Do We Suffer From Gun Violence Or From Violence Itself?

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.

 

hemenway

David Hemenway

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?

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What Types Of Guns Are The Most Lethal? Depends On How They’re Used.

One of the major gaps in public health gun research has just been filled with an article that details the kinds of guns that are used in gun violence of all kinds, in particular the slightly less than 80,000 who ended up in a hospital emergency room with some type of gun wound. The study was conducted by researchers and surgeons connected to Johns Hopkins University Hospital, and covered a representative national sample of all ER gun-injury admissions from 2006 to 2014.

ER             The importance of knowing what type of gun was used to inflict that violence shouldn’t be underestimated for the simple reason that regulating gun ownership with more than 300 million guns floating around can be a fairly costly dead end.  Right now the guy who walks into my gun shop and buys a bolt-action hunting rifle which holds 4-5 cartridges has to jump through the same legal hoops as the guy who walks in and buys a Glock 17 which holds 16 or 17 high-powered rounds.  And the idea that any gun which changes hands without a background check could be a greater threat to public safety flies in the face of how we usually think about the lethality of guns.  But thanks to the researchers at Hopkins, for the first time we can make the connection between what kinds of guns are involved in different types of gun violence and perhaps craft policies that better reflect what types of guns need to be controlled.

Along with figuring out what types of guns are used for different types of gun violence events, the researchers also put together some interesting data on the demographics of individuals who are injured with a gun. Interestingly, the age cohorts for persons sustaining gun injuries showed a similar pattern for accidents, suicides and assaults; i.e., in all three categories, victims ages 18-29 appeared most frequently, whereas I would have thought that gun suicide attempts were higher as the patient age went up.  We have always known that young men are most vulnerable when it comes to guns and assaults, but their vulnerability to gun violence evidently extends to suicide as well.

The most important takeaway from this research effort, however, is the finding that different types of guns figure prominently in different types of injuries.  When someone ends up in the ER as the result of a handgun wound, there’s better than a 50-50 chance that the shooting was an intentional assault. If the wound was from a shotgun, the chances were 4 out of 10 that it was an assault but intentional injuries from AR-style rifles were 3 out of 10. What was the weapon responsible for most unintentional injuries? A standard hunting rifle, figuring in more than 7 out of 10 accidents, followed by AR rifles at more than 60% of all AR wounds.

But here’s the real issue which needs to be understood.  Of all the patients who came into the ER with a gun wound from which they were suffering but were still alive, only suicide claimed more than 10% of those victims; for everyone else getting to the ER alive with a gun wound meant at least a 9 out of 10 chance of being saved.  What is the type of weapon which suicide victims are more than likely to choose?  Turns out that more suicides are attempted with hunting rifles than with anything else!

This is a very serious finding and one that needs more serious discussion in order to be better understood. Because in thinking about gun violence, we usually consider hunting accidents to be nothing more than the fact that in order to hunt you usually have to use a gun. No different than using a parachute to do skydiving and maybe the chute fails to open up. But if gun suicides are 2/3 of all gun fatalities and the weapon of choice is a bolt-action rifle which only holds 4-5 rounds, is any kind of gun less lethal than any other kind?

Kudos to Ladd Everitt for alerting us to this study.

 

Do Strategies For Reducing Gun Violence Really Work?

One of the enduring myths in the gun world is the idea that injuries occur when guns are used either by people whose behavior indicates they shouldn’t have access to guns or by people who use guns in unsafe ways. And what these two myths have spawned over the last twenty years is an approach to reducing gun violence which I don’t believe really works.  These two gun violence prevention (GVP) strategies, which have been supported by the work of public health research, can be summarized as the ‘wrong hands’ strategy for intentional gun injuries and the ‘safe guns’ strategy for accidents caused by guns.

gun control             More than 100,000 fatal and non-fatal intentional injuries each year are caused, so it is said, by guns falling into the ‘wrong hands.’ This is certainly true for 20,000+ gun suicides, which in this case the wrong hands belong to people who are under mental stress. It is also claimed to be true for people who commit 11,000+ gun homicides, because their legal/personal/family histories contain red flags for violent behavior so they shouldn’t be able to get their hands on guns. And as for the guys who commit 65,000+ aggravated gun assaults each year, they are no different from the gun murderers, except they didn’t shoot straight. What’s the best way to keep guns out of the ‘wrong hands?’ Make it more difficult for such folks to get access to guns through more background checks and better monitoring by mental health.

When it comes to 15,000+ fatal and non-fatal unintentional injuries, the problem here is not caused by ‘wrong hands,’ but by ‘right hands’ who don’t know how to safely use their guns. So what we need to do here is teach these right-handed people how to use guns in safe ways, remind them to always lock up their guns and maybe at some time in the distant future (don’t hold your collective breaths) we will have guns which won’t be able to be used at all until the rightful owner puts on some kind of bracelet which sends a radio signal to the gun and you can fill in the rest of this dream.

I’m going to say something which I hope won’t be taken the wrong way, because when it comes to reducing violence, the fact that a particular strategy or program hasn’t worked as well as we would like it to work doesn’t mean it shouldn’t be followed at all. I’m not here to advocate throwing out the baby with the bath water; I just think that GVP needs to be more realistic as we move ahead.

The reason the ‘wrong hands’ and ‘safe gun’ strategies haven’t yet gotten us where we want to go is because they are built on assumptions and experiences involving safety measures for other consumer products which in the case of guns simply do not ring true. Want to reduce injuries from car accidents? Design a safer car, mandate seat belts, get tough on DUI, we all know the drill. Want to prevent people from cracking their heads open when they fall off a bike? Require helmets, that’s all you need to do.

Those public health success stories are all fine and well but they shouldn’t serve as templates for reducing gun violence for the simple reason that autos and bicycles were designed for the purpose of moving us from here to there. On the other hand, guns are designed to do one thing and one thing only, and that is to cause an injury when someone points a gun at themselves or someone else and the gun goes – bam!

Until and unless we figure out how to make it more difficult for anyone to pick up something as lethal as a gun, to quote the great writer Walter Mosley, ‘walk around with a gun and it will go off, sooner or later.’ And when the gun goes off, no amount of research on the causes of gun violence will keep someone from getting hurt.

Another State Wants At-Risk Gun Owners To Protect Themselves From Their Guns.

Last week I wrote about a bill in the Oregon legislature that would allow family members to petition a court for removal of guns in cases where a gun owner was an immediate risk to himself or someone else.  The bill, known as a measure to be used only in instances of ‘extreme risk,’ would require the gun owner to surrender his firearms for up to one year, but the gun owner could also appear in court and present evidence that his access to guns no longer represented a risk to himself or anyone else.

gun-suicide             The Oregon initiative follows the adoption of a similar law in California, which allows family members to ask for a restraining order on access to guns. But this week the virus seems to be spreading to the other coast, because a similar measure has just been introduced in the Massachusetts House, and it appears to have enough sponsors to be taken seriously when and if the Massachusetts legislature stops arguing over the annual budget.

I learned about the Massachusetts law because of an email I received from my friends at the NRA, which linked to a statement about the law by the NRA-ILA.  According to America’s oldest civil rights organization, the Massachusetts law, if enacted, would “result in the immediate suspension and surrender of any license to carry firearms and firearms identification card which the respondent may hold.  The respondent would also be required to surrender all firearms and ammunition.” The NRA then goes on to repeat the usual canard about how such an order would be issued based on ‘little, if any real evidence,’ but that’s simply not true.

But the best part of the NRA’s attempt to explain Constitutional law to its membership is the sentence which reads: “Constitutional rights are generally restricted only upon conviction of a felony.”  Did the legal geniuses at Fairfax ever hear of something called ‘prior restraint?’ The rights enumerated in the Constitution are all subject to ‘reasonable’ restrictions imposed by governmental authority, as long as those restrictions meet basic tests regarding the intent and result of what government intends to do. Such restrictions are even explicitly stated in the landmark Heller decision, which states that “Like most rights, the right secured by the Second Amendment is not unlimited, and “nothing in our opinion should be taken to cast doubt on longstanding prohibitions on the possession of firearms by felons and the mentally ill.”

Which is exactly what these ‘extreme risk’ laws are designed to do, namely, keep guns out of the hands of individuals who have shown a disregard for the traditional rules of behavior under which we all live. Sorry, but telling someone that you are depressed to the point of wanting to commit suicide isn’t just an idle threat. Ditto stalking or threatening someone who told you to leave them alone. The Constitution doesn’t enshrine such behavior and such behavior becomes a much greater threat when it might involve a gun.

But remember who we are dealing with here, namely, an organization which increasingly promotes the idea that there should be no restrictions of any kind on the ownership or use of guns. Believe it or not, I would have no problem with the NRA or any other pro-gun advocacy group if they would just drop the nonsense about how guns aren’t really dangerous because we can use them to protect us from crime.  If the NRA would admit the truth, namely, that guns are extremely lethal and that access to a gun increases risk, I would fold up this website immediately, stick my guns, my wife and my cats in the Subaru and take off to a trailer park in the Florida Keys.

The fact that something is dangerous doesn’t mean it shouldn’t be owned. I know a guy who keeps rattlesnakes but treats them with extreme caution and care.  Are we asking too much of my gun-owning friends to behave the same way with their guns?

Some Suggestions For A Gun Violence Prevention Strategy In The Age Of Trump.

gun-violence           Now that the dust is slowly beginning to settle and the smoke slowly beginning to clear, Gun-sense Nation has to sit down and come up with a workable plan to drive the issue of gun violence prevention in the Age of Trump.  Because at least for the next couple of years, until he really screws things up and/or everyone gets sick of his noise, the organizations and individuals committed to ending the senseless behavior that kills or injures 120,000 Americans ever year are going to have to figure out how and what to do with the lunatics in charge.  So while I’m not suggesting that what follows should be adopted as an agenda by the gun violence prevention (GVP) community, I do hope that at least some of these ideas will at least be discussed as plans for the future of GVP begin to take shape.

  1. There must be a dedicated and serious effort to prevent Gun-nut Nation from achieving its most fervent goal, namely, a national concealed-carry law that will be valid in all 50 states. And I am opposed to national CCW not because it would necessarily increase gun violence, but because it would make walking around with a gun just as normal and mainstream as driving a car.  Which would lead to even less restrictions on the ownership and use of guns.
  2. States and individual communities should be encouraged to more strictly regulate the most lethal guns. A town north of Chicago – Highland Park – banned the ownership of AR-style rifles by town residents following Sandy Hook and the ban was upheld. The Attorney General in Massachusetts banned purchases of black guns in the Bay State which unleased a spate of lawsuits that will probably end up in the trash.  Let’s remember that the 2nd Amendment protects private ownership of guns but doesn’t say anything about purchasing a particular type of gun.
  3. Gun buyback programs work. The buyback program in Worcester, MA, has taken more than 2,500 guns off the streets of Worcester and surrounding towns at an average cost of $60 a gun.  Let’s increase the buyback tariff to $150 a gun and see if 20 cities with high levels of gun-violence could pull 500 guns of the streets of each city every year.  So it would cost $1.5 million to reduce the gun arsenal by 10,000 guns – that’s chump change for someone like Bill Gates or Warren Buffet or (God forbid) the Clinton Foundation to pony up for collecting a really big pile of guns.
  4. Start pestering school districts to mandate gun violence instruction in the primary grades. Guns don’t show up in high school; they first start appearing in the middle-school years.  Massachusetts mandated an anti-violence curriculum several years ago but confined the instruction to lessons about bullying after several unfortunate student suicides took place.  Shouldn’t they also have added a module on violence cause by guns?
  5. Don’t stop talking about gun violence – no public forum is out of bounds. Public discussions about gun violence used to be of the moment, provoked by this mass shooting or that.  The GVP community has gone far beyond rallying around the issue only when something dreadful takes place.  But keeping the dialog going and increasing its volume is not something that should only occur in response to specific events.  It should go on all the time.

Note that I did not mention the ‘usual GVP suspects’ like universal background checks or tightening up taking guns away in at-risk situations like suicide or domestic disputes.  I didn’t mention these issues because there is enough momentum behind them now to sustain such strategies even when the chances for success are less positive than they were before.  I just wanted to throw a few more items on the table because we need to attack this issue from as many different perspectives as we can, and let’s not forget that the next election is now less than two years’ away.

Center For American Progress Has Issued An Absolutely ‘Must Read’ Report On Gun Violence.

Our good friends at the Center for American Progress (CAP) have published a new study on the link between gun laws and gun violence which is a ‘must-read’ for everyone who is concerned about reducing gun violence.  Which means that nobody in Gun-nut Nation needs to read this report because Gun-nut Nation doesn’t believe that we need to regulate guns at all.  But notwithstanding the dwindling Trump supporters, for those who support the concept of reasonable discourse based on at least some attention to facts, the CAP report is a significant effort to figure out (I’m now quoting the report) “whether strong gun laws are effective at reducing gun violence.”
cap-logo2           What makes this report so important is not the fact that the authors attempt to answer the problem stated above about the effects of strong gun laws on rates of gun violence, but for the first time we have an attempt to connect the effect of gun laws to the totality of gun violence based on data covering 10 different categories of gun violence recorded in every, single state.  This is not the first time that scholars have attempted to link gun violence to the legal environment, the CAP study references the work of my good buddy Eric Fleegler and his colleagues, who found a clear link between gun laws and firearm-related deaths in a 2013 article which you can download here.

But there are two important differences between the Fleegler research and what CAP has now produced: first, the 2013 study only defined gun violence by combining state-level homicide and suicide rates, the CAP study breaks down gun violence into 10 separate categories covering every type of incident where the use of a gun creates physical harm; second, Fleegler’s group analyzed state-level gun law environments using the Brady CenterLaw Center reports from 2012, and it was after 2012 (following Sandy Hook) that many states changed their gun laws, in most cases making the legal environment less restrictive in terms of access to guns. So what we get from this CAP report is not only an updated analysis of the relative strength (and weakness) of gun regulations on a state-by-state basis, we also get a much deeper analysis of the different ways in which gun violence occurs.

And what is the result?  Same old, same old, namely, states with stronger gun laws suffer less gun violence, states with weaker gun laws suffer more.  Gee, what a surprise!  But don’t take my cynicism as in way a criticism of the CAP report. Because if you break gun violence down into its component parts, this at least gives you some leverage in trying to figure out not just whether gun laws work to reduce gun violence, but what kind of new gun laws might be implemented or current laws strengthened to address this issue in states where gun violence rates are simply out of control.

Montana is one of those mountain states which has a very high gun-suicide rate but very few gun homicides. It ranks 9th overall for gun violence, but 3rd for gun suicides and only 36th for gun homicides, which puts it below Massachusetts for gun homicides even though Massachusetts ranks dead last for gun violence overall.

But guess what? Montana goes back up to 16th for IPV female homicides, so gun violence in Montana isn’t just driven by suicides, it’s also a very deadly place for women involved in domestic disputes.  Which means that a safe storage law in Montana might have an effect on suicides, but you can be sure that a law which allowed cops to pull guns away from people engaged in domestics would save some lives in the Big Sky State.

By breaking down gun violence into its component parts, the CAP report gives us a realistic view of what gun violence numbers really mean. Which makes this report an inestimable resource for crafting proper laws.  But isn’t that what we expect from CAP in the areas of their concern?

Does Gun Violence = American Exceptionalism? Sure Does, Particularly In The South.

If you find yourself in a discussion with someone who doesn’t think that gun violence is a problem, just refer them to Jennifer Mascia’s great article in The Trace where she aggregates the data for 2015.  Or better yet, memorize some of her statistics and repeat them to the person with whom you are talking and if he doesn’t admit that we do have a gun violence problem, he can go lay brick.  Because along with some very nifty graphics, Jennifer really does look at a variety of data points that clearly illustrate how far we still have to go to change a gun violence trend that shows little, if any signs of ending soon.

traceBottom line according to Ms. Mascia: 2015 is going to be a “bloody year.” And it’s not ‘mass shootings’ or domestic terrorist attacks that account for all that blood being spilled; it’s the day in, day out random shootings that claim two children every day, fifteen black men every day and more than 50 suicides every day.  No wonder Trump and the other Republican clowns don’t want any more gun laws.  After all, if you make it more difficult for people to get their hands on guns, thus making it more difficult for them to shoot themselves or someone else, you can kiss this particular form of American exceptionalism goodbye, right?

But in looking at the numbers, I’m not so sure that our affinity for gun violence is necessarily an American problem. Because like so many other things, there are some remarkable regional variations in gun violence rates, and when you break the problem down on a regional basis, just as the numbers begin to change, so maybe the discussion about gun violence needs to change as well.

In 2005, according to the CDC, 30,694 Americans were killed by guns.  This number covers every type of gun violence – homicide, suicide, unintentional injury – and it’s probably somewhat less than the real total but the CDC is as close as we can get (although the numbers from the CDC-Wonder database are slightly more accurate).  In 2014 the total was 33,599 and estimates from the GVA folks point towards another increase this year.  In 2005, the Southern census region accounted for 44% of all gun deaths; in 2014 the South accounted for 46%.  The South, incidentally, is the only part of the country in which the percentage of gun deaths is higher than the percentage of the country’s population as a whole.  Further, while the gun violence rate between 2005 and 2014 fell in the Northeast and the West and stayed just about even in the Midwest, in the South it rose by 4%. If gun violence is an exceptional American phenomenon, it’s particularly exceptional in the South.

There is one other category of gun violence which is remarkably exceptional in the South, and that’s when the shooter points the gun at himself.  We can be gender-specific here because 90% of gun suicides are committed by men. And where do most of these events occur?  In the South.  In 2005, the South accounted for 44% of all gun suicides, it rose to 46% in 2014.  Meanwhile, the percentage of gun suicides in every other region has not changed over the last ten years, even though on an overall basis, gun suicides now account for 65% of all suicides, whereas they were 40% of suicides in 2005.

I’m not sure why the South has such a love affair with gun violence, but if the Southern numbers on gun violence were similar to the rest of the country, America’s most exceptional social phenomenon would look very different indeed.  And don’t make the mistake of thinking that the South’s exceptionalism just reflects the disparity in gun violence between Blacks and Whites.  What is the only region of the country where the percentage of Whites killed by guns is higher than the percentage of Americans living in that region as a whole?  Where else?

HAVE A HAPPY AND SAFE HOLIDAY AND IF YOU GO TO A PARTY, PLEASE LEAVE THE GUN AT HOME.