Living with guns rather than dying with guns

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{***Pause/Music***}
{***Noah***}

Coming up on Harvard Chan: This Week in Health…

Living with guns—rather than dying with guns.

{***David Hemenway Soundbite***}
(A key would be getting guns away from people who everyone agrees should not have these guns.)

The mass shooting at a high school in Parkland, Florida has reignited the national conversation on guns.

In this week’s episode, we speak with one of America’s top firearms researchers about why this “Never Again” movement is different—and how a public health approach can be used to prevent gun deaths.

{***Pause/Music***}

{***Noah***}

Hello and welcome to Harvard Chan: This Week in Health. It’s Thursday, March 22, 2018. I’m Noah Leavitt.

A little more than a month ago—on February 14—a gunman opened fire inside Marjory Stoneman Douglas High School in Parkland, Florida.

Seventeen people were killed—and 17 more were wounded, making it one of America’s deadliest school shootings.

That shooting and the students of Marjory Stoneman Douglas High School have reignited a national conversation about guns.

And while that is a familiar theme after mass shootings—this student-led movement, “Never Again”—hasn’t faded from the headlines.

On March 24, people across the country will gather for the March for Our Lives to protest gun violence—and to call for changes in firearm policy.

Ahead of the nationwide marches we spoke to David Hemenway, Director of the Harvard Injury Control Research Center, and one of America’s top firearms researchers. We’ve spoken to Hemenway before on this podcast about how a public health approach can be used to prevent gun deaths.

I spoke to him about that—but I also asked him why these student-led protests may finally be the tipping point for gun legislation in America. Plus—he shared the changes to gun policy that could have the biggest impact on saving lives.

I began our conversation by asking him to explain the daily toll that guns take in America.

{***David Hemenway Interview***}

DAVID HEMENWAY: So typically in the United States on an average day, over 100 people are killed and something like 300 people are shot. So about a third of the people are dying. In terms of the shootings, it’s mostly assaults and unintentionals, but in terms of the deaths, it’s typically over 60% suicides.

NOAH LEAVITT: Can you talk a little bit more about that? About the breakdown and the types of deaths or injuries we’re seeing from guns. Have we seen change in the recent decades? For example, more suicides, more homicides. What are some of the trends?

DAVID HEMENWAY: There’s always more suicides than homicides in the United States. There’s always more gun suicides than gun homicides. Recently, in the last few years, gun suicides are going up and non-gun suicides are going up, also. Over the last 20 years, gun homicides have gone down. Non-gun homicides have gone down. Overall crime, certainly beginning in the 90s for the next 15, 20 years, went way down, not only in the United States, but throughout most of the developed world.

NOAH LEAVITT: And on Saturday, March 24th is this March for Our Lives, which was kind of born out of the most recent school shooting in Parkland, Florida. This was obviously inspired by a school shooting, by a mass shooting, but what does the data show in terms of frequency of school shootings and mass shootings? Are they happening more frequently?

DAVID HEMENWAY: So in terms of public shootings, mass public shootings have been increasing in the United States. It really looks like there’s a contagion effect where people see other people doing these things and they get notoriety, and so they start thinking about them and then they act. Overall, of course, mass public shootings are only a tiny tip of the iceberg in terms of all the deaths in the United States from firearms.

But mass shootings, not only in the United States, but particularly throughout the world, are the catalyst or the impetus, I should say, to really make changes in the gun laws because it becomes very salient, what’s going on. It’s in the news. And so that is the time in Australia, it’s the time in the United Kingdom, and on and on, where then changes are made in the gun laws.

NOAH LEAVITT: And you touched on Australia, the UK, I think maybe two of the most famous examples of kind of where mass shootings influenced gun policy. So can you talk a little bit more about those examples? And then are there any other kind of lessons to be learned from other countries and their response to shootings?

DAVID HEMENWAY: So first, I think there’s lots of lessons to be learned from all of the other developed countries. There are about two dozen high income countries, and every one of them does so much better than we do in terms of the gun issue. It’s really crucial for everyone to understand that we are an average high income country in terms of virtually all crime and violence, and bullying, and you name it.

But where we are very, very different is guns. We have so many more guns, handguns, and military weapons. We have by far the weakest gun laws, and so we have huge problems due to our guns, and so we have very, very high homicide rates compared to these other countries.

So in Australia after the Tasmania, the Port Arthur massacre in 1996, the conservative government at the time– John Howard and his others– there stood up and said, enough is enough. We will never allow this to happen again. And one of the big things they did was they had this enormous buyback program where they bought back all the assault weapons, and have continued to this buyback program. But that initially was a mandatory buyback, and then they very strongly strengthened their gun laws. And it seems to have been an incredible success. They have not had a mass shooting in 20 years and their firearm homicide, their firearm suicide dropped immediately and continued to fall.

NOAH LEAVITT: And you mentioned that a lot of times, these mass shootings are the catalyst for national discussions on guns, gun policy. Once again, the Parkland shooting seems to have reinvigorated that. So do you sense that this movement is maybe different than previous movements? And if so, how?

DAVID HEMENWAY: Yeah. I do think it is different. One is that it’s in the news for so much longer. One is that we have these incredibly articulate high school students stepping up and saying, this is so silly. Enough is enough. We can do much better than this. And this is affecting all the students in the United States because even if you aren’t at a place where there was a mass shooting, now you have this shelter in place drills. This is the most incredible thing for small children in the United States to have to worry about, getting shot in schools of all places.

So and the other way it’s very different, I think, is that for the first time ever some major corporations have moved away from the National Rifle Association and are saying, again, we can do more. And so this hopefully is a tipping point. You never know. I’ve written about success stories and injury and violence prevention, and often there’s tipping points and you don’t really know exactly when they will occur. But if enough people start pushing at the same time, then often these changes will occur.

NOAH LEAVITT: And you touch on corporations kind of moving away from the NRA, and I know that some retailers– I know Dick’s Sporting Goods made some changes in terms of raising age limits, restrictions on the type of firearms they’ll sell. I mean, do you think those changes are likely to have any impact?

DAVID HEMENWAY: I think the big thing is that if everybody starts doing something, if everybody’s willing to say yes, we can do our bit– and it’s very nice to see some corporations saying, yes, we can do something. We just don’t have to sit and watch large numbers of Americans day after day get killed. This is unacceptable. And the rest of the world just looks at the United States and can’t understand why we don’t do anything. But this is a real, I think, opportunity.

NOAH LEAVITT: So you talked about the importance of this coming from the students. Do you think that is critical at all, that it’s kind of students maybe speaking up to power? Is there something different about that?

DAVID HEMENWAY: I think it may be. Students, really– I’m at an age where students really mattered in terms of the civil rights movement, in terms of the anti-Vietnamese War movement. And it was partly– particularly the Vietnam War movement was that they were directly affected, and in this case, high school students are really directly affected by what’s going on in the United States.

That yes, high schools are still so much more safe than walking the streets, but they should be completely safe. You shouldn’t ever have to worry about being mowed down. And these students are. And these students, they were basically born right at the time of Columbine, so their whole lives they’ve seen this and they’ve read about it. I think for them, they are also saying, enough is enough. And it just resonates.

NOAH LEAVITT: And so I know one of the kind of responses shortly after the Parkland shooting was President Trump kind of floated this idea of arming teachers. And I know you’re critical of that. I guess can you explain why it’s a bad idea, but also does that proposal also kind of misunderstand the reality of self-defense gun use?

DAVID HEMENWAY: Right. So there’s lots of reasons it’s bad. One could imagine, if the EPA came out with some strange proposal, people would say, well, let’s look at the costs and the benefits. And what are the potential benefits? And the potential benefits are so tiny because in the last 20 years, there’s only been– only, which is horrible– been 12 mass shootings in high schools where two or more victims have been killed.

And so that’s what the president is talking about, is you’re sheltering in place and you grab your gun and so you can shoot at these people. And so you basically– you have 100,000 schools K through 12, and you’re going to arm, I don’t know, 20 teachers in each school. And basically only once out of every two years is there any chance of doing something good.

And the likelihood in those once every two years in these 100,000 schools of doing something good is very low because in self-defense, you have to be really well trained. You can’t just be a good marksman. You have to be trained over and over and over and over again. And your heart’s beating like crazy. You have to know what to do. You can’t be shooting the wrong people.

You can’t have the police arriving and seeing people with guns and thinking they are the shooters. It’s really mayhem. And this notion that you’re going to really save lots of people seems incredibly unlikely.

We have, for example, Secret Service who guard our presidents and our Congress people and so forth. And look at how many times they have actually used their gun to prevent a president from being killed. A lot of times, they will jump on the person after the president is shot, but it’s– these shootings don’t last for hours. These shootings are over in a few minutes.

And then there’s the cost. The costs are enormous. Just training these people over and over, arming these people, and then the likelihood that– you have to realize that there’s going to be one three minute period in one school in over two years that somebody will have a chance to do something good, but at any moment, with all of these new guns in schools, people can use them inappropriately.

Somebody can get mad. Somebody can make a mistake. Already we had two school shootings where people thought guns went off over the last week. And there’s very, very few guns in schools now.

NOAH LEAVITT: And I know that some of the research that you’ve done here at the Harvard Injury Control Research Center kind of focuses on the fact that more guns, equal more homicides, equal more accidents shootings. Can you talk a little bit more about the research in that area?

DAVID HEMENWAY: So the evidence is incredibly strong that a gun in a home increases the risk for everybody in a home dying. It increases the risk for accidents. It increases the risk for suicide. It increases the risk for homicide, especially for the woman in the household getting killed. There’s really no evidence that there is a net benefit to people in the household, even a gross benefit, that there’s lots of people being saved with guns.

The evidence, for example, when you look at when are guns shot, almost always it’s in accidents and somebody in the household is getting killed by the gun in a household. You’re not shooting these intruders because there aren’t very– there’s very, very, very few. The likelihood of some stranger coming into your house to try to rape the whole family is so incredibly low. That’s not a very good way to be a successful criminal, is to go around and go into strange people’s houses and try to kill people. You will not last very long. And so that’s why even if there occasionally is someone like that, they’re very quickly in jail forever.

NOAH LEAVITT: It seems like after every one of these mass shootings, there seem to be two story lines that emerge. That on one side people are saying, gun control, gun control, and then maybe on the other side, it’s mental health, mental health, mental health. How does mental health play into this, and, I mean, isn’t it possible to address mental health deficiencies and gun policy at the same time?

DAVID HEMENWAY: Well, one would hope so. For any injury, there’s probably 10 things that would have had to happen for that actual injury to occur. And you could sort of focus on any one of those, or you can focus on all 10. In public health, we like to focus on the most cost effective things. And for most shootings in the United States, mental health is not an issue at all, even for a lot of the mass shootings.

For most suicides, it probably is an issue, but it’s pretty clear that what we learn from most successes is that it’s very hard to change people a lot. It’s very expensive. And you always try to. You try to improve parenting and you try to decrease bullying. You try to decrease discrimination and so forth. But the major successes have always been changing the product, changing the environment.

And we know that easy success is possible because there are 24 other developed countries who have achieved much greater success than we do. So all we have to do is, let’s look at France. Why does France do better than we? Well, let’s do something like they’re doing. And it’s not like France this much, much, much better mental health treatment than we do, necessarily, but we know they do something about guns.

Or we could look at Israel, or we could look at Japan, or we could look at Australia, or we could– and on and on and on and say, hey. We know something works. We don’t know that we can dramatically improve large numbers of people’s mental health so that we can reduce school shootings. We should be reducing mental health problems for lots and lots and lots of reasons and this is a tiny reason to do.

NOAH LEAVITT: And I know you talked earlier about kind of the high ownership of guns in the US, and we’re talking about other examples. I know, for example, Switzerland has a high gun ownership rate, but they don’t have the levels of shootings, et cetera, that we have. So if people aren’t familiar, I mean, what’s the difference between Switzerland and the US? What are they doing differently?

DAVID HEMENWAY: Well, the big thing is they have much stronger gun laws, and the second thing is everybody is really trained well. I mean, it’s not like training in the United States, where a lot of people have guns and haven’t been trained, or if they have been trained– we send people out to see what the training is like, and some of it is good and some of it is not good at all.

And what they learned– and there’s a real suicide success story in Switzerland– when they reduced the size of the military fewer people were armed, they had a dramatic reduction in suicides in Switzerland. And no change as far as we can tell in terms of crime and homicides homicide, in terms of any sorts of robbery, burglary, and so forth.

NOAH LEAVITT: And most firearms owned in Switzerland, were those military firearms?

DAVID HEMENWAY: Oh, yeah. The firearms mostly are military and there’s strong rules about them. And you have to keep the ammunition separate, and if you ever open the ammunition, that could be a court martial offense. So it’s not like in the United States where these are play things for us, for individuals to do whatever they want with.

NOAH LEAVITT: And in terms of gun ownership in the US, what are– I guess, what are some of the trends? I think it was Harvard Injury Control Center Research a couple years ago that showed that many people in the US own multiple guns, so it’s hundreds of millions of guns, maybe in a smaller number of hands.

DAVID HEMENWAY: Right. So what it looks like is that over time, in the last 25 years, there’s been a decrease in the percent of households with guns. And so the best estimates I believe now are about a third of households have guns. About a little over 20% of adults are gun owners. So most people in the United States don’t own guns. Most people in the United States do not live in gun owning households. And just as an aside they seem to be much safer in lots of ways than the people who have the guns because the guns are such a danger to the family.

NOAH LEAVITT: It seems like a common theme that emerges after one of these school shootings or mass shootings, is a focus on the specific type of weapons, whether it’s maybe an AR-15, et cetera. Is that a valuable approach at all to focus on these kinds of weapons?

DAVID HEMENWAY: Well, yes. The weapon really matters. If you want to kill a lot of people quickly, the weapon matters a lot. I mean, there is this notion that if we only had muskets, it would be really hard to kill lots of people. And in other countries when mass shootings– people try to kill lots of people. And sometimes they end up using knives because it’s hard to get the guns. And so yes, it’s horrible, and they wound people, but they don’t kill large numbers of people. And so, yes, the weapon really matters.

We just did a study about large capacity magazines. It really looks like if you have large capacity magazines, you’re able to kill more people because you can shoot faster. The AR-15 can kill more people because the type of bullet, and the bullet type, really the bullet wound, is much more severe than for a lot of other guns. So yes, it really matters.

That’s why these are military weapons. Because that’s the goal, is to kill lots of people and incapacitate them as quickly as you can. There’s no reason that individuals in the United States need to have these guns for protection or for hunting or for target shooting.

NOAH LEAVITT: And so for people calling for a ban on the AR-15 or large capacity magazines, I mean, is there any– from a policy perspective, is there any realistic chance of movement in that area?

DAVID HEMENWAY: What’s always said is that guns are a continuum. It’s really hard to say– you know, it’s pretty easy to say which guns are military weapons and which guns aren’t, and which guns have more firepower and which ones don’t. But this is a continuum, and where you’re going to draw the line is sometimes unclear, but other countries have been able to do it. And some states have been able to do it. So it’s not like it’s an insoluble problem.

And you can’t say, oh, it’s hard to– it’s hard to draw the line on a lot of things. When should the cops pick you up when you’re speeding? If the speed limit 65, what if you go 66? Well, what if you go 67? What if you 68? When is it right? You can’t pick them up if it’s 66. Well, what about 67? And say, where are you going to draw the line? It’s true in virtually every law. And so just because it’s a problem here, doesn’t mean we have to not do anything and continue to have a large number of people die.

NOAH LEAVITT: And when it comes to making changes to gun laws and gun policy, what are the changes that are likely to have the biggest impact, but also where there is currently the most agreement about what works?

DAVID HEMENWAY: A key would be getting guns away from people who everyone agrees should not have these guns. And what that would entail, I think would be strong licensure laws, strong background checks, and universal background checks. In virtually every other country, that’s what they have, and they seem to do much better.

And other countries– some countries have very few guns, like England and Japan, but there are other countries which have a sizable gun stock. Australia used to, and Canada, and so forth. And they don’t have the problems we have in part because, yes, they have guns. They don’t have quite as many handguns, but they have these stronger laws. They made it harder for the wrong people to get their hands on guns.

NOAH LEAVITT: I know one thing that you’ve written about in terms of the research data related to firearms, for example, are gun deaths. And how would knowing more about gun thefts, for example, maybe play in to that in keeping guns out of the wrong hands.

DAVID HEMENWAY: So there’s so much we don’t know about it. And one big thing is how guns so easily get into the wrong hands now. In one way, seems to be via gun theft, and it would be nice to know a lot about that so we could figure out ways which were reasonable and cost effective to reduce that easy supply of guns to the wrong people.

Any reporter who would look at the issue would want to know the who, why, what, where, and when, and we hardly know anything. There’s sort of anecdotal data now that looks like more and more guns are being stolen from cars. And if that’s the case, then we have to figure out how to prevent that from happening.

It looks like a lot of guns are being stolen when people don’t really secure them well, and we have to understand, well OK, is this really a big thing? How do you secure them? Are there better ways and worse ways to secure your guns to make it really less likely? Is it just going to be just a little less likely, or is it a lot less likely? How strongly should we be pushing various measures?

The key thing to recognize is that the United States will, as far as I can see into the future, will have lots of guns. And so we have to figure out, well how can we do better with our guns in the sense that not have so many people die?

NOAH LEAVITT: I know one of the things you’ve said often is this idea that we need to learn how to live with guns rather than die with guns, and I would be interested to know how kind of that mentality ties into this public health approach to preventing gun violence, whether it’s suicides or homicides. So what is the public approach?

DAVID HEMENWAY: Well, the public health approach really is a harm reduction approach. If there was one sentence I would say, it’s let’s make it easy to be healthy and difficult to die. I mean, let’s make it– And then more people will be healthy and fewer people will die.

So in the area, for example, of obesity, what the public health approach is, let’s make it really easy to get really healthy food and good, nutritious food, and not to over eat, and let’s make it really, really easy to get good exercise. And we sort of do the opposite in the United States and then we’re shocked, shocked, I tell you, that there are a large number of people who are obese. And you can blame those people, or you can just say, let’s solve the problem.

And that’s what public health really is about, is about figuring out ways to make it so the world’s a safer place. An analogy which is always given is in the public health world, it’s the motor vehicle. And you want to make it safer, so you want to have collapsible steering columns rather than spears pointed at your chest as you’re driving along. You want to have seat belts and airbags which protect you.

You want to make sure that if you leave the road in your car, you don’t crash into lampposts which were placed right along the side of the road. If you’re driving along and you’re falling asleep and you’re swerving out of your lane, to have here bah, bah, bah, bah, bah, the Botts’ dots say, get back in lane, stupid.

You want to make it so the world has been created so it’s beneficial to people, rather than detrimental to people. You want to make it easier for people to lead happy, productive, healthy lives, rather than difficult. Because you make it difficult, then fewer people will be happy, productive, or healthy.

NOAH LEAVITT: I heard you speak a few months ago and someone asked the question of kind of what are your unanswered questions with guns, and I believe the response was, it would take me too long to list all of that. So why are there so many unanswered questions about guns.

DAVID HEMENWAY: So a number of years ago, I wrote this book While We Were Sleeping and it has 64 documented successes in how the world’s been made safer, just in the injury and violence world. And in all of them, data mattered and research mattered. A big reason we don’t have as many successes in the firearms area is because data have been deliberately either not collected or collected and then withheld from researchers, and then our research has been deliberately underfunded.

The people who should be funding data collection and research typically are the federal government. That’s how we do in every area. When you want to study cancer, decrease cancer, the National Institute of Health gives lots of grants and we do better and better. In the same way, if we want to reduce arthritis, the same thing. That’s all we want.

And in this area, the federal government has said, we were going to make sure that researchers aren’t funded to do the important research necessary so we can understand what the problem is, whether or not what we’re doing is working, when we try different things, are those working? What are the kinds of things we should really try? What seems to– from the data– to make sense.

NOAH LEAVITT: Just a last question because I think this is a success story with firearms, and maybe in a small way, but the work you’ve been doing on suicides and in terms of kind of working with gun owners. So can you explain a little bit about your approach there and then any success you’ve had in terms of reducing access to firearms, and hopefully reducing suicide.

DAVID HEMENWAY: So the public health approach really is trying to get everyone together to work on the problem, basically to step back and say, do we have a big problem? And the answer is clearly in this area, we do. Let’s all agree to that and let’s all agree, what can we all do individually and collectively to try to reduce that problem?

So a key thing that we’ve been doing and public health typically tries to do, is let’s get everyone involved. So one area where there’s a strong convergence between public health and gun owners is in suicide because this is one area where I can say without a doubt that a gun in a home increases the risk for suicide. The average person in the United States doesn’t understand that, but the evidence is just overwhelming that bringing a gun into your house increases the likelihood that someone in the home will die from suicide. It increases about threefold.

So it doesn’t mean, oh, you bring your gun home, somebody’s going to commit suicide, but it means that if there a 1% chance that in the next 20 years someone would attempt suicide and die, now you’ve made it a 3% chance, so you’re three times as likely. And that’s a huge amount. And so lots of people who are dead from suicide are gun owners and their families, simply because they have this access to this incredibly lethal means.

And so we’ve been working with gun owners to say, what can we do to figure out ways to reduce the problem. And we of course think one of the ways is that if you really don’t need the gun, get the gun out of your house, particularly if you have a young person in the house, particularly if someone is going through a bad period, or whatever. But if you don’t want to do that, at least try to think about storing it better.

But the way we’re talking about now is– that something else has to be done– is it’s pretty clear that when people commit suicide, it’s not like, oh, I’ve always wanted to commit suicide. It’s that you go through bad periods often. And during these bad periods, which don’t last forever but can last for days or weeks, it’s really important not to have lethal means lying around. And if you do, then you’re much more likely to use them and to die.

And so we’ve been working with gun owners to try to figure out ways– if someone’s going through a bad period, let’s figure out a way to get the gun out of the house for a while. And everyone seems to agree that it make sense. And so we’re trying to promote this idea working with the gun owners who believe in this and the gun advocates who say, all right, this really makes sense. We never really thought enough about suicide.

{***Noah***}

That was our conversation with David Hemenway about guns in America—and the public health approach to preventing deaths from firearms.

If you want to learn more about the Harvard Injury Control Research Center, or anything he discussed in this episode, we’ll have more information on our website, hsph.me/thisweekinhealth.

And before we go, a reminder that this podcast is now available on Spotify. Just search for Harvard Chan: This Week in Health to find us. To make sure you catch new episodes be sure to “follow” us.

March 22, 2018 — On February 14, 2018, a gunman opened fire inside Marjory Stoneman Douglas High School in Parkland, Fla., killing 17 people and wounding 17 more. That shooting and the students who survived have reignited a national conversation about guns under the banner “Never Again.” On March 24, people across the country will gather for the March for Our Lives to protest gun violence—and to call for changes in firearm policy. Ahead of the nationwide marches we spoke to David Hemenway, director of the Harvard Injury Control Research Center, and one of America’s top firearms researchers. Hemenway discussed why these student-led protests may finally be the tipping point for gun legislation in America. Plus—he explained the public health approach to preventing gun violence and shared the changes to firearms policy that could have the biggest impact on saving lives.

You can subscribe to this podcast by visiting iTunes, listen to it by following us on Soundcloud, and stream it on the Stitcher app or on Spotify.

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Firearms research (Harvard Injury Control Research Center)

Lethal means and suicide (Harvard Injury Control Research Center)