By Melissa and Patrick Finnegan
In the wake of a
number of recent school shootings – including the Marjory Stoneman Douglas High
School shooting in February in Parkdale, Florida – we saw the re-emergence of gun
policy in national headlines and social media. In some ways, developments took a familiar turn; exasperated
members of the public call for better gun regulation while gun-rights advocates
– led by the National Rifle Association – argue that such measures are futile
and infringe on individual rights. In the estimation of the latter, the only
way to protect against school shootings is more armed personnel in schools. The difference this time is that
student survivors from Marjory Stoneman Douglas High School launched a campaign
to reform gun policy that has the potential to become a sustained national
movement.
We believe that this
is the time to have a discussion about gun deaths and public policy,
specifically from the public health perspective. There is a qualitative factor in gun deaths that make them a
public health issue. The purpose
of guns is to kill. Whether it be
in the context of animal hunting or use against another human being, the main
purpose of a gun is to kill efficiently.
How a gun is used is, of course,
integral to the discussion. The
fact remains, however, that even when utilized carefully and responsibly, a gun
is a dangerous instrument, the use of which carries an elevated risk of injury
and death, both to the self and to others.
To understand the
effects of guns on U.S. society, we need to confront some basic truths. Guns are ubiquitous in the U.S. As civilian populations go, U.S.
residents are heavily armed; with 42% of the world’s civilian-owned guns (see chart 2), our rate of ownership far exceeds all other countries in the world, including the runner up, Yemen, which is in
the midst of a brutal civil war. Gun
related deaths average approximately 33,000 a year in the United States. In our home state of Minnesota, 432 people died by guns in 2016, more deaths than were caused by
opioid use (395) or traffic crashes (392). Facts like these make gun deaths a public health concern. While the majority of these deaths are
suicides, the U.S. gun homicide rate still far exceeds any other high-income country (see charts 1 and 6).
Although it may be
tempting to assume that more crime explains our higher homicide rate, it turns
out that U.S. violent crime rates are comparable to that of peer countries; the key difference is that assault in the
U.S. is more fatal because it more
often involves guns. This holds for suicide attempts too (see charts 10-12); guns are far more effective tools of suicide than suffocation, poisoning, cutting, or
other methods. While “guns don’t
kill people, people do” may be a popular slogan, it would be more apt to say
that “guns don’t kill people, but they make it much easier.”
With all of this in
mind, we advocate approaching guns from the standpoint of public health. As a society, we regulate access to
hazardous things for health reasons all the time. If it becomes clear that current regulations are inadequate
in curbing preventable deaths, we attempt to change policy. Take the issue of
opioids: the over-prescription of these drugs has led to widespread
addiction-related deaths. Although
there are laws on the books that restrict access to opioids, these laws have
failed to prevent a public health crisis.
As such, we as a country are now in the midst of a national discussion
of which policies will be most effective in reducing opioid deaths. Many of the proposals on the table involve
restricting how often opioids are prescribed. Opioids have their purpose in medicine, even when used with
circumspection, but they still pose an elevated risk to patients.
In addition, we
restrict an individual’s use of a substance or product if there is a high risk of
harm to the self or others. Take
alcohol and driving for example.
Alcohol use is regulated in our home state of Minnesota (as it is
elsewhere): you have to be a certain age to purchase alcohol and providers (aka,
bartenders) can choose not to serve you if you appear to be inebriated. As a community, we have decided that – in
this instance – limiting an individual’s alcohol consumption is both
appropriate and desirable in the name of public safety.
It would paint an
incomplete picture, however, to only talk about restricting access to opioids
and alcohol without examining the underlying issues that lead to their abuse. Family histories of addiction or mental
illness, as well as poverty and other social determinants of health, are
critical factors to understanding widespread alcohol or opioid abuse. And so it should be when considering
gun policy. Our main point is that
we must have a variety of policy tools at our disposal to address complex public
health problems.
Reducing gun deaths
will require long- and short-term policy solutions, but also cultural change in
how the U.S. public, broadly speaking, views guns. We will briefly list some policy proposals we believe should
be adopted or considered to reduce gun deaths. This list is not exhaustive, nor is it meant to be
definitive. (This is a blog entry,
after all.).
Firstly, we need
good quality research on gun violence to craft good policy in the long term. The Centers for Disease Control was only
recently relieved of a ban on studying the causes of gun deaths. In our home state, Minnesota Statutes,
section 144.05, subdivision 5, prevents the Minnesota Department of Health from
even collecting statistics on gun ownership. Information on gun ownership can help
inform public policy regarding – for example – the safe and secure storage of
firearms, including the separation of ammunition. Additionally, public policy would benefit from deeper
research into the root causes of gun violence, including social determinants,
public attitudes about violence, and mental health concerns. As
such, we advocate (a) the immediate reversal of Minnesota’s research prohibition,
and (b) investment in health-based research on the causes of gun violence.
When discussing
potential policy options, we should also distinguish between homicides and
suicides. In terms of homicide, it
is also useful to separate mass shootings from “ordinary” murders. In the case
of most ordinary murders, the perpetrator and the victim(s) know each
other; material advantage or
interpersonal dispute are the primary motives. Mass shootings, while often involving revenge-based motivations,
are less discriminate. As such,
the tools of each type of homicide are a bit different.
The AR-15 has become
the preferred tool of mass shooters in the U.S. As detailed in Tim Dickinson’s exposé on the AR-15, it was originally a military weapon
designed to kill with maximum effectiveness. Its high-velocity rounds and rapid rate of fire enable it to
kill many people in a very small amount of time, even in its civilian iterations. It is substantially more lethal than a 9mm handgun.
Additionally, its mass marketing in the past decade, coupled with the
2004 expiration of the assault weapons ban, has made it widely available. Bump stocks – which increase the
weapon’s rate of fire – and other customizable options have enabled it to
become an even deadlier weapon. As
such, we advocate the re-institution of
the ban on civilian ownership of the AR-15 and other assault weapons, as well
as the accompanying accessories that increase the lethality of such weapons. President Trump’s executive order to
ban bump stocks seems like a step in the right direction, but it is still unclear if that policy will stick.
To be clear, we do not advocate a total ban on the
possession of all firearms. We do,
however, believe that there should be universal
background checks, as well as stricter permitting, licensing, and storage
regulations. The gun show loophole
is a well-known issue that enables the purchase of guns without a background
check at such events, which makes it easier for persons with criminal records
to legally acquire firearms. According
to recent survey data, most people – including most NRA members – support universal background checks on all gun sales.
A number of studies strongly suggest that robust background and gun storage rules
checks curb intimate partner
killings and accidental child deaths.
In Switzerland, the country with the world’s third highest rate of gun
ownership, persons who wish to purchase personal firearms undergo long background checks.
Owners must be licensed to possess semiautomatic weapons, rifles, and pistols, as well as keep
them unloaded at all times except during immediate use. While Switzerland’s rate of gun deaths
is the highest in Europe, it is still one third of the U.S. rate.
Connected to
background checks and permitting, we also advocate
the further exploration and adoption of Extreme Risk Protection Order policies. These orders, effectively a restraining order for guns, enable the authorities to confiscate the
firearms of persons deemed to be a violence or suicide risk. Such laws should be carefully crafted
to respect due process, of course, but also executable in a timely fashion to
prevent imminent violence.
One issue that gets
brought up time and again after a mass shooting is mental health. One common argument is that a more
robust and accessible mental health system will curb gun violence. When discussing the role of mental
health in gun deaths, it is critical to distinguish between homicides and
suicides. Untreated depression is
one of the main causes of suicide, so enhanced mental healthcare could very
well have a positive effect. If
the ultimate goal of the public health view is to reduce all gun deaths, then
policies that improve access to and the quality of mental healthcare must be a
priority.
In terms of mass
shootings, however, there is little convincing evidence that mental health interventions
would have a positive effect. As Olga Khazan wrote in The Atlantic in
the wake of the Las Vegas shooting last year, “While improving access to
mental health care might help lots of suffering Americans, researchers who
study mass shootings doubt it would do much to curb tragedies like these.
According to their work, the sorts of individuals who commit mass murder often
are either not mentally ill or do not recognize themselves as such. Because
they blame the outside world for their problems, mass murderers would likely
resist therapies that ask them to look inside themselves or to change their
behavior…very little violence is actually caused by mentally ill people.” With
this in mind, we advocate for investment
in the mental healthcare system, with an emphasis on accessibility, especially
for lower-income persons, while acknowledging that this policy intervention
would most likely be effective in lowering suicides rather than homicides. Additionally, it’s important to ensure
that efforts to address mental health in connection with firearms do not maintain
or exacerbate stigmas associated with mental health disorders.
While conventional
mental health services may not prevent mass shootings, fostering a culture of inclusion
and psychological support could prevent many school shootings. As an NPR story on public approaches to school climate notes, “the very kids who bring
weapons to school are more likely to report being bullied or threatened
themselves. They may be fearful of gang violence and feel a need to protect
themselves on the way back and forth to school. Or, they may be individually ostracized and aggrieved.” With this in mind, we advocate evidence-based school policies that stop bullying and
discrimination, as well as establish student trust in school as an abuse-free
environment. We do not support arming teachers or other
school personnel. And we cannot lay this burden on students alone, as the “walk
up” movement has espoused. Victims
of school shootings should not be further victimized by accusations that if
they had only been nicer to their fellow students, this tragedy wouldn’t have
happened. Anti-bullying and anti-discrimination
efforts are important, but cannot solve this problem on their own.
The political feasibility of many of these policy proposals will depend
on a number of factors, including public support and the political mobilization
of reformers. The political forces
that oppose further – or any – regulation on guns have tended to prevail in the
aftermath of previous mass shootings.
We believe in the possibility that, this time, things will be
different. We hope that the
mobilization initiated by the Stoneman Douglas High School survivors continues
to gain momentum. Sustained
engagement by reformers, both in advocacy and electoral politics, could turn
the tide.
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This post represents the opinion of the
authors in their personal capacity and should not be construed as the official
position of any agency, organization, or contractor by which the authors are
presently or have been previously employed.
