"We are talking about a big public health problem," said Hemenway, author of Private Guns, Public Health. "The issue is, what should we do about it?"

Banning guns is not the answer, he said. Instead, he advocates a public health approach that he says could sharply reduce gun violence–and backs up his assertions with statistical evidence that he and others have collected over the past 10 years.

"In the 1980s, it was decided that injuries were a public health problem, and the Centers for Disease Control and Prevention (CDC) created a division, the National Center for Injury Prevention and Control," he said. "In the last decade, there have been more and more studies from public health practitioners about guns and violence, and this was a good time to summarize the research."

Hemenway directs the Harvard Injury Control Research Center (www.hsph.harvard.edu/hicrc/), which houses the National Violent Injury Statistics System. The program was developed as a pilot project for a possible national system. Unlike information about deaths from motor vehicle crashes, a rich database does not exist for deaths from gunshot wounds. The CDC is working on establishing a National Violent Death Reporting System that would include information about all firearms-related deaths and other violent deaths around the country.

Private Guns, Public Health, published this month by the University of Michigan Press, takes available data, including Hemenway’s own studies, and describes the connections between guns and homicide, guns and suicide, guns and accidental injuries, and guns and self-defense.

One in four American adults, mostly men, owns a gun, writes Hemenway. He compares homicide rates among what he describes as "frontier" countries: the U.S., Canada, Australia, and New Zealand. These nations have in common per capita incomes, cultures, histories, and language. By 2000, the U.S. actually had lower rates of property crime and violent crime–such as assault–than each of the other countries. Yet, the murder rate in the U.S. was three times the average of the other frontier nations from 1999 to 2000. American assaults and robberies, writes Hemenway, are more likely to involve guns.

American children are at higher risk to die of gun violence than children in other high-income nations. One study comparing violent deaths of five- to fourteen-year olds living in the U.S. and in 25 other high-income countries in the 1990s indicated that America had a gun homicide rate 17 times higher than the rate of the other countries combined. The U.S. had 10 times the gun suicide rate of the other countries.

"There is really strong evidence that just having a gun in the house is a risk factor for suicide," said Hemenway.

The data on women and guns are also disturbing. American women account for 84 percent of all female firearm homicide victims in high-income countries, even though less than one-third of all women in high-income countries live in the U.S.

Why such startling differences? Hemenway suggested the answer can be found in how countries choose to regulate guns. Unlike many industrialized countries, the U.S. has no national requirements for training, licensing, registration, or safe storage of guns, writes Hemenway. Federal oversight is generally weak. Product safety requirements for guns are minimal. Loopholes in existing laws make their enforcement more difficult. When reasonable restrictions are placed on gun ownership and use, firearm injuries need not be such a large public health problem, Hemenway writes.

Hemenway, who worked for Ralph Nader in the late 1960s when the consumer advocate was raising questions about auto safety, said he is not "anti-gun," just as he is not "anti-car" because he favors laws requiring airbags and seat belts.

"We have not outlawed cars," Hemenway said. "We just outlawed cars that are manufactured without seat belts."

A similar approach can be applied to guns, he said. "I don’t think outlawing guns makes sense," he said. "Some people like to hunt with guns. They target shoot. That’s fine. Public health says there are lots of things that can be done to lessen the problem of gun violence without banning guns."

The place to start, said Hemenway, is with the establishment of a federal agency to regulate the manufacturing and distribution of firearms, similar to the National Highway Traffic Safety Administration. That agency is responsible for improving the safety of highway motorists and has mandated measures such as collapsible steering columns in cars to protect drivers in crashes.

Such an agency, Hemenway asserted, could require measures such as firearms with childproof safeties and tamper-resistant serial numbers. The agency could also promote new technology, such as "smart" or personalized guns that cannot be fired except by authorized users to reduce unintentional injuries of children and limit the criminal use of stolen guns, he wrote.

Licensing of gun owners and registration of handguns could also be required on a national level, and loopholes that allow firearms to be sold at gun shows without background checks should be closed, he added.

"In public health, often things do not happen as fast as you would like," said Hemenway, "but there are steps that can be taken now to reduce gun violence. Look at the tobacco situation. We’ve had a sea change in the United States for the good. In time, I think we can witness a similar change in the way we safeguard our children and our society against gun-related injuries and death."

--ML