Guns and public health

{***Pause/Music***}

{***Noah***}

Coming up on Harvard Chan: This Week in Health…A public health approach to preventing gun violence.

{***David Hemenway Soundbite***}

(The public health approach is a harm reduction approach. And we know there’s gonna be lots of guns for a long time in the United States. So the question is, right now we’re dying with these guns, how can we live with these guns?)

In the wake of the Las Vegas mass shooting we speak to an expert on gun violence about strategies to prevent gun violence—and why it’s time to lift restrictions on federally-funded firearms research.

{***Noah***}

Hello and welcome to Harvard Chan: This Week in Health…It’s Thursday, October 5, 2017.

I’m Noah Leavitt.

Each week on this podcast we talk about public health approaches to addressing a range of issues—from obesity to malaria.

But what does it mean to apply that same public health approach to an issue like gun violence?

That’s the topic we’re covering today in the wake of that horrific mass shooting in Las Vegas on October 1.

Fifty-nine people were killed—and more than 500 injured—making it the deadliest shooting in modern U.S. history.

Shootings like this are happening more frequently, according to David Hemenway, professor of health policy at the Harvard Chan School, and director of the Harvard Injury Control Research Center.

I spoke with Hemenway over the phone—and you’ll from him in a moment.

We spoke about why mass shootings are occurring more frequently—and how Australia took action following a mass shooting in 1996.

He also spoke about the need to lift restrictions on federally-funded gun research—and why doing so is a critical step toward preventing future violence.

Gun policy is also a part of this—and in the second part of the episode, we’ll be re-airing an interview with two of Hemenway’s colleagues—Matthew Miller and Deb Azrael. Earlier this year we spoke with them about new research on background checks in America.

But first—my conversation with Hemenway. I started by asking him what made the Las Vegas shooting so deadly.

{***Hemenway Interview***}

DAVID HEMENWAY: I think the big factor was the weaponry, that this individual was able to fire something like nine rounds per second. The other thing was that nobody really knew what was going on in the sense that he was so far away that they had no idea that there was shooting, where the shooting was coming from, who was doing the shooting, what they could do. And they were all crowded together in an area where there was hardly any place to hide.

NOAH LEAVITT: Are we seeing an increase in the rate of mass shootings in the US? I mean, are they occurring more frequently?

DAVID HEMENWAY: Yes, it certainly seems that way. Now, mass shootings have no precise definition. People use very different definitions– four or more people killed, or six or more people killed, or five or more people shot. And sometimes that includes or doesn’t include the perpetrator. So there’s no precise definition. But however you define mass shootings, they have been increasing in frequency in recent times. And I think there are two possible explanations, and probably both have some validity. First is that I think these shootings are somewhat contagious. They get so much publicity, and the shooter gets so much publicity that it puts ideas into people’s minds that, oh my goodness, this is something that’s possible to do that I could actually do. I think 60 years ago, no one would even– it would not have been on people’s radar that this is something that if I’m going to– if I have a grudge or I’m going to kill myself, that this is something I could do or should do or might do. Secondly, I think because of the improved weaponry that we have much more military-type weapons that have more firepower– can kill more readily– is that past shootings, which would not have made it into the mass-shooting category because not that many people would have died now make it into the mass-shooting category because it’s easy to wound and then kill more people.

NOAH LEAVITT: And when we talk about, like, more broadly about gun violence from a public health perspective, I mean, could you put into perspective for people, I mean, you just kind of touched on, I mean, these shootings do get a lot of media attention. But how do they fit in to the general context of gun violence as a public problem?

DAVID HEMENWAY: So this is just one small part of the problem. I mean, every day in the United States, about 100 people are killed with guns. This includes suicide, homicide, unintentional shootings. Probably over 300 or more people are shot. And so this terrible, terrible tragedy is on the same day where we have Las Vegas, where 50 people are shot and hundreds are wounded. There’s probably more than that in the rest of the country just on a regular basis.

NOAH LEAVITT: And you wrote in this Boston Globe op-ed, and you’ve talked about it extensively before, but this view of addressing gun violence, addressing mass shootings from a public health perspective. What does that mean when we talk about addressing it from a public health perspective?

DAVID HEMENWAY: Yeah. I think a big thing that means is that instead of focusing solely on the perpetrators, you want to figure out, let’s step back and figure out how we can prevent these things from occurring again and again and again. And what kinds of things can we as a society do? And it’s not just law enforcement. And it’s not just gun owners. And it’s not just any group. It’s like the whole society. So we’re talking about what can foundations do? What can the clergy do? What can the media do? What can gun laws do and so forth? And there’s so many things we can do because the public health approach is a harm-reduction approach. And we know that there’s going to be lots of guns for a long time in the United States. And so the question is right now, we’re dying with these guns. How can we– more of us– live with these guns?

NOAH LEAVITT: And so I know one of the examples that you point out– maybe a success story– is Australia, which had this massive gun buyback program after a mass shooting of their own. So for people who are unfamiliar, can you explain what the Australian government did, and then down the line what effect it had?

DAVID HEMENWAY: Yes. Yeah, so about 20 years ago, there was this terrible mass shooting in Tasmania at Port Arthur. And what was really important is that a conservative prime minister stepped up and said, “enough is enough, and we’re going to change this.” And so what they did is they bought back– a mandatory buyback or something like 750,000 of their more lethal weapons. And then they tightened their gun laws in a whole variety of ways. And over the last 20 years– so the 20 years before this, there, I think, had been 13 mass shootings in Australia. And since then, there have been zero mass shootings. So you couldn’t ask for more of a success. The other thing that happened is that both gun homicide and gun suicide have gone way, way down. They’ve been reduced by, I think, more than well over 50% in the last 20 years. So by any measure, it looks like an incredibly successful intervention.

NOAH LEAVITT: Given the current laws in the US, are there any strategies that may be just in certain states, in certain areas that have been shown to work and has been reducing gun violence? What works currently?

NOAH LEAVITT: So it’s really hard to say because our policies aren’t that strong and because crime guns are readily moved from one area to another. But the evidence certainly indicates that stronger gun laws generally do much better than weaker gun laws. Areas where there are strong gun laws typically have fewer guns. And so those areas have many fewer suicides because there’s fewer gun suicides, fewer homicides because there’s fewer gun homicides, and fewer unintentional injuries with guns. The particular laws– the one law that seems to, in some studies, look like it’s been very beneficial is universal background checks. Right now our recent study indicates that about 20% of recent gun acquisitions– that includes inheriting guns and also buying guns– there is no background check at all. So it makes it much too easy for anybody to obtain firearms. And clearly, wrong people obtain firearms all the time.

NOAH LEAVITT: So I know one of the barriers to gun research is this ban on the federal funding of gun research. I mean, can you, I guess, give an argument for why that ban should be lifted and why that ban is such a problem?

DAVID HEMENWAY: Yeah, so in all areas of science, it’s really important to have good data and to have good research. I wrote this book a few years ago about the success stories in injury and violence prevention– 64 documented successes where the world’s been made safer because of good injury prevention policy. And in virtually all those cases, the data were incredibly important. And the research was incredibly important in, one, showing that there was a problem; second, showing just aggregately what could be done about that problem; and third, good evaluation data that show is this really working, or should we change the policies in some way. So data and research are vital. To give just one example, about 20-plus years ago, the data showed that 16-year-olds were at incredibly high risk for motor vehicle deaths compared to 19-year-olds. Like, they were three times the rate of 19-year-olds, 10 times the rate of 40-year-olds. And the data also showed– with analysis, of course, showing that there were two particular times when these 16-year-olds were at the most risk by far. And one was at night, and one was when they were just driving with other teenagers. And so a couple states, following the example of New Zealand, said, all right, let’s let 16-year-olds drive because they need experience in driving. But let’s keep them away from these most dangerous times. And so you had graduated drivers licensing, which says you can drive, but you can’t drive at night. And you can’t drive with only other teenagers. And then the studies– the good data and the good studies– showed that this reduced teenage, 16-year-old deaths by over 30%. And so other states said, oh, look, this is really saving young people. We can do this, too. And so very quickly, all 50 states adopted these laws. And there’s been a substantial reduction in the harm, that 16-year-olds now are much safer than they ever were in terms of driving.

{***Noah***}

That was my conversation with David Hemenway.

And you heard him mention background checks as one way to reduce gun deaths.

Background checks are also one of the few areas in the gun debate where this broad agreement among gun owners and fire-arms experts.

But what are background checks exactly? And how can they work to prevent violence?

We want to re-play a story we did back in January, about a new survey on gun purchases from the Harvard Injury Control Research Center and Northeastern University.

That survey found that more Americans are undergoing background checks when they buy guns—but millions still don’t.

Take a listen.

{***Gun Background Checks Interview***}

NOAH LEAVITT: The survey of more than 1,600 gun owners represents the most comprehensive look at how people in America purchase their firearms. It found that 22% of gun owners said they purchased a gun without a background check. That’s much lower than the previous estimate of 40% from a survey done in 1994.

AMIE MONTEMURRO: When a gun buyer undergoes a background check, their name is checked against a database to see if they meet any criteria that disqualify them from owning a gun, such as a felony conviction or having been committed against their will to a psychiatric facility.

NOAH LEAVITT: We spoke about the findings with Deb Azrael, research director at the Harvard Injury Control Research Center, and Matthew Miller, co-director of the Injury Control Research Center and professor of epidemiology at Northeastern University. Miller explained the key differences between this recent survey and that 1994 survey.

MATTHEW MILLER: Our survey was really the first direct estimate of whether people said that they had a background check when they obtained their most recent gun within the previous two year period. Back in 1994 Phil Cook and Jens Ludwig analyzed a survey that asked a related but different question. The question that was asked in ’94 is whether or not you obtained a gun from a federally-licensed dealer. Although that’s generally interpreted as a proxy for having gotten a background check because it was in fact required when you’re a federally-licensed dealer to do a background check on anyone who is purchasing a gun from you, it wasn’t the same question. The other sort of historical piece of information that is helpful in trying to interpret our findings and whether there’s been a demonstrable shift or not in the percentage of people getting background checks is that in 1994 an electronic system with centralized information went into effect. Now what the ’94 survey did is it asked people about guns they had acquired in ’92 and ’93 before the electronic system went into effect when all you had to do is ask somebody, are you a felon? Are you a lawful possessor of a gun? They could say yes or no, but there wasn’t any vetting beyond that. And so it’s plausible that maybe once this central electronic system went into effect, there was a shift. But the two data points we have, given how poorly gun research is funded in this country, we really only have two data points, one looking in ’94 at ’92 and ’93 and another looking, when we did, in 2015 at 2014, 2013.

NOAH LEAVITT: Miller says the key findings of this survey go beyond that 22% of Americans who are buying a gun without a background check.

AMIE MONTEMURRO: Miller and Azrael say that many gun purchases happen online or in private transfers between two people. And what they found is that in states where there are more stringent regulations on these types of sales, gun buyers were twice as likely to undergo a background check. Here’s Miller again.

MATTHEW MILLER: It’s not that it’s 20% or 22%, but that when you live in a state where laws regulate the private transfer of guns, far more people in fact have background checks. But also sort of just as a further sort of clarification of what that 22% statistic means, it still means millions of people every year are getting guns without background checks, because in this country there are about 50, 55 million people who personally own guns. So 22% of people who acquired the guns in the last two years, which is about 70 million transfers in the last two years, 22% of them don’t have background checks. We’re talking about millions and millions of guns.

AMIE MONTEMURRO: Miller and Azrael say background checks are one area of the gun control debate where there’s actually broad consensus among firearm experts and gun owners.

NOAH LEAVITT: According to a recent New York Times survey, gun experts said that requiring all sellers to run background checks is one of the most effective ways to reduce firearm deaths. And 85% of registered voters surveyed by The Times were also in favor of universal background checks.

AMIE MONTEMURRO: Deb Azrael says that background checks are not a cure-all and won’t eliminate illegal gun markets, but she says there are strong arguments in their favor.

DEB AZRAEL: If a background check makes it marginally more difficult for someone who isn’t qualified to possess a gun to get one, sort of economics would suggest that the price of a gun to someone who isn’t qualified to get one goes up in terms of time or in terms of money and that there will be people sort of theoretically, and probably actually, who are thus deterred from getting a firearm. It’s not as though by instituting background checks you eliminate the possibility that there are illegal gun markets. But I think it does sort of demonstrate federally or at the state level that gun owners have a responsibility, have a communal responsibility to assure that anybody they give a gun to, anybody that they sell a gun to is qualified to possess that gun. It’s sort of a basic, sort of standard obligation if one wants to have a lethal weapon and to pass it on to someone else. To me that’s a significant benefit of these sorts of laws in addition to making it marginally harder for unqualified possessors to get a gun.