Analysis: Are Guns a Public Health Problem?

Whether to consider deaths and injuries from guns a public health problem, and therefore to bring to bear the statistical tools of epidemiology, has been a substantial controversy since at least the 1990s.

Gun rights attorney Don Kates was the lead author with four professors of biology and medicine of a seminal and influential 1994 law review article, “Guns and Public Health: Epidemic of Violence or Pandemic of Propaganda?” that argued political advocacy for the elimination of guns in society was being advanced under supposedly objective scientific auspices. The Centers for Disease Control (CDC), a federal government agency, they wrote, was taking the lead on a 1979 plan to reduce by 25% the number of guns in private hands by 2000. But “the objective has broadened so that it now includes banning and confiscation of all handguns, restrictive licensing of owners of other firearms, and eventual elimination of firearms from American life, excepting (perhaps) only a small elite of extremely wealthy collectors, hunters or target shooters.” This article was a principal factor in a ban enacted by Congress in 1996 that “none of the funds made available for injury prevention and control at the [CDC] may be used to advocate or promote gun control,” a ban eventually extended to the National Institutes of Health (NIH) and most other federal agencies. These funding bans have been repeatedly criticized by the medical community; a “Viewpoint” (op-ed) in the Journal of the American Medical Associaion (JAMA) in 2013 was explicitly titled “Silencing the Science on Gun Research” and an editorial was published in JAMA as recently as November, “Firearm-Related Injury and Death: A US Health Care Crisis in Need of Health Care Professionals.”

There is widespread confusion and misunderstanding of the scope of the issue. Statistical website FiveThirtyEight attempted an analysis that began, appropriately, with trying to define terminology and pull together numerous disparate sources. A sense of the difficulty is conveyed by their sourcing the CDC for causes of death except police shootings of civilians because, the website concludes, the CDC is “unreliable” on this and therefore data is instead drawn from non-governmental sources, and also for police officers killed in the line of duty, the data for which is drawn from the FBI. Data on “mass shootings” come from Mother Jones magazine, which (following federal government criteria) changed their definition from at least four people killed (excluding the shooter) before 2013 to three afterward. Terrorism data comes from the University of Maryland. Population data comes from the University of Minnesota, which differs from the federal census.

People often assume that high-profile incidents such as mass shootings and terrorism are a big part of gun deaths, but statistically they simply are not. Despite the publicity they engender, the total number of mass shootings in the Mother Jones database from 1982 to 2017 is 95 incidents. (It’s easy to find completely wrong factual assertions on the web, such as the claim of “a horrifying 42 mass shootings in 2015,” but that’s the death toll rather than the number of incidents, and it includes, for example, 14 people killed by a municipal employee in San Bernardino who became a radicalized Islamist terrorist.) Such deaths are horrific, of course, but statistically in a country of more than 320 million people the risk of being killed in a mass shooting is roughly comparable to being killed by a lightning strike, as I pointed out previously, and the risk of being killed by a terrorist act (excluding the 9/11 attacks, which are more properly regarded as an act of war) is roughly 10 times lower than being killed by a lightning strike. Mass shootings and terrorism are both so rare, statistically, that any attempt to prevent them by prospective detention, for example, would inevitably result in orders of magnitude more false positives than real offenders, a grave deprivation of basic civil liberties.

Such misunderstandings motivate a lot of fundamentally wrong-headed policy proposals, such as “assault weapons” bans. Aside from the problem of defining the term – the federal ban in effect from 1994 to 2004 focused on purely cosmetic aspects of rifles, since hunting requires more rather than less powerful ammunition compared to military weapons, a consequence of deer being much more massive than humans – a post-ban study found little evidence of a reduction in crime, mainly because the class of weapons affected are used in fewer than 2% of crimes in the first place.

What the numbers really tell us is that gun deaths are a symptom of the larger problem of suicide: About two-thirds of gun deaths are intentional suicides. There is an argument to be made that availability of guns plays some role in the suicide rate, just as the replacement of coal gas ovens with natural gas ovens made suicide much harder, as a 1976 study in Britain found. The problem is that everyone understands that banning ovens is a ridiculous way to deal with suicide.

One way to look at the effect of guns on suicide, and therefore on the likely effect of banning guns as a means of preventing suicide, is to compare the United States with other countries. According to data from the World Health Organization (WHO), the US age-adjusted suicide rate of 12.6 per 100,000 population ranks about the middle among nations, although reporting differences including legal and social stigma make such comparisons problematic. Many nations with relatively strict prohibitions against private gun ownership have significantly worse suicide rates, including Sweden (12.7), Finland (14.2), Japan (15.4), Belgium (16.1) and South Korea (24.1).

Of course, a significant number of gun deaths are homicides rather than suicides, but statistically it is important to remember that the number of gun suicides is more than double the number of gun homicides. As Kates et al. wrote, “The problem is that it simply is not true that previously law abiding citizens commit most murders or many murders or virtually any murders. Thus, disarming them would not, and could not, eliminate most, many or virtually any murders. Homicide studies show that murderers tend not to be ordinary law-abiding citizens, but rather extreme aberrants. The great majority of murderers have life histories of violence, felony records and substance abuse.”

But as homicide is decreasing, it is suicide that is increasing: As The New York Times explained in 2013 (“Suicide Rates Rise Sharply in U.S.“), “From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly 30%, to 17.6 deaths per 100,000 people, up from 13.7… The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000. The most pronounced increases were seen among men in their 50s, a group in which suicide rates jumped by nearly 50%, to about 30 per 100,000. For women, the largest increase was seen in those ages 60 to 64, among whom rates increased by nearly 60%, to 7.0 per 100,000.” And, The Times noted, although most suicides are committed using firearms, poisoning and hanging are increasing in frequency much faster.

Legitimate, well-informed debate about gun policy cannot and should not focus on statistical abnormalities such as mass shootings and terrorism, which are far more rare than most people believe because of the sensational publicity associated with them. Nor would rational gun policy address itself to rarely encountered “assault weapons.” Real reduction in gun deaths can only result from more effective mental health treatment and intervention to prevent suicide.

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