Is Gun Violence the Symptom or the Disease?

According to the Centers for Disease Control and Prevention (CDC), there are about 33,500 firearm deaths each year in the United States. There are also within those about 21,300 suicides by firearm each year in the United States. That’s over 50,000 a lot of people each year whose lives are ended by firearms. (Edit: I corrected the numbers. See the comment by “Brett” — if that’s even his real name — below. Apparently, I can’t read tables at three in the morning while trying to feed my baby. I hope that “Brett” can relate.)

Of course, the cynics out there will say that these people would have died by other means if guns were to suddenly disappear from existence. That logic doesn’t hold much water. Yes, people intent on killing someone will find other “tools” to achieve their purpose. So will people intent on ending their own lives. But here’s the thing: guns are very efficient while knives, ropes, rocks and baseball bats are not. You pull the trigger on someone and that bullet will cause major damage. You swing a bat at someone and they may dodge the hit, and survival is very likely. There may still be some homicides and some suicides if guns were to disappear, but the number would be significantly smaller.

Take a look at this graph from National Public Radio:

From the NPR report:

“Those countries all also enjoy low rates of gun violence, but the U.S. has the 31st highest rate in the world: 3.85 deaths due to gun violence per 100,000 people in 2016. That was eight times higher than the rate in Canada, which had 0.48 deaths per 100,000 people — and 27 times higher than the one in Denmark, which had 0.14 deaths per 100,000.

The numbers come from a massive database maintained by the University of Washington’s Institute for Health Metrics and Evaluation, which tracks lives lost in every country, in every year, by every possible cause of death. The figures for 2016 were released this fall. As in previous years, the data paint a fairly rosy picture for much of the world, with deaths due to gun violence rare even in many countries that are extremely poor — such as Bangladesh and Laos, which saw 0.16 deaths and 0.13 deaths respectively per 100,000 people.

Prosperous Asian countries such as Singapore and Japan boast the absolute lowest rates, though the United Kingdom and Germany are in almost as good shape.”

With the exception of one or two countries up there, most of those countries are thriving democracies. Japan, for example, has been at peace since the end of World War II. Germany has also been at peace, even after a tense period during the Cold War and in its military interventions/adventures with NATO, the United Nations and the United States. Singapore is a city-state of phenomenal wealth.

Let’s face it, though. Guns are not going away from the American landscape any time soon. They’re too entrenched into the fabric of American culture. There’s an Amendment in the US Constitution that speaks specifically to firearms. Enough people in political leadership positions are convinced that guns are the only thing standing in the way of a tyrant taking complete control of the United States and making slaves of us all. It’s not the rule of law. It’s not the respect of institutions. It’s not economic prosperity.

Nope… It’s the guns, right?

So what do we in public health do? How do we reduce the number of deaths and injuries from firearms? There’s about one answer for every researcher working on this. One researcher may be working on using injury prevention methods. Another is working on a communications program. Others are working on legislation advocacy. Some want to make guns safer, smarter, only to be used by properly trained people and only at an appropriate time. Etcetera.

We can draw from past examples on how some “tool” that caused excess death could not be completely done away with, such as motor vehicles. Instead of outlawing cars and trucks when traffic deaths reached into the 50,000 range in the 1960s and 1970s, public health and consumer safety advocates got to work on making cars safer. That brought us seat belts, air bags, anti-lock brakes, reinforced cabins, and crumple zones. (Lately, traffic fatalities have creeped up into that same range again, but the United States has about 100 million more residents than it did in 1979.)

Each time there is an air traffic incident or accident in the United States or involving a US-made aircraft, the National Transportation Safety Board (NTSB) conducts a detailed analysis of each incident. Experts in the different fields associated with aeronautics take a look at every aspect of the incident/accident. Almost every inch of the aircraft that is recovered is looked at. Lessons learned are then passed on to aircraft manufacturers, pilots, and the public. Because of this system, the United States had zero deaths from a commercial airplane mishap in 2017. No one outlawed planes or made air travel unattainable. Engineers and other scientists made planes safer, pilots smarter. Better messaging was given to passengers so they know what to do in an emergency. (Just look at how The Miracle on the Hudson worked out.)

But that’s cars and airplanes. What about homicides and suicides? Admittedly, they’re a little more complicated. The root cause of those two forms of violence are not manufactured in a plant where we can go see if the quality control broke down. There are no replaceable parts in the human condition that will correct what is going or might go wrong. People kill people for all sorts of reasons like money, power, misunderstandings, jealousy, accidentally, or because someone tried to kill them first. Likewise, people decide to end their lives for all sorts of different reasons as well.

Nevertheless, can we use the techniques and the science that make things safer to make guns safer. We can also use the science and understanding of the human condition to prevent homicides and suicides. And we can use evidence and science-based techniques to prevent violence in general. Imagine as well if we used the NTSB approach to each homicide and/or suicide incident. Imagine if we used a wide variety of experts to analyze these incidents and give feedback and recommendations. Could we achieve a similar level of success with firearms as we did with cars and airplanes?

I think we could… I think we could address gun violence, be it a symptom of an excess number of guns per person and a culture that reveres anything to do with them, or be it the disease itself. After all, Australia did it to the point that the entire continent-nation has as many homicides per year as Baltimore alone does:

“In 2011, David Hemenway, director of the Harvard Injury Control Research Center, co-authored a paper that reviewed the available studies, as of 2011, on the effect of Australia’s buyback program on firearm deaths. He wrote that “many studies … found strong evidence for a beneficial effect of the law.”

Hemenway and his Harvard colleague and co-author, Mary Vriniotis, summarized the evidence in support of the theory that the buyback program saved lives:

“While 13 gun massacres (the killing of 4 or more people at one time) occurred in Australia in the 18 years before the NFA, resulting in more than one hundred deaths, in the 14 following years (and up to the present), there were no gun massacres.”
“In the seven years before the NFA (1989-1995), the average annual firearm suicide death rate per 100,000 was 2.6 (with a yearly range of 2.2 to 2.9); in the seven years after the buyback was fully implemented (1998-2004), the average annual firearm suicide rate was 1.1 (yearly range 0.8 to 1.4).”
“In the seven years before the NFA, the average annual firearm homicide rate per 100,000 was .43 (range .27 to .60) while for the seven years post NFA, the average annual firearm homicide rate was .25 (range .16 to .33).”
“[T]he drop in firearm deaths was largest among the type of firearms most affected by the buyback.”
The authors, however, noted that “no study has explained why gun deaths were falling, or why they might be expected to continue to fall.” That poses difficulty in trying to definitively determine the impact of the law, they write.

“Whether or not one wants to attribute the effects as being due to the law, everyone should be pleased with what happened in Australia after the NFA — the elimination of firearm massacres (at least up to the present) and an immediate, and continuing, reduction in firearm suicide and firearm homicide,” the authors write.”

It’s going to be tough. People are going to oppose this left and right. Lobbying firms are going to be given a lot of money to pass on to legislators about this. And the change will be gradual, perhaps going beyond my lifetime. But it can be done.

It must be done.