Dr. Fred Rivara, of Seattle, has spent 20 years fighting to lift a federal freeze on funding for public-health research into gun violence. Opponents say “gun ownership is not a disease.”

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Harborview Medical Center’s Dr. Fred Rivara was 46 when Congress first froze funding for federal research into the public-health effects of gun violence.

He’s 66 now and, two decades later, the Seattle injury-prevention expert is still fighting to lift the ban he says prevents the U.S. from understanding how to prevent gun deaths — and how to treat the trauma surrounding them.

Rivara’s latest forum is an editorial in the journal BMJ published Wednesday.

“Research is needed on all aspects of gun policies and safety,” wrote Rivara and his colleagues, including Dr. Margaret Winkler, secretary of the World Association of Medical Editors.

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The title? “Unsafe and Unstudied: the U.S. gun problem.”

“By taking steps to permit public-health research, we can finally begin to understand the sources of the current epidemic of violence and how best to control it,” the authors added.

The funding ban dates to 1996, when the National Rifle Association (NRA) charged that the Centers for Disease Control and Prevention (CDC) was lobbying in favor of gun control through its published studies.

The move followed a 1993 study by Rivara and colleaguesin the New England Journal of Medicine that found homes with guns had a higher risk of homicide by a family member or intimate partner.

Before that, from the mid-1980s to the mid-1990s, the CDC conducted original, peer-reviewed research into questions surrounding gun ownership and use.

Spurred by the NRA, Congress added an amendment to a 1997 spending bill stating that none of the funds that went to the CDC “may be used to advocate or promote gun control.” Similar language was later added to funding for the National Institutes of Health (NIH).

The result has been “a chilling effect” on gun-violence research for nearly 20 years, said Rivara, founding director of the Harborview Injury Prevention and Research Center.

The omnibus spending bill for 2016 again included the language, despite efforts to remove it in the wake of a series of mass-shootings in the U.S. Even Jay Dickey, the former Republican congressman from Arkansas who authored the amendment that limited funding, has said publicly he regrets the move.

“I think it’s a perennial problem, and the scientific community is becoming more aware of it in general, not just the few of us who do gun research,” Rivara said.

Opponents of gun control, however, say there’s a good reason to continue to stop federal money from flowing to the CDC and other agencies to investigate gun violence.

“The problem we had was with how past money was spent with the CDC,” Alan Gottlieb, chairman of the Bellevue-based Citizens Committee for the Right to Keep and Bear Arms. “The research was aimed to push an agenda. If you had doctors who were doing responsible research that wasn’t biased, I don’t think there would be objections to funding it.”

President Obama lifted the formal ban on government research into gun violence in 2013, but the move has had little effect. Congress never authorized the $10 million Obama called for to pay for it then — or any funding since.

The result, Rivara said, was that researchers don’t know much about the causes or public-health effects of gun violence, which caused 33,599 deaths in the U.S. in 2014. Worldwide, 180,000 people were gun-homicide victims in 2013, according to the Global Burden of Disease. Among high-income countries, the U.S. accounted for 73 percent of those deaths.

Without federal funds, many researchers have relied on private money to conduct studies. In 2014, Rivara published a study that found shooting victims were more likely to die by gunfire in the future.

That research, however, was paid for with $153,000 from the Seattle City Council, the first city in the U.S. to provide public dollars for gun research. Another project is pending, with $275,000 from the city granted for a two-year study about ways to intervene with gunshot victims to reduce similar injuries in the future, Rivara said.

A portion of Seattle’s new tax on gun and ammunition sales will also fund such public-health research, city officials have said.

The NRA opposed that tax, as did Gottlieb, who said he sees no need for a public health agency to focus on gun violence.

“Gun ownership is not a disease,” he said.