More than half a million Americans committed suicide by firearm from 1965 to 2000. That is one of the reasons guns are a serious public health problem. It is no surprise that one of the foremost experts on public health makes the case for a public health approach to guns.
David Hemenway is Professor of Health Policy at the Harvard School of Public Health.
Hemenway makes it clear upfront is that his goal is not to ban or to confiscate firearms. "Public health is pro-health; it is not anti-stairs, anti-swimmimg pools, anti-cars, or anti-guns."
Besides, gun ownership is a
constitutional right, so there is no chance of a broad ban.
Instead, he advocates the same public health approach that our society takes with other serious threats to public health such as motor vehicle crashes, lawn mowers, smoking, drowning, etc.
His basic principle is that harm can be reduced and prevented by making changes in the environment so it's easier for people to choose safety and harder to choose risky.
One example is the problem of
new teenage drivers, who have the highest crash rates. An effective policy for 16-year-old drivers is the graduated license. It prohibits driving under the two most dangerous circumstances, namely at night and with a carload of peers. The result has been a 30 percent drop in the teen deathrate.
Applying the same strategy to reduce firearm injuries and deaths is hampered by inadequate data and research. Congress had banned federal funding in firearms research for two decades until 2020. In addition, data on deaths and injuries are not uniformly reported nationwide. Without sufficient data and funding, it is difficult to pursue research-tested policies.
International comparisons should be done with care. Nonetheless, comparing the U.S. to three other developed "frontier" nations is instructive. Canada, Australia and New Zeland have similar histories. When it comes to crime, their rates are as high or higher than in the U.S. with one exception: firearm homicide. In that category, the U.S. rate is several times higher. In addition, children under 15 are nine times as likely to die by a gun accident than their counterparts in the rest of the developed world.
Gun enthusiasts generally prefer to address the illegal or reckless use of firearms with blame and punishment for the perpetrators. This is reminiscent of the auto industry from the 1920s to the 1960s that advocated punishment for bad drivers instead of safety improvements to vehicles. While punishment has a important role, it is not the only tool that can reduce the problem. Just as safety-belts, padded interiors and air bags reduced traffic deaths, environmental changes reduce firearm deaths.
Another example is how widespread aspirin poisoning among children was addressed. For years Big Pharma blamed careless parents and proposed parental education as the solution. Aspirin poisoning eventually dropped by 90 percent -- not by punishing or educating parents -- but due to the mandate for childproof caps on aspirin bottles. In other words, the environment was changed to reduce the risks.
Guns play a major role in suicide in the USA, but it's a topic that gets little attention, despite the large death toll.
There is a growing body of evidence relating suicide to gun availability. For example, the Israieli Defense Forces responded to a rise in weekend suicides among young Israeli soldiers by prohibiting them from taking their firearms home. The result was a 40 percent drop in weekend suicides, with no compensatory increase at other times or using other methods.
In addition, rates of household gun ownership are the "key explanation" for differing suicide rates among cities. "As cancer researchers showed it was virtually impossible for any omitted variable to explain the strong cigarette-cancer connection, firearm researchers have shown that it is virtually impossible for any omitted variable to explain the robust connection between household gun ownership and suicide."
The issue is clouded by a widespread misapprehension, namely that suicidal individuals will inevitably find a way, whether or not guns are readily available. That is true for some chronically depressed individuals. For many others, however, the suicidal impulse is often a fleeting desire, and guns are far more lethal than common alternative methods. Suicidal individuals are often ambivalent about killing themselves, but when acting on a temporary impulse with a gun, few survive.
Men are more likely than women to use a gun, which accounts in part for four-to-one ratio of male-to-female suicides. Women attempt suicide about three times more often than men, but usually not with guns.
The firearm suicide rate for children 14 and under is 11 times higher than in other high-income countries, while the non-firearm suicide rate is roughly similar.
Comparing five states with the highest levels of gun ownership to five states with the lowest levels, gun suicides were 3.8 times higher in the high-gun states. Based on the evidence, removing firearms from the home, especially where there are adolescents or young adults, is the single most effective suicide prevention measure.
In sum, "all the U.S. evidence continues to indicates that gun availability makes it far more likely that suicide attempters will use a gun and die."
Guns are used in two-thirds of all murders, and the U.S. had a murder rate five times higher than the average for other developed nations during the 90s. High-gun states had three times the homicide rate of low-gun states. The firearm homicide rate for children 14 and under is 16 times higher than the average for other developed countries. The weight of the evidence clearly indicates that "more guns in a community lead to more homicide."
A main reason people buy guns is for protection. A number of studies, however, find that the risk of gun homicide rises with the presence of a gun in the home. Homicide by other means is not much affected by whether a gun is present.
The U.S. also has a higher rate of gun accidents than peer countries. Fifteen-to-nineteen year olds have by far the highest rate of accidental firearm fatalities. Residents from U.S. states with the highest rates of gun ownership were more than ten times as likely to die from a gun accident than residents of low- gun states. It was 24 times higher for children from ages 5-14 in high-gun states. As one researcher said, "we childproof medicine bottles and swimming pools. But we put loaded handguns in bedroom drawers."
Accidents can be curbed by effective policies, as has been done with lawn mowers, chain saws, and childproof medicine caps. Opposition from the gun lobby prevents adoption of mandatory safety standards to curb accidental shootings. For example, guns could be required to not fire when dropped. They could also be required to have minimum trigger-pull standards to prevent small kids from pulling the trigger. There are several other safety features that are possible -- if they were politically feasible.
Hemenway summarizes findings from several hundred studies. His overall conclusion is that more guns means more gun accidents, more gun suicides and more gun homicides. Here is a small sample of the hundreds of research findings summarized in this book:
▪︎ Handguns, as opppsed to long guns, are used disproportionately in crimes, homicides, suicides and accidents.
▪︎ For every accidental firearm death, there are an estimated 13 victims who are injured.
▪︎ Using guns in self-defense is "quite rare" and does not reduce the likelihood of injury, of burglary or of any other crime. The claim of 2.5 million annual incidents of self-defense "is a vast overestimate."
▪︎ The large majority of firearms researchers believe that a gun in the home makes it a less safe place rather than a safer
one.
▪︎ For every unintentional firearm death in the U.S. there are about 40 gun suicides.
▪︎ A cross-national study of 171 countries found that the rate of gun availabilty correlates with guns assaults and gun robberies.
▪︎ The combined death toll from gun accidents and suicides always exceeds homicides.
▪︎ Mental health problems do not account for a significant share of gun crime. A comparison of the U.S., England and Australia found similar rates of mental illness, but large differences in homicide related to gun availabilty.
▪︎ The gun industry makes a consumer product, "but the product is less regulated than that of almost any other consumer product." A variety of safety mechanisms could be required -- except federal law exempts firearms from safety regulations that other products must meet. In addition, gun dealers face weak enforcement of the law due to underfunding of the ATF.
The author critiques studies and assertions by the favorite researchers of the gun lobby, Gary Kleck and John Lott. Hemenway highlights the limitations, mistakes and distortions in their writing.
One major shortcoming of this book is that it was completed in 2003, so much of the data are from the 1990s and earlier. When the second edition came out in 2017, a new preface was added. There is also an afterward from 2006 summarizing research up through 2005. Unfortunately, in the 2017 edition, the data were not updated since 2005, except in the preface. The data from the early 2000s, however, was generally consistent with earlier findings.
One area of the book that is seriously out of date, however, is its treatment of the Second Amendment, where recent landmark SCOTUS decisions have recognized a constitutional right to have and carry guns. Gun laws have undoubtedly gotten more permissive since the book was written. The SCOTUS will soon tell us whether new regulatory attempts by states will be permitted.
In short, though the public overwhelmingly favors more effective gun control measures, there is now a judicial barrier to overcome. The other barrier stems from the different levels of intensity and commitment between advocates and opponents of better gun regulation.
All in all, Private Guns Public Health makes a a strong case for prevention by changing the risky environment, not just punishing "bad guys with guns." The multi-pronged public health approach would more effectively curb the huge toll of gun deaths and injuries. It is better to prevent a gun tragedy than it is to punish the perpetrator after a victim has been crippled or killed. -30-
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