If there is one argument which has carried gun violence prevention (GVP) efforts forward over the last twenty years, it is the idea that the USA is not necessarily more violent than other advanced countries, but that our violence results in a much higher mortality rate because of our access to guns. The connection between guns and mortality rates was first noticed by Frank Zimring back in the 1970’s, it was validated by our friend David Hemenway in 2004, findings which Hemenway updated in an extensive article published last year.

Updating the data, Hemenway and the co-author Erin Grinshteyn concluded that, “Violent death is a serious problem in the United States.” Why? Because of our “enormous firearm problem compared with other high-income countries, with higher rates of homicide and firearm-related suicide.” And these conclusions continue to find their way into the literature, the public-policy strategies and the fundraising campaigns of every GVP organizations, all of whom shape their messaging based on gun-violence research by scholars in public health.

There’s only one little problem, however, and the problem arises from something known as the ‘substitution effect.’ What this means in plain English is that comparing outcomes from different types of violent behavior forces us to assume that if the way in which the violence was committed was the same, the outcomes would be similar as well. For example, the latest research on guns and suicide states that access to guns increases the suicide rate. Therefore, if 1 out of 10 people who used guns to commit suicides had chosen instead to end their lives by cutting themselves or taking pills, there would have been 1,900 less suicide deaths. But what if suicidal individuals chose hanging or asphyxiation (where successful suicides run above 60%) instead of slashing themselves or swallowing medicines, the latter behaviors being much more a symptom of distress than a determined suicide attempt? Since we cannot answer such a question with any degree of certainty, how can we figure out the real effect on suicide rates if there were no access to guns? In fact, the number of non-firearm suicides in both gun-rich and gun-poor states is exactly the same.

The issue of substituting gun violence for overall violence becomes even more problematic when we consider homicides with or without the use of guns. Grinshteyn and Hemenway find that the US gun-homicide rate is 3.6 compared to Germany, Hungary and Spain at 0.1, Australia, Austria, France and Netherlands at 0.2 (comparing to the lowest nation-states in the OECD.) But the disparity between the United States and these other countries for non-gun homicides is substantial as well. The United States rate is 1.7, the average for the former group of OECD countries being 0.8, for the latter being 0.6. In other words, even without using guns, Americans tend to murder each other at a rate which is two to three times higher than what occurs throughout the OECD.

Would the murder differential between the United States and other Western countries disappear if Americans couldn’t get their hands on guns? To the contrary, the differential would probably be greater precisely because of the ‘substitution effect;’ namely, Americans who tried killing other Americans would find a way to accomplish this act without using guns.

I am not trying to ignore the degree to which open access to guns, particularly handguns, creates issues of public safety and public health in the United States which do not exist in any other country within the OECD. Nor am I trying to dismiss or denigrate the efforts of the GVP community to focus public attention and promote sound public policies that would reduce every category of gun injuries, fatal or not. What concerns me are scholarly attempts to understand our elevated rates of gun violence while ignoring our elevated rate of violence with or without the use of guns. To end on a rather hackneyed note: are gun-violence researchers looking at the forest or the trees?