Private Guns, Public Health
The public health community began researching gun violence about two decades ago, a late entrant in a field traditionally occupied by criminologists. David Hemenway, an economist at the Harvard School of Public Health and the director of the Injury Control Research Center there, has been a leader in this effort. His book is the first to synthesize the findings in this new field and to reference other literature as well. The book provides an account of the nature of the problem of gun violence and views about what can be done to mitigate it, engaging all the principal controversies. Scholars will appreciate the author's logical caution in drawing inferences from the evidence, as well as the methodologic appendix and superb bibliography. Yet the book is highly readable and will serve advocates and other interested citizens as an accessible, comprehensive briefing on the relevant statistics and arguments. (Figure) Hemenway develops the public health approach as a pragmatic, science-based effort to reduce injuries and deaths from gun violence. The goal is not to assign blame but, rather, to find solutions, with an emphasis on prevention. The canonical example for injury-control investigators is highway safety, in which the comprehensive approach propounded by Bill Haddon, a physician who served as the first director of the National Highway Traffic Safety Administration, continues to provide the conceptual framework. Haddon sought to direct the focus in highway safety away from improved driving and toward improved design of vehicles and roadways. For gun violence, the analogy is to focus less on the shooters and more on access to guns and their design. Of course, it is not obvious that an approach that has been successful in reducing highway crashes, which are mostly unintentional, will also be successful in curtailing the intentional acts (suicide and assault) that produce most gun injuries and deaths. If shooters were determined, resourceful people with clear and sustained deadly intent, then regulating guns would likely have little effect on the number of homicides and suicides; they would find a way. But in the real world, as Hemenway spells out, a large portion of serious intentional violence would be less deadly if guns were less readily available or less user-friendly. Furthermore, although gun "accidents" make up only a small fraction of the total gun injuries, they are common enough that the Consumer Product Safety Commission would surely give them high priority if it were not barred from doing so by federal law. Another feature separates firearms from vehicles: the possibility of "virtuous use." The belief in the importance of giving civilians a means of self-defense has long been used as an argument for preserving the right to keep handguns in the home. In recent decades, that philosophy has fueled a successful effort to ease state restrictions on carrying concealed weapons in public. This campaign has made great use of the work of criminologist Gary Kleck, who concluded from his analysis of survey data that there are millions of virtuous self-defense uses of guns each year. Hemenway has done more than any other scholar in rebutting that absurd claim. The book includes a summary of his results, which are so definitive as to settle the issue for any open-minded observer. When it comes time to assess the evidence on the effectiveness of particular interventions to reduce gun violence, Hemenway is restrained. He notes, "Unfortunately, there exist few convincing evaluations of past firearms laws." In reviewing the evidence on what works and what might work, he tends to believe that studies support the feasibility of reducing accidents and suicides more than they do the likelihood of cutting down on gun assaults. Here again, he summons a public health core principle: that good data are the precondition for progress. Indeed, he and his center get much of the credit for designing a practical system that is now in the pilot stage in a number of states, with funding from the Centers for Disease Control and Prevention. The public health approach rests on the optimistic belief that good science will engender good policy and practice. Optimism is a scarce commodity in the area of gun policy. Private Guns, Public Health supplies reason to hope.Philip J. Cook, Ph.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.--This text refers to an out of print or unavailable edition of this title.