Guns and Public Health

The New England Journal of Medicine has an informative podcast of an interview with David Hemenway on “gun violence in the United States and the likely effects of the Supreme Court case D.C. v. Heller.”

Hemenway covers the effect of gun control laws from the public health point of view. He provides a good international perspective, based both on variation in policy and research. One thing I did not know was how the US has become a major supplier of guns to Mexico, Japan and elsewhere–sold here, then imported illegally there. He also describes the impact of major gun control in Australia, where there was a significant reduction in violence post legislation.

The New England Journal of Medicine also provides a full-length editorial, Handgun Violence, Public Health, and the Law, by Gregory Curfman, Stephen Morrissey, and Jeffrey Drazen. Here is the opening: “Firearms were used to kill 30,143 people in the United States in 2005, the most recent year with complete data from the Centers for Disease Control and Prevention. A total of 17,002 of these were suicides, 12,352 homicides, and 789 accidental firearm deaths. Nearly half of these deaths occurred in people under the age of 35. When we consider that there were also nearly 70,000 nonfatal injuries from firearms, we are left with the staggering fact that 100,000 men, women, and children were killed or wounded by firearms in the span of just one year. This translates into one death from firearms every 17 minutes and one death or nonfatal injury every 5 minutes. By any standard, this constitutes a serious public health issue that demands a response not only from law enforcement and the courts, but also from the medical community.”

The same issue of NEJM also has a free-access article on this topic, Guns, Fear, the Constitution, and the Public’s Health, by Garen Wintemute. Focusing specifically on the Washington DC statute being challenged in the Supreme Court, Wintemute writes, “In 1976, Washington, D.C., took action that was consistent with such evidence. Having previously required that guns be registered, the District prohibited further registration of handguns, outlawed the carrying of concealed guns, and required that guns kept at home be unloaded and either disassembled or locked. These laws worked. Careful analysis linked them to reductions of 25% in gun homicide and 23% in gun suicide, with no parallel decrease (or compensatory increase) in homicide and suicide by other methods and no similar changes in nearby Maryland or Virginia.”

9 thoughts on “Guns and Public Health

  1. Oooooo… gun control. Now you’re really going to get some folks angry, Daniel. Actually, I can’t believe how my impression of gun violence has changed in the 2.5 or so years I’ve been living away from the US. Back home, I got so accustomed to gun violence on the news. I grew up in a house with guns and even shot targets competitively.

    Now that I’m living in Australia, I’m completely sensitized to the insanity of easy-access guns. We just do NOT have gun violence here like in the US, and when we get news reports of school massacres or other shocking stories, I have to say that I’m beginning to respond like an Australian: with a mix of horror, incredulity, and disgust. The newly sprung Australian voice in me says, ‘What is WRONG with these people and their damn guns?!’

    To me the DC statistics are particularly interesting because it’s pretty well known that, even with the restrictions, it’s very easy to get a gun by simply crossing the border into a neighboring state (we heard about this on the news when I was living in Virginia). So these reductions in gun-related mortality are really coming from minor legislative bumps-in-the-road for those truly intent on purchasing a firearm.

    In Australia, the conservative Liberal administration (confusing, I know, but it’s Labor to the left of them here) pushed through major gun control reforms in 1998 after the Port Arthur Massacre in 1996 in which 35 people, many of them tourists, were killed in Tasmania by Martin Bryant. With a number of other of gun crimes in the news, this prompted the federal government to take action (although shooters’ groups, even the American National Rifle Association resisted).

    You can still get a gun in Australia, especially for the control of feral animals or for target shooting. I think I read somewhere that it’s estimated around 5% of Australians have guns legally. There’s still plenty of illegal guns, and they’re seized in nearly every drug raid or raid of notorious ‘bikey’ bars or clubs; and I’ve read that 80% of gun crime is with unregistered guns. But the end result is pretty clear. According to a major study, between 1991 and 2001, Australia’s already low violent crime rate dropped; firearm related deaths, including both suicide and murder, dropped 47% (there has, however, been an increase in the non-firearm-related suicide rate, partially offsetting the benefit). Certainly, the incidence of mass shootings has dropped precipitously in Australia since Port Arthur; there hasn’t been that kind of mass murder in twelve years. And the legislation has had other knock-on benefits, such as increased awareness among shooters’ groups and police of the need to secure firearms against theft; firearm theft has also dropped significantly.

    There’s still too much gun related murder and suicide, and the murder rate hasn’t changed that much as people still find other ways to do each other in (unfortunately, we’re creative animals that way), but it certainly does change one’s perspective on guns. I’m too much of a country boy to be in favor of an outright ban, but I also know that the vast majority of guns are useless for the kinds of things one actually does need a gun for (like shooting an animal who’s developed a taste for livestock, controlling feral animal numbers, or putting down a large animal — grim, but sometimes has to be done).

    Nevertheless, bringing up this topic could get us a whole crop of readers who wouldn’t normally be interested in ‘neuroanthropology’…

  2. The response from Gregdowney implies that the use of firearms for taking one’s own life is somehow bad or undesirable. This is a moral position about suicide that should be distinct from arguments about firearms used to commit murder or causing accidental death. For those who wish to end their own lives, firearms may be the only legal and viable means to do so. This is the majority of firearms deaths.

    Of the remaining 12,352 homicides, no data is presented as to how many of these are justifiable by accepted legal standards. That leaves 789 accidental deaths that are clearly unintended.

    For an even more “staggering” statistic, consider that automobile accidents consistently kill between 30,000 and 40,000 people per year in the USA and injure more than 1,000,000. Where is the outcry?

    It’s easy to jump on a bandwagon for or against firearms. It’s more difficult to accurately assess risks in a society. Suggested reading is “Risk and Culture: An Essay on the Selection of Technological and Environmental Dangers” by Douglas and Wildavsky

  3. On further reflection, I have to ask whether we, as a society, really care, or should care, about firearms deaths at all. Could there be be societal benefits to these deaths? By definition, the young people who kill each other with firearms are violent criminals. Is it better for society if these criminals self-destruct? Benefits of firearms could include self-elimination of violent criminals, justifiable homicides, tools for those who wish to end their own lives, tools for hunters, and the use of firearms to deter crime. The downside of firearms proliferation is accidental death, and the violent death of innocent non-criminals. Perhaps a researcher somewhere could tally up these numbers?

    This may sound like a cold calculus, but we as a society make these types of decisions all of the time. There is no outcry about the deaths caused by automobiles because we judge the utility of the automobile to be worth the price of death and mutilation. There is no outcry about the lack of health care for the poor because we as a society judge this to be too expensive to provide. Be imaginative and you will find many examples of this calculus.

  4. Dear Jim —
    I’m not sure whether I’d agree with you that there’s ‘no outcry about the deaths caused by automobiles.’ Certainly, at the moment I’m putting up with a lot of construction on my commute, and a fair bit of it is to fix parts of the road that are considered dangerous. Just recently, there was a huge controversy when the RTA cut down a number of old trees close to the road in Kangaroo Valley; they did it because of two fatal car collisions on a stretch of road.

    And we, as a society, in paternalistic, nanny-state ways try to protect people from themselves in all sorts of ways; we mandate that drugs and dangerous chemicals be in child-proof bottles, many of which are aggravating to those of us who have no children; we make it hard to get things like heavy equipment; we make people sign for decongestants and control cigarettes and alcohol. So I’m not so worried that society seems to ‘care’ about firearm death. I find it very hard to believe that every child that gets killed with a gun is a ‘violent criminal.’ Actually, I find it hard to believe that anyone COULD believe that, especially with children getting killed by accidental discharges, errant shots, or simply because their quite normal depression happened in close proximity to dad’s gun.

    As I understand it, most firearm deaths are members of the households that own guns. This would seem to suggest that most firearm deaths are accidental, suicide, or domestic violence, perhaps with a small number of defense against domestic violence cases. I guess I’m just less blase about people dying. Suppose that makes me a bleeding heart…

  5. Hello Greg D.,
    My intent is to get “out of the box” in how we think about issues and problems. The normal pattern of for-and-against debate does not seem to give us much progress on firearms or other issues, just debaters with entrenched points of view.

    The safety of children is a great example. Sure, we have child-proof medicine bottles. We also have 20% of children living at or below the poverty level in the richest nation in the world (according to UNICEF, the childhood poverty rate in the US is over 20% and has been rising since 2000). There is an active public debate about providing health care for children. That means that significant numbers of US citizens are AGAINST providing health care for children. I submit that the “safety of children” is a poster issue, something we like to believe in, but not something we act on consistently.

    These subjects are difficult for people to discuss because they often violate our constructed self images. Again I recommend Douglas and Wildavsky for some insight on how people choose which issues to worry about.

  6. The New York Times has a review article on “Gun Laws and Crime: A Complex Relationship,” which is certainly a good addition to this discussion:

    Some highlights? For guns, background checks seem to make some of a difference; beyond that, the effects of specific laws/policies and the nature of gun use and gun users both matter–hence the complexity. As for crime, demographics, economics, the drug trade, gangs, and cultural mores about violence do make a difference, whether or not guns are involved.

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