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Guns, Again.

Posted on March 27, 2018

This month it is hard to write about anything other than gun violence. And yet it is also hard to say anything that has not already been said many, many times, to no avail. It feels futile.

The statistics are staggering: United States residents own more guns per capita than any other country (about 90 firearms per 100 residents), a range of weapons developed with no other purpose than to kill people (not hunting or sport) are easily available, and there are more public mass shootings in the US than in any other country in the world. The gun homicide death rate is much higher in the US, as much as 25 times higher- yes 25- than in other high-income countries. It is hard to argue that the availability of guns and gun deaths are not related, and yet miraculously, revealing how ideology and special interests easily trump fact and simple common sense, many do argue this, and many more appear to believe these arguments.

This is unfortunately a terrain where logical arguments and data have little power. The conversation is driven by beliefs often manipulated and distorted by special interests with little regard for the common good. And yet we need to continue to make the data visible and articulate the logical arguments, if only to support the moral and common-sense argument that easy availability of guns presents enormous social and health risks and very little if any benefit.

The argument against restricting gun availability has, at least as I have seen it most commonly reflected in the media, two core elements. The first is the argument that the true cause of the deaths is not access to guns but the mental health of the person using the gun. This is a classic example of mistaken attribution of causation. Certainly mental health issues are important and need to be addressed. But mental health problems would not lead to gun deaths if guns were not easily available. This attribution of the cause to individual-level factors is what leads us down the sometimes distracting path of mental health screening of potential gun owners, gun locks, and efforts to protect ourselves from the inevitable via lock down drills in schools and sophisticated technological approaches to “contain” the shooter, all well intentioned but not very effective. The most perverse manifestation of this approach is the proposal to arm teachers.

A second argument made by opponents of restricting guns (somewhat paradoxically given that these groups tend not to be big fans of scientific evidence) is the lack of compelling evidence that gun restrictions within the US have had an impact. Of course research in this area has been hampered by real or assumed restrictions on studying the health effects of guns. In addition the challenge of identifying health impacts of minor restrictions to gun access implemented in various US states in the context of the overwhelming availability of guns in the country as a whole is monumental. The nature of the policies that have been implemented (often very limited) and the broader context in which they occur make it very difficult to identify effects using natural experiments, which is the only viable approach, as randomization is unlikely. But do we even need to study this? We have compelling evidence that has been staring is in the face for years: the enormous difference in gun deaths between the US and other high-income countries and the strong association of gun availability with these differences.

This brings me back to whether there is anything new to say. There are no new arguments, just the old powerful ones. But perhaps there are new ways to say them or new people to say them. On Saturday, when I joined the March for our Lives in Philadelphia, I saw one new powerful thing: the high school students, their eloquence, commitment and passion, their no-nonsense approach.

The students linked gun violence to guns, but they also viewed gun violence within a broader picture that does include mental health and discrimination and other interconnected social issues. They showed a sophisticated understanding of causes, and of the complexity involved. But this did not paralyze them. They did not lose sight of the urgency and the simple things we can do now by restricting gun access to stop the deaths. The Philadelphia high school students who spoke came from all backgrounds: white and black, Asian and Latino and straight and gay. These students gave me a glimmer of hope that perhaps we will as a society come to our senses and do the right thing for public health, and for all of us, after all.

Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished Professor, Epidemiology, Dornsife School of Public Health