Why gun violence is a public health issue
David Hemenway of the Harvard Chan School of Public Health makes an emphatic case for why more research is essential.
While gun violence remains a politically fraught issue in the United States, there are few who would claim that it’s not a public policy problem of some kind. Yet those who go one step further and characterize the issue as a public health problem face considerable blowback.
In an interview conducted just a month after the horrific shootings at Sandy Hook Elementary, Harvard School of Public Health Professor David Hemenway, a research affiliate of the Kennedy School’s Rappaport Institute for Greater Boston, makes an emphatic case for why gun violence needs to be researched through the lens of public health.
Each week on PolicyCast, Host Matt Cadwallader (@mattcad) explores the ways individuals make democracy work by speaking with the world’s leading experts in public policy, media, and international affairs about their experiences confronting our most pressing public problems.
Transcript
Note: This transcript was automatically generated and contains errors.
Matt: [00:00:13] It’s now been more than a month since the shootings at Sandy Hook Elementary. But the issues that the tragedy brought to light namely gun control and mental health issues are still on people’s minds. In your book Private Guns Public Health you offer a public health approach to tackling gun violence in the U.S.. Could you explain what that means.
Prof. Hemenway: [00:00:58] So public health was a late entry I think into this whole area of violence. But public health brings a whole different dimension than sort of criminal justice. And what I would say that it’s hard to explain in 30 seconds. But the focus of. Public health the public health approach is really about prevention. And it’s always about prevention. Some people like to say who’s at fault and often not that precludes prevention what we like to say we don’t care who’s who you want to blame you can blame anybody you on. You can blame the guns you can blame the kids you can blame the mom you can blame society you can blame poverty will care. We don’t want to blame anybody what we want to do is prevent. So you don’t have to blame anybody. Second thing is of course is that we focus on populations who are not that interested in why this particular shooter did what he did or why. So you know Mary is obese. What we really want to understand is why there’s so much death violent death in the United States and why there are so many kids who are who are overweight in the United States and what to do about it. And I think the key element in the public health approach is that you don’t want to focus solely on the last clear chance the final person who did something you want to often go upstream which is where you can have the biggest bang for the buck you can make the biggest difference. And I could talk about that a lot.
Matt: [00:02:26] Well we often hear about these large scale tragedies Sandy Hook Aurora Columbine well before it. But are those the really important things when we’re talking about the same issues.
Prof. Hemenway: [00:02:38] Those are important in themselves, but they are very important in terms of galvanizing activity possibly because in every other developed country when they had these tragedies they stood up and said we’re going to make real changes to try to make a difference. But in terms of the real costs of gun violence in the United States that there is a it’s a minuscule amount. I mean every day in the United States 85 people on average die from guns. And then there’s all this intimidation with guns and robbery with guns and nonfatal accidents and non-fatal shootings with guns. So so this is just the tip of the iceberg. But if it gets people interested and focused on the problem. And what I think it’s important for everyone to understand that compared to every other developed country. So that’s sort of the 26 industrialized democracies the United States is unique in having this huge problem. Nobody else has this size of the problem we have. Every other developed country has similar rates that we have were sort of an average country in terms of crime. We have average crime rates in terms of burglary robbery assault sexual assault gun thefts car theft. We are our kids seem to be very similar to other kids whenever there are studies in terms of things like fighting or bullying where it’s sort of an average country. But we are really different is guns. We have so many more guns than these other developed countries per capita and we have by far the weakest gun laws. And so not surprisingly we have lots lots more gun homicide and homicide overall and just death.
Matt: [00:04:23] So how does that square with a country like say Switzerland where there is a large ownership gun ownership. In fact it’s mandated for men between 20 and 30 in Switzerland.
Prof. Hemenway: [00:04:34] It’s interesting Switzerland has a large military everyone’s trained in the military but those military guns they’re not personal guns. Sometimes you are allowed to take them home if you take them home. You have to keep them locked up with the ammunition separate. If you ever open the ammunition that’s a court martial offense. Switzerland has very as we have the United States has many more private private guns per capita than Switzerland has and Switzerland has by far stronger gun laws than we have indeed. I think most people in the United States and public health would be thrilled to have the type of gun laws in the United States that they currently have in Switzerland.
Matt: [00:05:19] Now you mentioned the large gun ownership that seems to be an impediment to gun control for gun control advocates.
Prof. Hemenway: [00:05:28] Yes and No. I mean I don’t think there’s no question that we’re going to have lots of guns in the United States. And then the question is how are we going to live with his guns. This notion of quote gun control and people hear the words gun control I never used that word because that’s so laden with emotion that people think it’s something about taking guns away. And really what we’re thinking about is gun policy. And let me step back and just to get you to understand the public health approach. A nice analogy to so many successes in public health which is why it’s very exciting area to be in a nice analogy is with cars. So I think we are currently in a situation with guns where we were with cars in the 1950s when I was growing up in the 1950s the car manufacturers in effect not these exact words but said cars don’t kill people people kill people and they presented data showing that 95 percent of car crashes were due to driver error and most car deaths were due to people deliberately breaking a law. So this was actually a law problems. And so what should you do. You ought to focus on the driver. That’s the one who’s causing all the problems right. And so your driver’s ed which turns out not to be that successful enforce the traffic laws and it wasn’t until the 50s that public health physicians asked the different question not who caused the accident but what caused the injury.
[00:06:54] And it was clear that people were being speared by steering columns who went right through their chest because they were collapsible their faces were being lacerated by windshields which were not made of Safety Last. They were leaving the car and heads would hit the cement of the hoods and they would die because there is no seatbelts and no airbags. And sometimes the car ever left the road. There were big trees planted along the sides of the roads and there were the lampposts planted along the sides of road you hit one of these and you die. And public health physicians were saying can’t we do something to make the car safer can’t we do something to make the road safer. Can we have a better emergency medical system. And over the past I’d say 60 years. Cars have gotten incredibly better. Roads have gotten much much better. The system is somewhat better. Nobody thinks drivers are any better we’re better about alcohol we’re much worse about texting about cell phone use about road rage fatalities per mile driven in United States have fallen over 90 percent and it was focusing away from the final user. It doesn’t mean you shouldn’t talk about the final do something but you have to look at other areas. And so that’s really important and the same way we’re going to have lots of cars in the United States. So there are what you eat. There’s lots that we know lots of guns what should we do so instead of currently we’re dying with guns why can’t we figure out how to live with guns like we do with cars.
Matt: [00:08:24] So there have been a lot of regulations in states including in Connecticut that have increased the safety of gun ownership in terms of having to keep Gunnlaugsson on guns keep ammunition start separately. Has that made it different it seems so it’s hard.
Prof. Hemenway: [00:08:40] It’s hard to know what our studies show conclusively is that in states like Connecticut where there are somewhat fewer guns and stronger gun laws there are fewer many fewer accidental gun deaths many fewer suicides because there are so many fewer gun suicides. Guns are the evidence is incredibly strong that a gun in the home is a risk factor for suicide for everybody in the home. You know that the gun owner the spouse the kids and indeed what happened to Sandy Hook was a suicide. And there is evidence that a gun in the home is a risk factor for femicide. And that’s what happened in this case to the woman got killed because of the gun in the home and there’s a lot of evidence the strong evidence that in these states there fewer homicides and it’s not is as huge a difference as as in these other two areas because homicide guns often move and they move from states with weak gun laws allotting guns to states with strong gun laws like Massachusetts and Connecticut. So what would a public health approach says is that you know what could we do about this particular case. A lot of times I don’t like to talk about particular cases because what you want to do is is here’s a good law I will say lots of people to save every person I will and say well it would have saved these people perhaps not. But one of the things that what public health really tries to emphasize is that you can not just change laws but you have to change social norms.
[00:10:18] So for example in the motor vehicle area a key social norms change was about driving when I was young adult. It was illegal to drink and drive. But everybody did it. The social drinking the same ways the legal the speed five miles over the speed limit. Now but everybody you know it’s fine. But suddenly we had that designated driver program we had ideas such as Friends don’t let friends drive drunk. And they made a big difference. Changing social norms whenever. Now there’s a crash people reporters report whether there was alcohol involved they never did that went out. So you get this message over and over and over don’t drink and drive the alternatives you can. One of the many things I would like to see changed is among gun owners. This notion of that you should really help each other and that if somebody is going through a rough patch say that somebody gets divorced there they start drinking more and they start talking crazy as friends don’t let friends drive drunk. You should work together with that person and try to get the gun out of the house for a little while because that person is at high risk for suicide may not be high risk. Three months from now or six months from now. But at this crisis the really high risk. I think if that had been the norm in Sandy Hook the woman would have recognized maybe everybody got their guns out of a house when it’s needed. My son is 20 and he’s not doing well or there are friends who are gun or friends sort have come and said Look this kid you know two years from now he may have a girlfriend and everything will be fine.
[00:11:56] But right now there’s things that I do not see he does that seem right and get the guns out of the house for awhile. That’s all you need to do and I think that actually not only could have saved the suicide which this was and almost all the majority of these horrific shootings are suicides but may have saved all these poor little kids.
Matt: [00:12:16] So the majority of gun violence out there if I understand correctly is committed by people who haven’t gotten the guns through legal means.
Prof. Hemenway: [00:12:25] It depends. I mean it’s it really depends on what you really want to divide things up. So if you’re just talking about gun death it’s mostly suicide and it is almost all legal guns and the guns in the home. If you’re talking about femicide. Most of those are fairly legal gun. We think they’re probably off that usually legal guns where the husband or the lover kills the wife. And if you’re talking about the elderly it’s unclear we haven’t gotten good data on that yet. If you’re talking about. Which is Pawi the majority not all but the majority of homicides then often you’re talking about urban street crime and those guns are typically illegal. And then one of the big questions is which we want to see change the gun a normative change is in Boston where it’s very hard to get guns and it should be hard to get guns because of strong laws on these inner city kids. We’re not born with guns their parents usually didn’t have guns. They can’t get guns by stealing guns because there aren’t many people with guns. Somebody brought in those guns and instead of focusing solely on which kid shot which kid it’s. Where did the gun come from. And you want reporters to start reporting. Every time there’s a shooting. Where did the gun come from. Cause that’s a big issue. That’s the issue. If adults. Do not bring guns in and make money doing that that’s why they’re doing it. These killings.
[00:13:57] You know what you’d have instead is maybe knifings and you have to raise that you know the United States. All the other developed countries as far as we can tell they have gangs they have people who have mental problems. They have people who watch violent video games.
[00:14:17] The only thing that’s different that makes us so different is our guns and our gun policies. And I’d say that these Everton’s differences are norms. It’s not like oh it’s so we for example looking at 5 the 14 year olds. Here’s an age. This is what the you know the kids who were killed in Sandy Hook. These are these are just kids. How are we doing protecting our kids. A child in the United States compared to a child in these other developed countries five the 14 year olds K through 8 is not just like 20 percent more likely to be murdered with a gun are 50 percent more likely are twice as likely 13 times more likely to be murdered than an average kid say and in Belgium or Japan or Italy or Canada the non gun homicide rate is the same. The gun suicide rate in the United States eight times more likely to find his dad’s gun. He just got a bad report card whatever it is kill himself or non gun suicide rate for these kids is the same as the average of all these countries. Ten times more likely that this kid will be unintentionally or unintentionally killed with a gun. The differences are just enormous.
Matt: [00:15:28] So isn’t the Boston case a case that gun rights advocates would use for the fact that people should have access to guns for self-protection.
Prof. Hemenway: [00:15:37] Well the problem is there’s two problems. One is that all the evidence is where there’s more guns there’s there’s there’s more crime and there’s more death. And so if you say OK we have incredibly weak gun laws we make it really easy for anybody to get guns for criminals to get guns. So what we should do is arm everybody. This was sort of the. The notion I remember when there’s hijackings and Archie Bunker solution was let’s arm all the passengers. It’s like this was a joke 51 30 years ago when I was younger and now it’s like this is a potential policy and this is there’s no evidence that this works works at all. I mean I’ve done a lot of work about self defense gun use there’s. I haven’t seen any evidence at all. Note that guns deter anything. And what we know is that most reported self defense gun use is not self-defence gun use at all at least in a real sense what this is escalating arguments people just get angry with each other it’s very hard. You have to realize to use a gun effectively in self-defence. Mostly people who go through life their life and they’ll have no chance to use a gun in self defense. You or I piously all through our lives and we’ll never have a chance to use a gun but we’ll have if we’re armed all the time we have a chance all the time every day to be afraid to be angry to be drunk to be whatever.
[00:17:03] And that’s what seems to happen is that when you have guns around people tend to use them in a way that that’s not good the same way in the Old West. Dodge City. So you had. Cowboys coming in with guns and what could you do. And then sometimes they shoot each other. That’s mostly what they do and that’s what mostly gangs in the inner city they shoot each other and shoot other people they shoot John. So what could you do.
[00:17:28] Well let’s arm all the all the citizens. Or you could do what we did. And what all the other countries do and what we in the United States did is you just had laws that say keep your gun out in the range you come into town don’t bring your guns to town boy. And that’s that’s what tamed the West that wasn’t everybody arming themselves and having shootouts continuously.
Matt: [00:17:51] Representative Howard Coble Republican of North Carolina who said in an interview that he thought talk of gun control was quote probably a rush to judgment. And he said that quote I think it’s more of a mental health problem than a gun problem right now. Do you think that’s valid.
Prof. Hemenway: [00:18:13] I mean again if you look at high gun states versus local states in the United States the Huygens states do not have more mental health problems but they have lots more death. If you look at across the you know across the developed world we don’t have lots more mental health problems is no evidence of that at all. But we have lots lots lots more death and it’s the guns. I mean it’s it’s it’s it’s not a rush to judgment. What it is is that this is an opportunity to do something when we’ve always had this problem and now is a real chance to make a difference now has a real chance to protect our children. And my really feeling is if not now when. When are we ever going to 25 other industrial countries look at us and can understand they say when are you going to protect your own children your children are dying you don’t care about your children. And my feeling really is God forgive us if we don’t do anything. These are our kids. And right now they are dying and it’s not just the kids in Sandy Hook. It’s kids every day in the United States are dying from guns and it’s not happening in any other developed country nearly to this extent it’s happening here. And why are we different. It’s our gun policy.
