared to most other countries, our astronomically higher numbers of gunshot deaths and the financial and emotional costs they exact. As I wrote in my February 2016 editorial on gun violence, “firearms accounted for 417,583 deaths—253,638 suicides and 163,945 homicides between 2003–2013.”

There’s more information about gun violence and the dismaying number of injuries and deaths among children in our report in the September issue. And a study just published in Health Affairs puts the annual cost of emergency and inpatient care for firearm injuries at $2.8 billion.

The numbers of deaths and injuries we can measure. The sense of helplessness and frustration, and the creeping sense of anxiety we experience as we go into public spaces, are more invidious.

I’m not sure what the answer is, but the first step seems obvious: we must acknowledge we have a clear threat to public health, continue to research the topic, and begin a frank discussion of steps to take to mitigate the threat.

We’ve talked about and dealt with deaths from smoking, alcohol, motor vehicles, and drugs, all of which cause or are implicated in thousands of deaths each year. Yet somehow we can’t seem to address deaths caused by firearms—according to nearly all existing research, as much a public health problem as other social and environmental factors. It’s dumbfounding.