David Hemenway: Who Can Solve America’s Gun Problem?
In this episode of Ask a Harvard Professor, David Hemenway describes public-health strategies that can save lives by making guns less dangerous.
Mass murders committed with firearms are becoming more frequent in the United States. And the total number of gun deaths, a majority by suicide, is now on par with those caused by automobile accidents. None of this has broken the political gridlock in Washington that surrounds the issue of gun control. In this episode, professor of health policy David Hemenway describes public-health strategies that can save lives, often without political intervention, by making guns inherently less dangerous, and by enlisting gun advocates and gun-shop owners in efforts to reduce fatalities.
Transcript (the following was prepared by a machine algorithm, and may not perfectly reflect the audio file of the interview):
Jonathan Shaw: Welcome to the Harvard Magazine Podcast, Ask a Harvard Professor. I'm Jonathan Shaw. We'll spend today's office hours with David Hemenway, a Professor of Health Policy at the Harvard TH Chan School of Public Health. Professor Hemenway directs the Harvard Injury Control Research Center and the Harvard Youth Violence Prevention Center. He is the author of Private Guns Public Health, and of a Harvard Magazine Forum article advocating a public-health approach to the problems of gun homicides and suicides. Welcome Professor Hemenway.
David Hemenway: Thank you.
Jonathan Shaw: What is the incidence of gun deaths in the United States?
David Hemenway: On an average day in the United States, over 300 people are shot and a little over 100 die. There's more suicide deaths than homicide deaths, but there are more people being shot and assaults.
Jonathan Shaw: How does that compare to other developed nations?
David Hemenway: We are such an outlier compared to the other 29 high-income countries. They can't understand how we can do so badly. We have typically 90% of people, like our children, ages five to 14, being shot in the entire developed world, which includes Germany and Japan and England and on and on, but 90% of those children being shot and killed are American children.
Jonathan Shaw: I see. Suicide is the largest problem, but are mass murders becoming more frequent in the last decade than frequently, or is that just a perception?
David Hemenway: Certainly, public mass murders or mass shootings are happening much more frequently. If you just... It used to be so many of the "mass murders, mass shootings" were much more private. They were intimate partner violence. The husband would shoot the wife to two kids and himself and that would count for four mass murderers, mass shootings, but now the public mass shootings have grown much more rapidly in terms of frequency. It's really... A lot of people think it's a contagion problem that one mass murder excites people to commit others.
Jonathan Shaw: What is the relationship between other forms of crime and guns?
David Hemenway: Well, guns don't cause crime. There's lots of crime in other developed countries. We are not an outlier in terms of non-gun crime. What guns do is they make crime more lethal, so what happens is when there's a robbery and it's not a gun robbery, people don't get killed. One of the interesting things that we've been looking at is police shootings and police getting killed. If you compare, say the United States to any other high-income country, say Germany, a police officer in the United States is 30 times more likely to be killed on the job than a police officer in Germany. Why? Because we have lots of guns. Also, a civilian in the United States is 30 times more likely than a German civilian to be killed by a police officer and it's just the guns.
Jonathan Shaw: Is there a relationship, a parallel to... let me re-record that. Is there a parallel to the relationship between suicide and guns? Is a suicide attempt in the United States more likely to result in death?
David Hemenway: Yeah. One of the things we really know for sure, because the evidence is just overwhelming, is that a gun in the home in the United States increases the risk for suicide to everyone in the household something like threefold. That doesn't mean if you have a gun in the household, someone will automatically die of suicide, but it means if, say over the last 40 years in your whole family there was a one half of a percent that someone would die in a suicide, now it's one and a half percent. Guns are just so lethal. The case fatality rate for guns is something like 90%. If you attempt with a gun, you're undoubtedly going to die. The case fatality rate for other common forms of suicide... the most common form is either cutting your wrists, or taking lots of pills, and there the case fatality rate is 2% to 3%. If you can get someone not to shoot themselves, but to do something else like take pills, you've basically saved their life.
Jonathan Shaw: Mm-hmm. How do deaths from guns compare to other causes of death or injury such as automobile accidents?
David Hemenway: Typically gun deaths in the United States, it varies from year to year, but it's about on the order of motor vehicle deaths now. Used to be two years ago, three years ago, suicide was the leading cause of death in the United States and half or more of all suicides in United States are gun suicides, but the opioid poisoning epidemic has now made poisoning the number one cause of injury death.
Jonathan Shaw: I see. How many accidental deaths are attributable to guns each year in the United States?
David Hemenway: Yeah, so there are a lot of accidental gun shootings. We don't know exactly how many, but it's probably 10 times as many as the number of fatalities from accidental shootings. The number is probably 400 to 500 a year, so that's like a little over one, one and a half people getting killed a day.
Jonathan Shaw: I wondered if as an illustration you could tell us what happens when you put a group of boys alone in a room with a handgun.
David Hemenway: Yeah, so there've been a number of really interesting and scary experiments where kids have been trained in the Eddie Eagle program and then they've been put in a room where they are left with by themselves with sort of a one way mirror, so that people could see what was going on, and just told to play. The kid, and especially the boys, would find the gun and some of them would even recite the mantra, don't touch, tell an adult, and they would pick up the gun, they would hold it, they would pull the trigger. The parents who saw this really couldn't believe it, but boys especially are just so curious about guns. To protect children, you don't just train them. I mean, you really got to make it safe for them and it's up to parents to do that. We haven't done a good job of that in the United States.
Jonathan Shaw: Are there safety mechanisms that could reduce the risk of accidental discharge?
David Hemenway: Oh, absolutely. I mean, we've done lots of studies of accidental firearm deaths to children. For example, one of the things we found is that most of these children are being killed by other children, but two to four-year-olds are more likely to shoot themselves, so it's really horrible. They find that their dad's pistol and they're able to... they point it at themselves, with their little thumbs they're able to pull the trigger, and they're dead. You can blame the kids, you can blame the parents, you can do a lot of blaming or you can solve the problem.
David Hemenway: We used to have, 30 years ago we had a major problem with little kids finding aspirin bottles and taking aspirin and dying. Now, we have not completely solved the problem, but we reduced it dramatically by having childproof aspirin bottles where the kids have to push down on the bottle to open it and they can't do it, so suddenly instead of having a lot of little kids dying, we have very, very few and we can do the same thing with guns. For example, Wesson of Smith and Wesson fame over 120 years ago was worried about children and he created a childproof gun. It's really easy to do. What he did is he made it so in order for the gun to fire, you had to put a little pressure on the handle at the same time you pulled the trigger and the same ways kids can't push down and turn to figure it out, they weren't able to do that and it'd be really easy to solve the problem.
David Hemenway: The most common problem is that boys find their dad's semiautomatic pistol and they take out the magazine, which has all the bullets and they think it's unloaded. Hey, I have a magazine, the bullets are gone. Then they play with the gun and sometimes they pull the trigger and there’s still a bullet left in the chamber and the gun goes off. It's so common for a boy to kill his best friend, a boy to kill his younger brother, younger sister. Again, you can blame everybody. You can blame the parents for leaving the gun or you can just solve the problem. Just make it so that when you take out the magazine that the gun cannot fire.
Jonathan Shaw: Makes a lot of sense. Do gun advocates have a role to play in making firearms safer?
David Hemenway: Absolutely. One of the main things in the public health approach, which I promote, is to try to get everyone together to help solve the problem. Rather than blaming, blaming, blaming, let's figure out ways to get together, thisis a major American problem, and reduce the death rate and the wounding rate. It's not only that, you should recognize too that there's major problems caused by gun violence because of trauma, this exposure to trauma, the evidence is overwhelming now that people exposed to trauma get traumatized often and hurt people hurt people, but let me go back to the gun advocates. We've been working a lot very successfully with gun advocates because we approach them as part of the solution rather than part of the problem. In my group, Cathy Barber has just been exemplary in this. She's worked with gun shops, so for the first time ever in the last few years, gun shops are trying to take a role in reducing suicide. Now, in 20 states, gun shops are trying to do something.
David Hemenway: For example, a woman comes into your shop and says, "I want a gun," and you say, "Great, what are you thinking about?" She says, "I don't care, any gun's fine." You say, "Okay, how about this one?" She says, "Okay." Then you say, "How many bullets would you like?" She says, "One's enough," you don't have to sell her the gun. You should help get her help because maybe 3% or 4% or 5% of all gun suicide, someone's recently bought a gun for the prime purpose of suicide, so they can really help. They've never done anything in the past about suicide. Now, they're really trying to do something to take their role.
David Hemenway: Cathy went to Utah, which is a very red state. It's probably the gun training capital of the United States and a lot of concealed gun training. She got invited to this group of concealed carry trainers and she was trying to talk to them. She was saying, "You do such a good job trying to reduce gun accidents, but did you realize in Utah for every accidental gun death, there are 85 gun suicides?" They said, "Is that right?" Because they did nothing about gun suicides. She said, "Yeah." She said, "Raise your hand if you know someone who accidentally got killed with a gun," and a few hands go up. "Raise your hand if you know someone who killed themselves with a gun in a suicide," and every hand goes up because these are all older white males, the typical gun owner. That's who is at the highest risk for gun suicide. She said, "How about if we work together and create a little module that you might use in your gun training class?" They said, "Okay, let's see."
David Hemenway: She created this module with them and they love it. They think this is the greatest thing. She said, "Can we get... Will you use this?" They said, "Absolutely." She wanted to get all the trainers to use it because there are hundreds of thousands of gun trainers in United States. They thought and they said, "Yeah, we'd have to educate them and that's going to take a lot of time. We know everybody in the state legislature in Utah, we'll just make it mandatory." Now, in Utah, it's mandatory if you teach a concealed carry class to teach about suicide and suicide prevention. The message is a simple message. Very much like friends don't let friends drive drunk. It's, if somebody's going through a bad patch, your best friend, your good friend, he's just getting a divorce and he's drinking and he's talking crazy, it should be your responsibility, and he should understand it's your responsibility, to "babysit," those are their words, his gun for a while until things get better. He gets a new girlfriend and then he can get his gun back.
David Hemenway: That's why we have suicide watches in prisons because there are periods where people are at very high risk for suicide. If you can get through those periods, you're going to be safe. It's really very exciting. Then, they got the state legislature to do a study about suicide in Utah and they gave us the money, which was incredible. The key thing they were able to do is they required, the legislature required, that everybody in the state work with us and link data, which had never been linked before. We have data on every gun suicide, we have data on the medical records of every person in the last... who committed suicide with a gun. We know whether or not they had a concealed carry permit. We know whether or not they could've passed the background check the day they died. We know whether or not they were the original purchaser of the gun or somebody in their family was.
David Hemenway: We're learning so much more about suicide, there's so many things you can do to reduce suicide in the United States. Probably the most important ones turn out to have nothing to do with mental health. People think suicide, mental health. Almost everyone focuses on the why do people commit suicide. We focus on the how and if you can... Some of the, probably the greatest suicide prevention success stories of the last 60 years in the world have had nothing to do with mental health, but about the how of suicide. Getting rid of lethal means.
Jonathan Shaw: Gun advocates can play an important role in this problem.
David Hemenway: Absolutely. They're crucial for two reasons. One, the message is crucial and they know how to say the words in the right way. We say, Oh, well, we should say... why don't we say this and they say, "No, no, no, you can't say this. You have to say this other thing." Then, I'd say, "Isn't that exactly the same thing?" They say, "No, no, it just sounds just a little..." Then, the second thing is the messenger matters. It has to be someone of their own tribe. If somebody from Harvard or somebody from public health tells a gun owner something, they're not going to listen at all, but if somebody who they really trust, who is also a well-recognized and respected gun owner says, "You should think about doing this," then they will.
Jonathan Shaw: What about women? Are they more likely to advocate for firearm safety?
David Hemenway: Oh yeah. Women are so much better than men. I mean, in virtually every injury area, it's men who are the perpetrators. You want to reduce injury in United States a lot, somehow either get rid of the men or certainly get rid of the men age 15 to 30 for a while and then bring them back when they've matured a little more. Women are so much better about guns, they don't have the fetishes about guns that men have. They're so much better about reasonable gun control and we're trying to figure out ways to help women play a larger role about whether there's a gun in the house, because we've done studies that indicate that women don't always know there's a gun in the house and certainly don't know whether it's stored appropriately. You asked the woman, "Yes," she says, "I have a gun, but I’m sure it's stored locked up, unloaded with the ammunition separately." Then you ask the guy and he says, "No, that's not true." Women play a major role in the United States about most household things, but somehow, they don't about guns. We'd like to figure out how to get them to play a more important role.
Jonathan Shaw: What can we learn from state laws regarding firearms?
David Hemenway: Well, since nothing good has been happening at the federal level for the last, since the early 90s, we have to learn a lot from the states. In all areas, states are good experimental places in terms of policy. Different states have tried different things. Unfortunately, after the mass shootings, the blue states get stronger gun laws, but the red states get weaker gun laws and that's where most of the gun deaths are occurring is in the red states with lots of guns and the weak laws.
David Hemenway: Different states try different things, so the hot topic now is the red flag laws, which were tried in a number of states. That's a law that says if you know somebody is maybe planning to hurt themselves or to hurt someone else that you, if they're part of your family, you can ask the police to maybe take the gun for a short time and try to reduce the likelihood of mass shootings. They seem to have had maybe perhaps some effect. There was a recent study out of California which just looked at 21 cases where clearly they took the gun away for a while from people and clearly nobody wanted these people to have a gun. I mean, if you had seen what they had written on the internet, you would think, no, this is not a good person.
Jonathan Shaw: How many states require a license to own a firearm?
David Hemenway: Very, very few. Massachusetts requires one and we are such an outlier. Massachusetts has some laws, we have among the strongest laws and we have typically year after year we're either the lowest or the second lowest rates of gun death. Sometimes Hawaii beats us, sometimes we beat Hawaii and we are an exemplar of doing things pretty well, but we could even do much better because we're just like the smart kid in the dumb row. We look better compared to a lot of the US states, but when you compare us to the other high-income countries, which are a lot, they all have better laws, they virtually all have better laws than we have and much lower rates of gun violence.
Jonathan Shaw: Even in Massachusetts, anyone can buy a so-called primitive firearm with a rifled barrel and a scope. These are highly accurate. Are those types of rifles part of the problem?
David Hemenway: The big part of the problem is that I think in the 1700s
Jonathan Shaw: people mostly had muskets and they're a very different type of weapon. Now, what's happened is the gun manufacturers are in a tough situation. They recognize that the US population is less likely to hunt than it ever has before and less likely to be enamored with guns, and guns last a long, long time. How to keep sales going, they unfortunately promote fear and then they try to have more and more sexy weapons, which typically means more and more military style weapons, which were designed for military use and not for civilian use. It's sort of fun to get them, so people get them, but unfortunately then sometimes they get stolen or people get angry or whatever and they're used and more people die.
David Hemenway: Even though medical care has advanced greatly over the last 50 years in treating gunshot wounds, we still have this enormous problem because the physicians can't save you when you're hit by so many bullets and bigger bullets.
Jonathan Shaw: How good is the data surrounding the circumstances of gun deaths?
David Hemenway: It could be much better. One of the things I'm most proud of in my career is that we help create the National Violent Death Reporting System, which is now in 50 States, so we know a lot more now about violent death and circumstances, but there's still so many things we don't know in terms of the data. One of the things we don't know even as we don't really have a good point estimate of how many people are shot in the United States. We know virtually nothing about the circumstances of non-fatal injuries, shootings, in the United States. We actually collect data about... to trace data about where gun came from, but it's been really hard to get the data from the government. The government deliberately withholds it from researchers, so there's lots of things we don't —
David Hemenway: There used to be a question on the CDC's Behavioral Risk Factor Surveillance System, which is this great data system, which is why we know a lot about what's going on about health in the United States. They asked maybe 350,000-400,000 people a year all these questions. They used to have a gun question, three gun questions actually, about is there a gun in your home, how is it stored? Now they have none, so it's people just make... estimate the number of guns in each state where we used to know much more accurately.
Jonathan Shaw: Why isn't there more support for gathering data on gun deaths to help shape policy?
David Hemenway: Yeah. The problem has been that the gun lobby has successfully fought against collecting the data, against researchers getting the data, and then even more importantly, against the federal government funding research in this area. In virtually every area of public health, one of the reasons we know so much is because of the National Institutes of Health, and the CDC, and so forth, funding research. Now, for the last 20 years, because of the gun lobby's control really over the Republican party, the CDC has done zero work about guns, zero research funds, no research. They are afraid to even say the word guns in public meetings. After every mass shooting, what does the Surgeon General say, our lead public health person in the United States? The answer is nothing. Nothing. What does the head of CDC say? Nothing. Nothing at all. Why? Because they're afraid they're going to lose funding.
David Hemenway: I know a good number of people at CDC, researchers, but when I talk to them, if I sort of say the word guns, they will sometimes say, "Wait, wait a second, let me call you back." They will go outside into the parking lot and instead of using their official phone, they'll call me back on their private cell phone and talk about guns because they recognize that if CDC does anything about guns, this huge public health problem, that they'll be hauled in front of Congress and berated and probably in the appropriations time, they'll lose money.
Jonathan Shaw: When you're looking at the statistics on fatalities, are there at least distinctions that can be made between the kinds of firearms involved?
David Hemenway: Oh, absolutely. The bigger problem by far are handguns. They're the ones that are used in most crimes, in most homicides. They're still predominantly used in suicides, but long guns are also used and for children, say 17-18, they often use long guns because they can't buy handguns themselves. In terms of the mass shootings, the thing which really seems to matter a lot are large capacity magazines because they allow you to shoot so many bullets without reloading, so it's very hard for anyone to sort of stop the shooter.
Jonathan Shaw: Why is the gun control debate often framed as an either/or situation in which people's guns are taken away or not?
David Hemenway: Unfortunately the whole gun issue has become part of the culture wars, I think. It makes it so, at least from the side of the gun lobby, that's the debate they want to have. Either we have guns or you take all the guns all away. Of course, that's not good policy. In public health, particularly injury prevention, we have so many good success stories and one of the examples we often use is in motor vehicles. When I was growing up, a lot of my classmates, a fair number of my classmates died in motor vehicle crashes and we were told, and the evidence is right there that over 95% of crashes are due to driver error, people making mistakes. If people never made mistakes, you wouldn't have crashes. Most of the fatalities are due to drivers disobeying the law. It's always the notion, education and enforcement, if people didn't disobey the law and never made mistakes, we wouldn't have problems.
David Hemenway: It wasn't until the 1950s that public health physicians asked a different question, not who caused the accident, but what caused the injury. Just looking at it a different way, they thought, oh my goodness, people were being speared by steering wheels that went right through their chest. Their face is being lacerated by windshields, which were not made of safety glass. They were being thrown from the car and their heads would hit the cement or the hood of the car and they would die. They would leave the road for one second and they would hit lampposts and trees which were planted right along the sides of the highways. Public health physicians were saying, "We don't plant lampposts along the side of airport runways. That wouldn’t be very smart. Can't we make cars safer? Can’t we make roads safer? Can't we make the emergency medical system better?"
David Hemenway: Fast forward, say 65-70 years, nobody thinks drivers are any better. We're better today than when I was a kid about drunk driving. We are much worse about distracted driving, but fatalities per mile driven have fallen 85% to 90%. An incredible success story, so every 20 people that were killed in my era, only two or three are killed now. It really was because now we have seatbelts in cars. We didn't have seatbelts when I was young. Then we have airbags, we have collapsible steering columns, we have safety glass, we have all these incredible things. Now, for the first time, after 20 years, I just got a new car and you can... The blind spot in a sense is gone. My mirror sort of says, "Hey, there's somebody over there," and it makes it so much better.
David Hemenway: Public health is all about creating a world where it's difficult to make mistakes and if you make mistakes, nobody dies. Instead of just trying to say be good, watch out. People are people, they make mistakes all the time. One of the nice things is now you ride along the highway and you start to go to sleep and if you go off the highway, you get killed. It's your fault, bad, bad, bad. Or you can, in California, you go ba, ba, ba, ba, ba, you hit these Botts' dots that say, "Wake up stupid, get in the lane," and nothing bad happens. Where now, on my new car, it buzzes when I start swerving a little and I wake up and I go straight and it's so much nicer.
David Hemenway: What they did in motor vehicles, too, is they created really, really good data systems, so we really know what works. There's money for research and we'd always do the right thing, but at least we do the right thing more often than not. Then, it's so different than in the firearms area.
David Hemenway: It's getting, I think, closer and closer, but things will tip and suddenly people say, "Why didn't we do this before?" From my point of view, why didn't we have airbags 20 years sooner and a lot of people died? Why didn't we have good seatbelts? Why didn't we have collapsible steering columns earlier? Why didn't we make the roads as safe 40 years ago as they are now, so that when I go off the road, I don't get killed?
Jonathan Shaw: Right. Well, thank you very much, Professor Hemenway.
David Hemenway: Sure. Thank you.
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