Guns: A Public Health Approach

Great Debates
1

Private Guns, Public Health, by David Hemenway of the Harvard School of Public Health. University of Michigan Press. From the publisher’s website: “…reveal(s) the advantages of treating gun violence as a consumer safety and public health problem. David Hemenway fair-mindedly and authoritatively demonstrates how a public-health approach – which emphasizes prevention over punishment, and which has been so successful in reducing the rates of injury and death from infectious disease, car accidents, and tobacco consumption – can be applied to gun violence.”

I saw this author on C-Span’s Book TV. He supplied some interesting history on public health approches. He said that 50 or so years ago, time after time, investigations into what caused a given auto accident would come up with the same thing: driver error. Finally, it occured to people to think, okay, so the cause is usually driver error. But can’t we come up with ways to reduce the harm done; decrease the chances that the people involved in the accident will be killed or seriously injured?

Once they considered the question, they found a number of things that could be done, such as collapsible steering columns and shatterproof windshields. Slowly, gradually, these and other improvements were applied. The public health approach suceeded in reducing the auto accident death toll.

I like his ideas. For some time, I’ve thought that the US’s long running gun debate was counter-productive. Years ago, the anti-gun people decided to go for the all or norhing “quick fix” of banning the things. We’ve spent years arguing about banning guns; we’ve let this arguent distract us from the possibility of reducing the death and injury toll without a ban.

On the program I saw, Hemenway explained all those cases where someone is killed or wounded by a supposedly unloaded gun. It seems that when you take the clip out of an automatic, it’s not completely unloaded: there’s still a bullet in the chamber (apologies if I’m getting the terminology wrong). You read about these incidents where a young teenager finds a gun, can’t resist showing his friends and playing around – and it “goes off” even though they took the clip out. They didn’t understand that it was not completely unloaded. One solution would be to teach kids more about guns, so they’d know this. Another would be to redesign the guns.

I see no chance of guns ever being sucessfully banned. But if they were, what good would it do? It would work about as well as Prohibition did; as well as pre-Roe vs. Wade abortion laws; as well as our current failed, futile war on drugs – that is, not at all. People finding they could not buy guns legally would buy them illegally, from the thriving black market. One already exists. With stricter gun laws, it would expand to meet the increased demand.

We can’t get rid of guns. It’s not possible. Why not quit wasting effort on the attempt and try a publc health approach instead?

2

Erm, didn’t they do a pretty good job of reducing death by guns in Europe, specifically England?

3

My Googling skills are evidently lacking but I don’t believe that this is correct. Remember that events like Dunblane and Hungerford - and Columbine - are aberrations, not the rule. Indeed, I would argue that Dunblane and Hungerford were made worse by there not being an armed citizenry. Had nearby citizens had firearms, they would have been able to engage Hamilton at an early stage or whoever thus saving the lives of some of the children.

4

This is only the case if a round from the magazine has been chambered or a round is deliberately put into the chamber. However, all such negligent discharges can be completely eliminated by following the number one rule of firearms safety:

There is no such thing as an unloaded firearm.

How many? The latest statistics I am aware of from the CDC put the number of accidental firearms deaths somewhere around 1500 per year. More people drown in any given year than die of accidental firearms injuries, and still far more die of other injuries, from mistakes made by doctors, and in automobile accidents (somewhere around 50,000 annually).

The numbers that exist are extrarodinarily low, and have been dropping for at least the last twenty years.

Education is a good solution. Teaching people the cardinal rules of firearms safety and the importance of following them from the time they are small children is a very good idea. Younger kids should be taught not to touch them at all, while older children, teenagers, and adults should remember if nothing else the first two rules.

1.) There is no such thing as an unloaded firearm.
2.) Never point a firearm at anything you do not intend to kill.

As for redesigning guns so that it is impossible to keep a round in the chamber (which is the only way I could see to make sure that all rounds are removed when the magazine is removed), you’d render it fairly useless for police and self defense purposes. Joe Q Badguy is not going to give you the extra time it takes to chamber a round.

The short answer is that people involved with the type of public health you’re talking about are typically very good at epidemiology, but don’t know the first thing about firearms. I don’t go to see my gunsmith about mononucleosis, and I don’t go to see my doctor about replacing worn trigger mechanisms.

Such as I remember of the Edinboro, PA incident in which a citizen retrieved a firearm and subdued the shooter. So effective, in fact, that I don’t recall that one ever making the national news.

You’re right that ‘school shootings’ are isolated incidents, made to seem more prominent by the ‘if it bleeds, it leads’ news media (right wing, left wing, it doesn’t matter, blood gets ratings) in their search for higher Neilsen numbers. Columbine, also, would’ve been a lot worse than it turned out had the Kelbold and Harris’s main idea worked, but they screwed up the bombs.

5

All those cases really don’t add up to being very much. The number of accidental gun deaths in the United States represents a tiny fraction of the firearm related deaths in comparison to homicide and suicide. I don’t see how such a device would help stem the flow of homicides or suicides.

Marc

6

Hazel,

I am not going to get involved in another gun control/rights debate!

And the reason why is the answer to your question.

For years the medical community has been trying to discuss reducing deaths from gun violence as a public health issue, bringing epidemiologic tools to bear in the same manner that they’d analyze AIDS or tb or car accidents. Generally the response of gun control advocates has been to accuse the medical community to be in the pockets of some anti-gun industry and/or political hacks. Simply put, much of that side is very afraid of the slippery slope; they believe that the goal is to remove all guns and any movement is a movement to that end. Anything proposed is part of an agenda to remove their guns. In reality very few are talking about banning guns.

Which is not to say that there are not points to made on the gun rights side of the fence. Specifically, additional controls are unlikely to do much if they are as poorly enforced as the current crop is.

But here goes with the public health approach, my version:

For any disease you must identify the vector of the disease, how it is transmitted to those suspectable to have adverse outcomes from it, and what environmental factors make the disease more rampant.

The vector is mainly handguns; a weapon well designed to be used both in self-defense and in criminal activities. Certainly reducing the total number of handguns available is one public health approach that has been advocated. Redesign of the weapon to make it nonfunctional other than by its legal owner has been played with but such technology is not yet practical.

It gets to those involved in criminal acitivities usually by criminal means. Theft (and many legal gun owners feel no obligation to secure their gun in a non-secure manner). Straw man purchases and illegal resale. Some are bought for criminal purposes in a legal manner. There is room to tighten up enforcement and to do a better job preventing guns from getting into the hands of those with criminal intent. Laws need to be consistent (and consistently enforced) across the states as well: it doesn’t do much good to have good rules/well enforced in one state, when a gun profiteer can go to another state and buy a few dozen cheap handguns with no questions asked, drive them into the first state and resell them them illegally there.

Finally the environment that fosters gun violence. (Think about draining the standing water to get rid of the mosquitos) In this case it is the fire power brought to bear in the drug trade; the power of which has correlated with the Drug War more than any other factor. When the Drug War ramped up the stakes in enforcement (mainly targetting marijauna use) gangs stepped up the battle for the commensurately increased profits (just as did Al Capone and his ilk for alcohol in the Prohibition era) Either win it (an impossibility) or decriminalize all but the hardest drugs. Of course a better economy means fewer gun deaths as well, as there are then other games in town than selling drugs.

7

Haxel: I’m sure you mean well, but Hemenway and his ilk are just another, more subtle variant of the Brady mantra of “blame the gun;” a mental fixation on instrumentality that completely ignores the root causes of violence in American society. But the Loaded Chamber Indicator and mechanisms to keep firearms from discharging without a clip inserted have allready been adopted by several manufacturers (these mechanisms are obviously useless on revolvers).

Many traditionalists (such as myself) feel that these safety measures can, in some cases, lull people into a false sense of “safety” with regards to their firearms and actually make them more dangerous, as they rely upon mechanical safeties to do their thinking for them instead of practicing safety consciousness religiously.

Zagadka: Incorrect. Britain’s death-from-firearms rate was allready quite low before their draconian handgun ban went into effect. It has slowly been trending upward since, mostly, I am given to understand from U.K. Dopers, from organized crime or gang violence. Because it was so low to begin with, even minor changes produce statistically scary sounding numbers.

I mean, if you only have 4 firearm deaths per year in a country of millions, an increase to 5 per year is, technically, a 25% increase. Scary sounding, but probably not indicative of anything meaningful.

As MGibson says, accidental deaths by firearm are a tiny fraction of the total deaths by firearm; the last time I looked up the numbers, suicides by firearm comprise about 60% of firearms deaths [in the United States]. If Dr. Hemenway wants to really reduce firearms deaths, he and his colleagues would address the rampant depression problem and institute effective suicide prevention programs.

8

I saw this presentation too. I thought it was very interesting.

One problem with this approach is that guns are not replaced like cars are. We don’t use a gun for a couple years and then get a new model. There are more guns than people in America. Requiring manufacturers to change guns will not result in enough “safe guns” in circulation to save enough lives to measure.

There is some validity in this argument. However, I have not seen many proposals from this camp which do not amount to preliminary gun bans.

One of the proposals I did like from him was that we should do a better job of compiling statistics on the facts surounding gun deaths. His points about the increase in the number of data points collected regarding car deaths and how this was nationalized makes a lot of sense.

9

You’re thinking of a magazine disconnect, a feature that disconnects the firing mechanism when the magazine is removed. This device has been around for ever.
Many of the Smith & Wesson 5900 seris models have it. It’s nothing new. And it would save very few lives if made mandatory. Screwing around with a loaded gun is going to get someone dead no matter how many safety feature are on it.
Many gun owners don’t want this device on their pistols. I know many police departments particularly do not want the feature on duty weapons. It’s just another thing that can go wrong and prevent firing during a crucial moment.

10

Just rereading my own post. I think a reasonable reader knows what I meant to say, but “Generally the response of gun control advocates has been to accuse the medical community to be in the pockets of some anti-gun industry and/or political hacks.” should have been “gun RIGHTS advocates”; and "Theft (and many legal gun owners feel no obligation to secure their gun in a non-secure manner). " should have been “in a SECURE manner”. Sorry. Please continue. I’ll go away now.

11

Haxel? Uhm, Hazel, I’m sure you know who I meant.

[sub]:slinks off to same corner as DSeid:[/sub]

12

So what happens when someone take a “Public Health Approach” to expanding the search and siezure powers of the police? Or limiting speech? Or outlawing certain religious practices?

Afterall, if it’s proven to be an acceptable rationale for abridging one Right, it works just as well for the others…

13

1010 etc.,

Well, it already does. In each case society looks at the benefits to be garnered by imposing some limit upon citizens’ rights, and balances it off against its cost (which includes the monetary cost, the unintended consequences, and the degree of imposition). Look at the threads on car seatbelts, on marijauna use, and many others. We have limits on speech when safety is involved (no yelling fire, etc). We have justified search and seizure expansion in the name of protecting ourselves from terror. Certain religious practices are not allowed (animal sacrifices and others). It is a question if the benefits are worth the cost is all. Gun rights advocates see little benefit and lots of cost. Gun control advocates see that significant benefits from moderate cost. Some is how they each choose to interpret the data, but more is what value they place on the respective benefits and costs. Where to place the line of balance is what the debate is all about.

14

Church of Lukumi Babalu Aye v. City of Hialeah (1993) struck down a city ordinance outlawing animal sacrifices.

15

Mea culpa. That item was apparently in error. Although the point still stands.

16

And interestingly enough, the court left open the possibility that religious rights could be abridged for secular interests, in some other future circumastance.

17

Oops, sorry! I somehow omitted this URL.

http://www.press.umich.edu/titleDetailDesc.do?id=17530

18

It seems to me that the only thing the anti-gun crowd ever does is work to pass laws forbidding anyone from owning certain types of gun, and forbidding certain people from owning any guns at all. At the same time, all the pro-gun people do is fight to hang on to their right to bear arms.

There are measures we could take to reduce gun-related deaths and injuries. Neither side is working to institute these measures, but both sides would benefit from doing so. (Not to mention the people who would benefit by not being killed or injuried.)

Attn Anti-Gun People: Why are you against the pvt ownership of guns? Because people use guns (usually on purpose but sometimes accidently) to kill and injure other people. If you want to reduce the number of deaths and injuries, why not work to reduce the number of deaths and injuries? An actual ban is a grail that has eluded you for decades – and wouldn’t eliminate deaths and injuires even if you got one. You can’t wave a magic wand and make all guns vanish. They’ll be a black market. Work for a ban if you insist, but why not, at the same time, work to reduce the deaths and injuries?

Attn Pro-Gun Rights People: Yes, the accidental gun deaths and injuries are quite rare. But every time one occurs, the anti crowd shouts it from the rooftops. Why oppose methods of cutting down on these accidents?

The only ideas I can remember from Hemenway’s TV appearence are the magazine disconnect idea (which I aluded to, but could not name) and the keeping good statistics idea (of which pervert has reminded me). My own ideas aren’t as good, but here they are.

I mentioned the scenario where a kid circa age 14 finds a hidden gun, sneaks it out of the house, shows it to his pals. They get to playing around and showing off. Someone winds up dead or injured. Another scenario is, kid who is being bullied finds gun, decides it’s just what he needs to scare off the bully or bullies. He doesn’t intend to actully shoot anyone, but somehow, someone gets shot. I think we need gun safety education in the schools. We need to tell anti-gun parents, yes, okay, you wouldn’t have such a thing in your house – but your neighbors may have guns. The parents of your child’s best friend may have a gun. Your children may encounter guns – for their own protection, they need to know about them. These tragedies could be reduced if all of our kids were taught the basics about guns and gun safety.

Then there are the cases where a very young child finds a gun and does not understand that it’s a real gun; thinks it’s a toy. Well, very young kids can be taught to recognise the poison symbol. They can be taught to call 911. Why can’t they be taught to tell the difference between a real gun and a toy? And to help them, why can’t we have a campaign: don’t buy toy guns that look real. Stick to toy guns that look like toys.

And someone mentioned suicide – yes, by all means, let’s beef up suicide prevention programs. Try to “suicide proof” kids. Provide assistance for depressed people.

19

Like?

That is a rather fallacious argument. We can’t make anything 100% gone, so we can’t make anything illegal?

I don’t know quite where I stand on guns. I don’t quite view a utopia where there is no crime because everyone has a gun to shoot at each other (the vast majority of murders are “crimes of passion” where the victim and the accused know each other well - I don’t quite see how giving everyone F*ING GUNS helps this situation at all). I also think the “if you outlaw guns, then only outlaws will have guns” line is stupid. Citizens - even those with guns - aren’t SUPPOSED to fight crime. The police HATE it when citizens pull out guns and start shooting at each other to “prevent crime” - it only makes the situation more dangerous (and makes the use of deadly force more likely). On the other hand, as you point out above, you can’t get rid of all guns. However, you can regulate the market as much as possible.

20

*I said, “There are measures we could take to reduce gun-related deaths and injuries.”

Zagadka said, “Like?”*

Such as the methods I desribed later on in the post to which you’re replying.
*I said, “Attn Anti-Gun People: … You can’t wave a magic wand and make all guns vanish. They’ll be a black market. Work for a ban if you insist, but why not, at the same time, work to reduce the deaths and injuries?”

Zagadka said, “That is a rather fallacious argument. We can’t make anything 100% gone, so we can’t make anything illegal?”*

My point was this: Outlawing guns cannot be achieved quickly, and in any case will not eliminate gun deaths and gun injuries. So why not devote some of your time and energy to an effort to put into place various public health measures designed to reduce the death and injury toll?