Making the case for a world without guns
Authors: Sandro Galea
Journal: The Lancet Public Health (2019)

The time has come for a world without civilian owned guns, especially handguns and military style assault weapons. These weapons are inherently dangerous consumer products manufactured with the central purpose of causing harm to other humans. With the exception of narrowly defined recreational use, handguns and military style assault weapons have no positive value in the modern world. Many gun owners cite self-defence as a reason for gun ownership,1Azrael D Hemenway D ‘In the safety of your own home’: results from a national survey on gun use at home.Soc Sci Med. 2000; 50: 285-291Crossref PubMed Scopus (35) Google Scholar but this argument is both circular—individuals would not need to defend themselves if handguns and military weapons were not easily accessible—and not supported by the available data, which show that one of the greatest risk factors for firearm-associated deaths is owning a gun.2Anglemyer A Horvath T Rutherford G The accessibility of firearms and risk for suicide and homicide victimization among household members.Ann Intern Med. 2014; 160: 101-110Crossref PubMed Scopus (335) Google Scholar Therefore, most guns are produced, sold, and bought with the sole purpose of causing harm to ourselves or others. The closest comparative example of this is cigarettes, and during the past few decades the sale of cigarettes has been regulated and in many countries cigarette manufacturers now pay fees to mitigate the harm caused by their products. No such progress has been made with guns. Gun manufacturers continue to operate with impunity avoiding liability worldwide, protected by powerful lobbies and statutory cover in many countries, particularly the USA, where federal law protects all gun manufacturers from lawsuits and consumer protection regulations, which almost all consumer product makers and toy gun manufacturers must comply with. Although substantial heterogeneity exists in the availability of guns, they continue to be available, and they continue to cause harm globally. Paucity of data has hindered the articulation of a compelling case for the removal of civilian owned handguns and military weapons from society.3Stark DE Shah NH Funding and publication of research on gun violence and other leading causes of death.JAMA. 2017; 317: 84Crossref PubMed Scopus (97) Google Scholar The comparative analysis by Anna Dare and colleagues in The Lancet Public Health makes an important contribution to the argument that the world should be without guns.4Dare AJ Irving H Guerrero-López CM et al.Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990–2015: a comparative analysis of vital statistics data.Lancet Public Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2468-2667(19)30018-0Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar The authors report that between 1990 and 2015, nearly 2·5 million firearm deaths occurred in the USA, Brazil, Mexico, and Colombia, of which nearly 1·8 million (70%) could have been prevented, if countries were able to achieve the same national mortality rates as those observed in their lowest-burden states. Furthermore, most firearm deaths occurred among poorly educated, young men (aged 15–34 years) in the study countries. These conclusions make a strong argument for a world without guns, especially handguns and military style weapons. Guns are a preventable cause of substantial mortality and morbidity worldwide. Dare and colleagues4Dare AJ Irving H Guerrero-López CM et al.Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990–2015: a comparative analysis of vital statistics data.Lancet Public Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2468-2667(19)30018-0Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar estimated that almost 1·8 million firearm deaths between 1990 and 2015 in the USA, Mexico, Colombia, and Brazil countries could have been potentially avoided. The data used by the authors did not enable the calculation of morbidity associated with gun violence, but other studies5Kalesan B Adhikarla C Pressley JC et al.The hidden epidemic of firearm injury: increasing firearm injury rates during 2001–2013.Am J Epidemiol. 2017; 185: 546-553Crossref PubMed Scopus (38) Google Scholar suggest that for every gun death, two to three individuals incur other non-fatal injuries, many of which are associated with substantial long-term disability. According to this estimation, around 5 million non-fatal injuries could have been avoided in the same time period, not accounting for the mental health problems associated with firearms, which are often overlooked. However, these data provide a comprehensive analysis of the burden of firearm deaths in only four countries. The Global Burden of Disease study6Naghavi M Marczak LB Kutz M et al.Global mortality from firearms, 1990–2016.JAMA. 2018; 320: 792Crossref PubMed Scopus (130) Google Scholar suggests that 250 000 gun deaths occur annually worldwide. The burden of gun violence, especially from handguns, falls disproportionately on marginalised and young adults. The sale of firearms benefits corporations and their stock holders, at the expense of minority groups or groups with lower socioeconomic status, who themselves seldom benefit from the profits associated with these sales. Such situations are morally unacceptable. The observation that most firearm deaths occur in young populations adds another dimension: incurring a cost that reaches far beyond the immediate loss, to the disadvantage of societies for decades into the future. Is it then not time for us to consider a world without most guns? Such a call is opposed by arguments against its practicality and the Second Amendment of the United States Constitution. The global community has a history of finding solutions when an approach is deemed worthy of investing in. For example, the number of people who smoke cigarettes in the USA has been reduced by half,8Filion KB Steffen LM Duval S et al.Trends in smoking among adults from 1980 to 2009: the Minnesota heart survey.Am J Public Health. 2012; 102: 705-713Crossref PubMed Scopus (20) Google Scholar and globally, the number of people living in extreme poverty has decreased by four times in the past 40 years.9Roser M Ortiz-Ospina E Global extreme poverty.https://ourworldindata.org/extreme-povertyDate: 2017Date accessed: January 15, 2019Google Scholar These changes were unimaginable in 1980s. A world without most handguns and military style assault weapons might be unimaginable now, but data such as these from Dare and colleagues4Dare AJ Irving H Guerrero-López CM et al.Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990–2015: a comparative analysis of vital statistics data.Lancet Public Health. 2019; (published online May 21.)http://dx.doi.org/10.1016/S2468-2667(19)30018-0Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar support the argument against civilian owned firearms, and prepare for a time when the question is not whether there should be a world without most guns, but simply how can this be achieved. This online publication has been corrected. The corrected version first appeared at thelancet.com on/public-health May 31, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com on/public-health May 31, 2019 I declare no competing interests. Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990–2015: a comparative analysis of vital statistics dataFirearm mortality in the USA, Mexico, Brazil, and Colombia is highest among young adult men, and is strongly associated with race and ethnicity, and low education levels. Reductions in firearm deaths would improve life expectancy, particularly for black men in the USA, and would reduce racial and educational disparities in mortality. Full-Text PDF Open AccessCorrection to Lancet Public Health 2019; 4: e266–27Galea S. Making the case for a world without guns. Lancet Public Health 2019; 4: e266–27—In this Comment, the last sentence of the fourth paragraph should read “The Global Burden of Disease study6 suggests that 250 000 gun deaths occur annually worldwide.” This correction has been made to the online version as of May 31, 2019. Full-Text PDF Open AccessFirearms: the cost of inactionEvery day, an estimated 688 people die from firearm injuries around the world, thousands more are injured, and firearm-related violence darkens the lives of millions who have witnessed it, know victims who have suffered it, or those who simply fear it. Surprisingly, firearm-related violence is not mentioned in the health Sustainable Development Goal (SDG 3). One has to look to SDG 16—promoting peaceful and inclusive societies, for the mandate to reduce all forms of violence and related deaths. The public health community needs to reconcile this counter-productive dichotomy: firearm violence is a public health issue. Full-Text PDF Open Access