Public Health Arguments for Gun Control
An excerpt from "Guns Are Not Our God! The NRA Is Not Our Church!"
Posted Mar 20, 2018
The public health rationale for gun control is clear
States with higher percentages of households owning guns tend to have higher gun fatality rates.1 Gun regulations that aim at restricting and reducing gun ownership reduce firearm suicide rates. Anestis, Anestis and Butterworth studied2 suicide rate changes in 2013 and 2014 in all 50 states and the District of Columbia, comparing the rates in states with and without specific laws (mandatory waiting periods, universal background checks, open carry restrictions and gun lock requirements). They found significant difference in suicide rate changes in states with mandatory waiting periods and universal background checks relative to states without these laws. No changes were observed in states with open carry restrictions and gun lock requirements. They conclude that laws aimed at reducing gun ownership were the most effective at preventing firearm suicides. Of note, people denied guns do not typically then find other means of harming themselves. Suicide rates go down when gun ownership and storage is more regulated. Kposowa et al similarly found3 that higher gun ownership increased suicide risk, but loaded and unlocked guns in the home were an even more powerful risk factor. Guns are a suicide magnet, and gun regulations and safe storage make a big difference.
Fleegler et al came to similar conclusions about firearm laws and overall fatalities, both suicides and homicides.4 They looked at all 50 states over four years, dividing the states into quartiles based on their gun regulations. The quartile with the most regulations had the lowest gun homicide and suicide rates, and the states with the least regulations had the highest gun homicide and suicide rates. However, the authors could not conclude the link was a direct cause and effect. There could be other factors working in these states, for example different levels of gun ownership or different attitutes towards guns, which both make it more difficult to pass gun laws and more likely that guns will be used. Still, working towards stronger gun laws would be helpful, and could clarify these other factors.
Kalesan et al looked5 at 25 firearm laws across the United States, and analyzed their correlation with firearm mortalities. They found that the three laws most significantly associated with reduced mortality were universal background checks for guns, background checks for ammunition and requiring firearm identification by microstamping or ballistic fingerprinting. While their analysis of the magnitude of the effect is complicated and to some, controversial, they estimate that these laws could reduce firearm fatalities by 90%. They also found that so-called “stand your ground” laws were associated with increased mortality rates.
Gun ownership increases risk of fatalities, and families with risk factors for suicide and homicide are modestly more likely to own guns.6 Parents with depression, who binge drink or use illicit drugs are more likely to have or acquire guns. This puts them and their children at risk. The mental health system might play a role in treating the risk factors, or screening for firearms in these homes, but this makes the regulations described by the above authors, like waiting periods and background checks, all the more salient.
In addition to gun control legislation and reducing the number of firearms on the street, there may be other ways to cut gun violence. Public health experts have looked at how gun violence spreads as social contagion, through a network of individuals embedded in the same relationships, activities and environment, thus sharing risk factors. A preventive approach might be akin to contact tracing used in disease outbreaks.7 We could also encourage the media not to cover shootings in sensationalistic ways that inspire copycats.8
The American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, and American Congress of Obstetricians and Gynecologists, representing a total of 450,000 physicians, have all called for governmental action on the epidemic of gun violence.9Rationally, gun control makes sense. But instead, those who support gun ownership usually throw the first stones at those with mental health problems.
1. Kristof N. How to reduce shootings. New York Times, updated February 20, 2018. https://www.nytimes.com/interactive/2017/11/06/opinion/how-to-reduce-shootings.html accessed 2/19/18
2. Anestis MD, Anestis JC, Butterworth SE. Handgun legislation and changes in statewide overall suicide rates. Am J Public Health. 2017;107:579-581
3. Kposowa A, Hamilton D, Want K. Impact of firearm availability and gun regulation on state suicide rates. Suicide Life Threat Behav. 2016 Dec;46(6):678-696
4. Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013;173(9):732-740
5. Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet 2016;387:1847-55
6. Ladapo JA, Elliott MN, Kanouse DE, et al. Firearm ownership and acquisition among parents with risk factors for self-harm or other violence. Acad Pediatrics 2016;16:742-749
7. Green B, Horel T, Papachristos AV. Modeling contagion through social networks to explain and predict gunshot violence in Chicago, 2006 to 2014. JAMA Intern Med. 2017;177(3)326-333
8. Meindl JN, Ivy JW. Mass shootings: the role of the media in promoting generalized imitation. Am J Pub Health. 2017;107:368-370 doi:10.2105/AJPH.2016.303611
9. America’s frontline physicians call on government to act on the public health epidemic of gun violence. February 16, 2018 https://www.psychiatry.org/newsroom/news-releases/america-s-frontline-physicians-call-on-government-to-act-on-the-public-health-epidemic-of-gun-violence accessed 2/28/18