Private Guns, Public Health

by David Hemenway

"In this small book David Hemenway has produced a masterwork. He has dissected the various aspects of the gun violence epidemic in the United States into its component parts and considered them separately. He has produced a scientifically based analysis of the data and indeed the microdata of the over 30,000 deaths and 75,000 injuries which occur each year. Consideration and adoption of the policy lessons he recommends would strengthen the Constitutional protections that all of our citizens have to life, liberty, and the pursuit of happiness."
-Richard F. Corlin, Past President, American Medical Association

"This lucid and penetrating study is essential reading for anyone who wishes to understand the tragedy of gun violence in America and-even more important-what we can do to stop it. David Hemenway cuts through the cant and rhetoric in a way that no fair-minded person can dismiss, and no sane society can afford to ignore."
-Richard North Patterson, novelist

"The rate of gun-related homicide, suicide, and accidental injury has reached epidemic proportions in American society. Diagnosing and treating the gun violence epidemic demands the development of public health solutions in conjunction with legislative and law enforcement strategies."
-Kweisi Mfume, President and CEO of NAACP

"In scholarly, sober analytic assessments, including rigorous critiques of NRA-popularized pseudoscience, David Hemenway constructs a convincing case that firearm availability is a critical and proximal cause of unparalleled carnage. By formulating such violence as a public health issue, he proposes workable policies analogous to ones that reduced injuries from tobacco, alcohol, and automobiles."
-Jerome P. Kassirer, Editor-in-Chief Emeritus, New England Journal of Medicine, and Distinguished Professor, Tufts University School of Medicine

"As a former District Attorney and Attorney General, I know the urgency of providing safe homes, schools and neighborhoods for all. This remarkable tour-de-force is a powerful study of one promising a data-rich, eminently readable demonstration of why we should treat gun violence as an American epidemic."
-Scott Harshbarger, Former Attorney General of Massachusetts, President and CEO of Common Cause


On an average day in the United States, guns are used to kill almost eighty people, and to wound nearly three hundred more. If any other consumer product had this sort of disastrous effect, the public outcry would be deafening; yet when it comes to guns such facts are accepted as a natural consequence of supposedly high American rates of violence.

Private Guns, Public Health explodes that myth and many more, revealing the advantages of treating gun violence as a consumer safety and public health problem. David Hemenway fair-mindedly and authoritatively demonstrates how a public-health approach-which emphasizes prevention over punishment, and which has been so successful in reducing the rates of injury and death from infectious disease, car accidents, and tobacco consumption-can be applied to gun violence.

Hemenway uncovers the complex connections between guns and self-defense, gun violence and schools, gun prevalence and homicide, and more. Finally, he outlines a policy course that would significantly reduce gun-related injury and death.

With its bold new public-health approach to guns, Private Guns, Public Health marks a shift in our understanding of guns that will-finally-point us toward a solution.

Genres: Nonfiction, Politics, Science, Sociology, Law

326 pages, Hardcover

First published February 17, 2004

Reviews

[Roy Lotz · Rating 4 out of 5]

Viewed from abroad, America’s so-called freedom is portrayed as the freedom to sit behind a door with a gun.

Guns were one of my first and longest childhood obsessions. I would ask my mom to buy me encyclopedias of guns, complete with illustrations of pistols, rifles, shotguns, machine guns, assault rifles, and grenade launchers. I learned about the different loading and firing mechanisms, different sorts of bullets and bores, and even about the history of firearms. I had memorized, for example, which guns had been used by each side in World War II. In middle school I even took to designing my own guns on paper.

While my own gun obsession took a predictably nerdy form, in a way it was not at all unusual. First-person shooter video games were and remain intensely popular, and a lot of the fascination comes from the thrill of virtually firing all sorts of exotic weapons. Most action movies have a similar appeal. At one point, all the boys in my neighborhood even acquired realistic-looking airsoft guns, which we would use to pelt one another with little plastic pellets. (When white children do this, the cops aren’t called.)

But it was only when I had graduated high school that I held a real gun. It was just a .22 caliber practice rifle, which we used to shoot a few soda cans. Even so, I remember the powerful and disturbing sensation of knowing that the only thing between safety and injury was a mere twitch of the finger. Contrary to my childhood fantasies, the reality was not something I much cared for.

Gun culture in the United States is odd by any standard. With less than 5% of the world’s population, American civilians own nearly half of all the firearms on the planet. There are more guns than people; and this, despite the fact that only about a third of the population owns a gun. Nowhere else in the developed world is close, and nowhere else has gun ownership become such a divisive and persistent issue.

David Hemenway, the director of the Harvard Injury Control Research Center, wrote this book to inject some reason and data into the conversation. This book is filled with study after study—mostly statistical analyses—that all aim to prove a simple point: that guns are a threat to public safety. To most people living elsewhere in the world, this point will probably seem blindingly obvious; but it is just such a point that is debated incessantly in America.

One of the most common arguments in favor of guns is that they can be used in self-defense, and thus protect citizens from criminals. But having a gun in the house also introduces different sorts of risks. For one, there is the question of gun accidents. This can take many forms. Guns can be dropped and misfire, or can be fired in the mistaken belief that they are unloaded. Tragically, many young children die while playing with guns that have been unsafely stored. And then there is suicide. Studies have shown that a substantial portion of suicides are impulsive decisions made in a moment of crisis, not carefully-planned acts. This means that having access to a deadly weapon in a crisis can dramatically increase the chances that a suicide attempt results in fatal injury. Added to this are mistakes that turn deadly:

A fourteen-year-old girl jumped out of a closet and shouted ‘Boo’ when her parents came home in the middle of the night. Taking her for an intruder, her father shot and killed her.

Yet maybe the increased risks from accident and suicide are balanced by decreased risk from criminality? The evidence is not encouraging. Hemenway finds no evidence to support the notion that gun ownership acts as a deterrent for criminals. He also finds surprisingly few examples of guns being used to successfully ward off robbers. Indeed, studies show that the safest thing to do in the event of a robbery is to call the police and run away (not necessarily in that order). What is more, in evaluating the policy of allowing guns for self-defense, we also must factor criminal access to guns—that a robber is more likely to be armed.

Another argument in favor of guns is that regulations will only stop the “good guys” from getting guns, not the “bad guys.” This argument is unconvincing for many reasons. For one, the population of the world is not so easily divided into good and bad people. Take, for example, the couple who threatened Black Lives Matter protesters with their guns last July. Were they good guys or bad guys? According to the law, they were committing a felony; yet according to the Republican Convention, they were acting heroically. This is a silly example, but it does show how many illegal uses of fire-arms are considered “self-defense” by the users.

This argument is also unconvincing because the weight of evidence is all on the other side. In states where there are stricter gun laws there are fewer guns. In countries with stricter gun laws, it is far less likely that a criminal will be able to purchase a firearm. This is obvious as soon as one leaves the United States. Indeed, the truth is that “bad guys” all over the world are often able to get guns due to our lax gun laws. Most of the guns used in criminal activity in strict states like New York come from permissive states like Florida; a third of the guns in Japan from the United States. In short, while we worry about drugs and gangs entering our country, lethal weapons have been illegally leaking out.

But the sticking point is always the Constitution—specifically, the Second Amendment, which guarantees the “right to keep and bear arms.” Yet Hemenway convincingly shows that this amendment was not written to guarantee individuals the right to buy guns, but in part of a larger debate about standing armies. After all, the amendment begins: “A well regulated Militia, being necessary to the security of a free State… .” One must remember that the United States Constitution was written to replace the Articles of Confederation, which gave too much power to the individual states at the expense of the federal government. This amendment seems to have been a way of placating the Anti-Federalists, who wanted to maintain the states’ right to have their own militias.

The amendment was actually interpreted along these lines—as guaranteeing the right to state militias—up until 2008, when the Supreme Court first decided that the right does indeed extend to individuals. (In my opinion, the constitutional wording is almost incoherent if meant to apply to individuals, but I am no legal scholar.) Nevertheless, that decision still conceded the government’s right to regulate the sale and purchase of firearms; so there is no legal reason why we could not enact more sensible regulations.

Still, a common pro-gun argument goes that civilian gun-ownership is a major check on government tyranny. It is difficult to see the logic in this argument. For one, the government has tanks and fighter jets, so this is not even realistic. And of course people living all over the world, in places with far fewer guns, enjoy the same civil liberties as Americans do. Indeed, as the opening quote shows, most non-Americans consider an armed society substantially less free, since freedom is incompatible with the threat of violence. One could even make the argument that civilian firearms directly threaten freedom, since they give government forces a pretext for violent action.

Besides, there is no historical evidence that the founders even thought this was desirable. Shays’ Rebellion was an armed revolt against the government on behalf of debtors, led by a Revolutionary War veteran. The revolt was put down by the state government after the nascent federal government could not raise enough money, which further exposed the weaknesses in the Articles of Federation. In short, far from inspiring the founders, this armed rebellion likely goaded the founders to further empower the federal government.

Some years later, during the presidency of George Washington, there was another armed revolt: the Whiskey Rebellion, so named because it was against the taxation of whiskey. Far from supporting this citizen justice, Washington rode out himself at the head of an army, accompanied by Alexander Hamilton, to put it down. (Luckily, the rebels dispersed before any fighting.) If these examples do not show the founders’ attitude towards armed civilian uprisings, then I am not sure what could.

To cut this short, American gun laws are extremely lax by world standards. Meanwhile, the evidence suggests that guns do not help keep people safe, but precisely the reverse. And there does not appear to be any legal reason why we cannot improve the situation. Even the American public broadly supports gun restrictions, such as mandatory background checks, closing legal loopholes, and improving gun design to make accidents less likely. This has been shown in survey after survey. And yet, despite all this, there does not seem much hope of significant change.

Although gun control is not the most pressing issue facing the United States (the list grows daily), I think that the issue does crystalize one of the most frustrating and depressing aspects of American political life: our inability to make progress on issues that do (or should) have broad consensus. Like so many problems—climate change, abortion, and recently COVID-19—guns have been fully assimilated into the American culture war machine, which inevitably turns all nuanced discussions into simple pro and against stances. Once this happens, even repeated tragedies seem unable to shake us out of our paralysis.

For me, this was made brutally apparent after the Sandy Hook school shooting. Even the cold-blooded murder of children was not enough to cause meaningful change. By the time of the Stoneman Douglas high school shooting, six years later, the culture war had polarized the issue so greatly that the two sides were not even living in the same universe anymore, as we can see from the many conspiracy theories claiming that the entire tragedy was somehow faked. As one thousand Americans die per day from the virus, and as wildfires rage and hurricanes batter the coast, this same dynamic plays out again and again—threats to public health that we are unable to address due to the culture war machine.

I find David Hemenway’s contribution to this issue to be both compelling and strangely touching. He has held onto the belief that he can change people’s minds using statistics, and that he can steer the conversation away from simple pro and against stances to a more nuanced discussion based on shared interests and values. Yet such a book as this—written dispassionately, full of careful reasoning and research, devoted to the public good—seems particularly unlikely to make a significant impact. And that, perhaps, is the most depressing fact of all.

[Jeanne · Rating 4 out of 5]

Private Guns, Public Health is not a book that I would normally pick up. Guns? Where I grew up, guns were only owned by “bad” people. Where I currently live, guns are owned by many (hunting is big). I read Private Guns as a prayer to the students and adults killed at Uvalde – and the victims and survivors of the many shootings in the US so far this year.

Private Guns is a heavily researched and pretty nerdy book – and very well written, such that none of us in our admittedly nonrandom group complained about its nerdiness. David Hemenway addressed the holes in the research: cannot easily perform randomized control trials, which means the research is often messy and plagued by confounds. (If you plan to read this book, also read Appendix A, which addresses problems in design.)

Nonetheless, Hemenway tells a clear story. In the US, there are more gun-related suicides than both homicides or accidental injuries. It is more dangerous to live in a high gun-owning state or country than a low gun-owning state or country. In fact, as of 2010, it was 11.2 times as likely that a 5 to 14 year-old would die of a gun-related suicide as in 33 other high income countries. They were 11.2 times as likely to die from gun-related homicides and 12.2 times as likely to die from unintentional gun deaths. Rates of homicides and suicides using other means were similar between the US and other similar countries. Guns increase the lethality of suicide and homicide attempts. In fact, guns make people less safe in their homes.

In the US, we often frame our conversations as dichotomies: good/bad guys, mental health/not. As a result, the National Rifle Association (NRA) and others have been able to frame the argument such that we must control people, not the context or the gun. Hemenway, however, argued that we should treat gun violence as a public health issue, much like we did for car accidents, tobacco, or alcohol. We don’t need to outlaw all guns, but make them safer for all (e.g., change the gun designs, mandate gun safes, encourage parents to ask other parents to ask about guns in the home).

My only complaint about Private Guns, Public Health is that the 2017 version, the one I read, is largely unchanged from the earlier 2004 edition. I first thought that Hemenway had stopped publishing. He hadn’t. It certainly isn’t that the data are unchanged; in fact, it appears that gun violence is worse and attitudes towards guns in the US have become more benign.

The US needs an updated version of this book. Our politicians, journalists, and everyday citizens need to read it.

[Mari · Rating 5 out of 5]

If you are someone who is concerned about how the impact of gun violence is affecting our world, then this book is for you.

This book takes a non-debatable, research-based and statistical look at how private gun violence smothers and affects the medical community, local communities, and families.

An eye-opening book that will, at the very least, make you want to ask before your child goes to a friend's house to play, "Is there a gun in the house?"

The statistics are non-evaluative (not pro gun, nor anti gun), but they are what they are, and they will inspire you to take a stand against rampant gun violence.

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[RYD · Rating 4 out of 5]

Flip to pretty much to any page of this book, and you'll find a statistic that shows how screwed up America's approach to guns is. I especially appreciated author David Hemenway's focus on gun-related suicides and accidental deaths and injuries, two topics that are often neglected during the U.S. debate on unlimited gun ownership. This book makes a compelling case for how, through rational steps to make guns safer, we can prevent harm that to gun advocates is merely inevitable.

[T-bone · Rating 4 out of 5]

I love guns. Some of my best friends are guns. But like any friend, guns are dangerous and need strict regulation. This book summarizes research data from a wide range of studies and frames the argument over gun control in the US in a public health policy context, where it belongs. The large volume of statistical evidence doesn't make it a thrilling read, but the argument is irrefutable. As with cars and tobacco, better regulation of the manufacturing, sale and use of guns will save thousands of lives every year. The gun lobby, not popular opinion or the constitution, is the only thing standing in the way.

[Dan Slimmon · Rating 3 out of 5]

Most of this book is spent summarizing the results of various studies on the public health dangers of gun prevalence. That was interesting for a while, but it ended up being too dry and wonky (even for me, and I'm not one to shy away from wonkiness).

But when I skipped ahead to the last few chapters, I found some very compelling arguments. Hemenway expertly synthesizes the immense wealth of evidence with incisive cultural criticism. Although I'll never be a single-issue voter, this book has convinced me to place a lot more weight on the issue of gun regulation.

[Paul Froehlich · Rating 5 out of 5]

More than half a million Americans committed suicide by firearm from 1965 to 2000. That is one of the reasons guns are a serious public health problem. It is no surprise that one of the foremost experts on public health makes the case for a public health approach to guns.

David Hemenway is Professor of Health Policy at the Harvard School of Public Health.
Hemenway makes it clear upfront is that his goal is not to ban or to confiscate firearms. "Public health is pro-health; it is not anti-stairs, anti-swimmimg pools, anti-cars, or anti-guns."
Besides, gun ownership is a 
constitutional right, so there is no chance of a broad ban. 

Instead, he advocates the same public health approach that our society takes with other serious threats to public health such as motor vehicle crashes, lawn mowers, smoking, drowning, etc.

His basic principle is that harm can be reduced and prevented by making changes in the environment so it's easier for people to choose safety and harder to choose risky. 

One example is the problem of
new teenage drivers, who have  the highest crash rates. An effective policy for 16-year-old drivers is the graduated license. It prohibits driving under the two most dangerous circumstances, namely at night and with a carload of peers. The result has been a 30 percent drop in the teen deathrate.

Applying the same strategy to reduce firearm injuries and deaths is hampered by inadequate data and research. Congress had banned federal funding in firearms research for two decades until 2020. In addition, data on deaths and injuries are not uniformly reported nationwide. Without sufficient data and funding, it is difficult to pursue research-tested policies. 

International comparisons should be done with care. Nonetheless, comparing the U.S. to three other developed "frontier" nations is instructive. Canada, Australia and New Zeland have similar histories. When it comes to crime, their rates are as high or higher than in the U.S. with one exception: firearm homicide. In that category, the U.S. rate is several times higher. In addition, children under 15 are nine times as likely to die by a gun accident than their counterparts in the rest of the developed world.

Gun enthusiasts generally prefer to address the illegal or reckless use of firearms with blame and punishment for the perpetrators. This is reminiscent of the auto industry from the 1920s to the 1960s that advocated punishment for bad drivers instead of safety improvements to vehicles. While punishment has a important role, it is not the only tool that can  reduce the problem. Just as safety-belts, padded interiors and air bags reduced traffic deaths, environmental changes reduce firearm deaths.

Another example is how  widespread aspirin poisoning among children was addressed. For years Big Pharma blamed careless parents and proposed parental education as the solution. Aspirin poisoning eventually dropped by 90 percent -- not by punishing or educating parents -- but due to the mandate for childproof caps on aspirin bottles. In other words, the environment was changed to reduce the risks. 

Guns play a major role in suicide in the USA, but it's a topic that gets little attention, despite the large death toll.  
There is a growing body of evidence relating suicide to gun availability. For example, the  Israieli Defense Forces responded to a rise in weekend suicides among young Israeli soldiers by prohibiting them from taking their firearms home. The result was a 40 percent drop in weekend suicides, with no compensatory increase at other times or using other methods. 

In addition, rates of household gun ownership are the "key explanation" for differing suicide rates among cities. "As cancer researchers showed it was virtually impossible for any omitted variable to explain the strong cigarette-cancer connection, firearm researchers have shown that it is virtually impossible for any omitted variable to explain the robust connection between household gun ownership and suicide."

The issue is clouded by a widespread misapprehension, namely that suicidal individuals will inevitably find a way, whether or not guns are readily available. That is true for some chronically depressed individuals. For many others, however, the suicidal impulse is often a fleeting desire, and guns are far more lethal than common alternative methods. Suicidal individuals are often ambivalent about killing themselves, but when acting on a temporary impulse with a gun, few survive. 

Men are more likely than women to use a gun, which accounts in part for four-to-one ratio of male-to-female suicides. Women attempt suicide about three times more often than men, but usually not with guns.

The firearm suicide rate for children 14 and under is 11 times higher than in other high-income countries, while the non-firearm suicide rate is roughly similar.

Comparing five states with the highest levels of gun ownership to five states with the lowest levels, gun suicides were 3.8 times higher in the high-gun states. Based on the evidence, removing firearms from the home, especially where there are adolescents or young adults, is the single most effective suicide prevention measure.

In sum, "all the U.S. evidence continues to indicates that gun availability makes it far more likely that suicide attempters will use a gun and die."

Guns are used in two-thirds of all murders, and the U.S. had a murder rate five times higher than the average for other developed nations during the 90s. High-gun states had three times the homicide rate of low-gun states. The firearm homicide rate for children 14 and under is 16 times higher than the average for other developed countries. The weight of the evidence clearly indicates that "more guns in a community lead to more homicide." 

A main reason people buy guns is for protection. A number of studies, however, find that the risk of gun homicide rises with the presence of a gun in the home. Homicide by other means is not much affected by whether a gun is present.

The U.S. also has a higher rate of gun accidents than peer countries. Fifteen-to-nineteen year olds have by far the highest rate of accidental firearm fatalities. Residents from U.S. states with the highest rates of gun ownership were more than ten times as likely to die from a gun accident than residents of low- gun states. It was 24 times higher for children from ages 5-14 in high-gun states. As one researcher said, "we childproof medicine bottles and swimming pools. But we put loaded handguns in bedroom drawers."

Accidents can be curbed by effective policies, as has been done with lawn mowers, chain saws, and childproof medicine caps. Opposition from the gun lobby prevents adoption of mandatory safety standards to curb accidental shootings. For example, guns could be required to not fire when dropped. They could also be required to have minimum trigger-pull standards to prevent small kids from pulling the trigger. There are several other safety features that are possible -- if they were politically feasible.

Hemenway summarizes findings from several hundred studies. His overall conclusion is that more guns means more gun accidents, more gun suicides and more gun homicides. Here is a small sample of the hundreds of research findings summarized in this book:

▪︎ Handguns, as opppsed to long guns, are used disproportionately in crimes, homicides, suicides and accidents.

▪︎ For every accidental firearm death, there are an estimated 13 victims who are injured.

▪︎ Using guns in self-defense is "quite rare" and does not reduce the likelihood of injury, of burglary or of any other crime. The claim of 2.5 million annual incidents of self-defense "is a vast overestimate."

▪︎ The large majority of firearms researchers believe that a gun  in the home makes it a less safe place rather than a safer 
one.

▪︎  For every unintentional firearm death in the U.S. there are about 40 gun suicides.

▪︎ A cross-national study of 171 countries found that the rate of gun availabilty correlates with guns assaults and gun robberies.

▪︎ The combined death toll from gun accidents and suicides always exceeds homicides.

▪︎ Mental health problems do not account for a significant share of gun crime. A comparison of the U.S., England and Australia found similar rates of mental illness, but large differences in homicide related to gun availabilty.

▪︎ The gun industry makes a consumer product, "but the product is less regulated than that of almost any other consumer product." A variety of safety mechanisms could be required -- except federal law exempts firearms from safety regulations that other products must meet. In addition, gun dealers face weak enforcement of the law due to underfunding of the ATF.

The author critiques studies and assertions by the favorite researchers of the gun lobby, Gary Kleck and John Lott. Hemenway highlights the limitations, mistakes and distortions in their writing.

One major shortcoming of this book is that it was completed in 2003, so much of the data are from the 1990s and earlier. When the second edition came out in 2017, a new preface was added. There is also an afterward from 2006 summarizing research up through 2005. Unfortunately, in the 2017 edition, the data were not updated since 2005, except in the preface. The data from the early 2000s, however, was generally consistent with earlier findings. 

One area of the book that is seriously out of date, however, is its treatment of the Second Amendment, where recent landmark SCOTUS decisions have recognized a constitutional right to have and carry guns. Gun laws have undoubtedly gotten more permissive since the book was written. The SCOTUS will soon tell us whether new regulatory attempts by states will be permitted. 

In short, though the public overwhelmingly favors more effective gun control measures, there is now a judicial barrier to overcome. The other barrier stems from the different levels of intensity and commitment between advocates and opponents of better gun regulation.

All in all, Private Guns Public Health makes a a strong case for prevention by changing the risky environment, not just punishing "bad guys with guns."  The multi-pronged public health approach would more effectively curb the huge toll of gun deaths and injuries. It is better to prevent a gun tragedy than it is to punish the perpetrator after a victim has been crippled or killed.  -30-

[Alex Flynn · Rating 5 out of 5]

I highly recommend this book to anyone that interested in gun policy in America, whether you are for or against greater restrictions. The book takes a public health approach to reducing gun injury and death, and instead of relying on arguments based in rhetoric, conjecture or natural rights it examines the statics about gun violence and injury in America. I think people on both sides of the debate will be enlightened by the findings. As someone in favor of greater restrictions on guns, I was surprised at the actual factors that play into gun access and violence in this country. There are a lot of things which actually don't have much of an impact on violence but have become central to the debate and other things which smaller focused policies can address which would have a much greater impact.

[Dallas Swindell · Rating 3 out of 5]

There’s dichotomy at the heart of Hemenway’s book on the role of public health in one of the most politically controversial industries in the United States. While avoiding making the work overly political, he peels back the arguments of those in favor of less regulation of guns in America with cool statistical accuracy. In doing so, Hemenway is forwarding the point that, “The public health approach is not about banning guns. It is about creating policies that will prevent violence and injuries.” This is his established side of the main dichotomy, standing in contrast to a public and a nation that “has more guns in civilian hands than any other industrialized nation.” The ease of access, and the ubiquitous nonchalance over guns by a large portion of the populace provides the dramatic violence which Hemenway seeks to reduce. The question within the contrast is whether his efforts will fall on selectively deaf ears, engendered to the political ethics they prefer, over the data clearly depicted.

Public Health’s rigorous methodology (depicted by the appendices) is a great asset to Hemenway’s argument. Its legitimization of his cited research is strengthened by Hemenway’s seeming grudge with Gary Kleck, whose own research is repeatedly and thoroughly trounced throughout PG,PH. Hemenway uses Kleck’s conclusions and research to show just how important properly vetted data is in influencing public policy and marketplaces. With the wrong, or incorrectly represented, information on the table America has become a nation where gun sales, manufacturing, and public opinion exist in a fog of obfuscation. From that fog we sow and reap more suicides, more child death, more mass killings, more domestic murders, more violent assault, and more accidental deaths. Confronting those ill gains head on is the point of PG,PH and Hemenway always takes time to address how to do so in his chapter summary sections. The pragmatism he provides in the face of such harrowing data and case studies is the strongest dichotomy within the work. It would be hard to imagine the impact of this book without it.

[Valery]

I don’t know how to rate this book. It’s wonky and deeply researched and dense as heck. I’m glad I read it. I learned a lot about the actual policies that could be implemented in helping to reduce gun violence of all types. “To prevent injuries, it is more effective to build a system that makes it easier for people to act properly, more difficult to make errors, and less likely for serious injury to occur when people behave improperly, inappropriately, or illegally.” We could learn a lot about how to lessen gun violence from the public health approach. I hope we do.

[Tommy George · Rating 2 out of 5]

It's a book that does a great job of presenting the firearm issue from one side. It's clear that the author has an agenda, which is fine, but just know before getting into this book that it is not here to objectively analyze the issue. The book is primarily designed to support a series of arguments aligned with a particular partisan agenda.

[Tommy George · Rating 4 out of 5]

It was a good book and you get a very good understanding of how the author feels about firearms and injury prevention. There is a healthy dose of public health data referenced but it could benefit from more robust representation of opposing viewpoints and a more honest response.

[Ietrio · Rating 1 out of 5]

Theft and robbery as a moral act, more, as an altruist act "for your own good".

[Gregory · Rating 5 out of 5]

Most excellent. Must act

[Deborah · Rating 5 out of 5]

Hemenway’s book offers a fascinating and refreshingly pragmatic approach to the topic of gun-related death and injuries: the public health approach. The described research and proposed corrective measures have much in common with those which revolutionized car safety, resulting in a dramatic decline in automobile-related injury and death within a few decades of implementation.

An important message of the book is that “pro-health” is not “anti-gun” any more than it is “anti-car.” Another is that our solutions to gun-related public health problems cannot be effective in pure terms of “good guys” against “bad guys” any more than our solutions to car-related public health problems could be addressed purely in terms of “good drivers” and “bad drivers.”

While gun-related problems may at first appear quite different from car-related problems, the best solutions may be very similar. For example, while there is inarguably a correlation between fewer cars/ less driving and fewer automobile-related injuries in a population, it is also true that fewer guns/ fewer people carrying guns in a population will correlate to fewer gun-related injuries in that population (when compared to similar populations—i.e. rural to rural, urban to urban, etc). It may not be necessary, however, to reduce gun ownership in order to achieve a meaningful reduction in gun-related injuries and deaths. After all, the impressive gains we’ve achieved in reducing auto-related injuries and deaths have been driven primarily by changes to the product—the car, rather than changes to the driver or driving habits. A particularly interesting chapter of this book discusses a variety of gun safety features which could be inexpensively and effectively deployed, if only gun manufacturers and dealers could be compelled to do the right thing (which will probably require federal standards, just as we experienced in the case of automobile safety). Additionally, just as a combination of public awareness campaigns and government-backed incentives were instrumental in convincing people to trade in their four-wheeled death traps for newer, safer cars, similar campaigns and incentives would probably help to accelerate the process of replacing older guns with safer guns—guns which should not fire when dropped or when the clip is removed; guns which should have standardized indicators to alert a user when a bullet is in the chamber; guns which are “personalized,” so that only authorized users can fire them.

To be clear, the suggestion is not that we should cease to apprehend and punish criminals, but rather that our gun-related problems are bigger than crime; accidental shootings and suicides with firearms should not be ignored. Furthermore, a pro-active and preventative approach renders greater benefits than focusing exclusively on post-event punishment.

A great number of policy options are examined in addition to the product-focused policy option I have elected to describe (mainly because I find it the most innovative and inspiring). I would recommend this book for anyone who takes an interest in the gun debate, regardless of current leanings or impressions.

[Joe Smith · Rating 1 out of 5]

Anyone interested in this subject should read this....then turn around and go read "more guns, less crime" by John Lott. It will give you a great overview of each side of the argument....in my opinion Lott blew Hemenway out of the water.

The major difference in the logic of each book is this. Lott says if you're going to measure the affect of guns and if you're hurting more people with them around, you must measure the TOTAL murder rate....not just gun related murder rates. Why? Because when people know the population could potentially be armed, they are more scared to commit terrible acts such as murder because they know they might get shot. So with guns around there is a deterrant effect that must be considered. How do you measure this accurately? You measure total murder rates before and after guns control laws are in place - IN THE SAME AREA.

Why in the same area? Lott shows how violence even within adjacent counties in the same state can be drastically different...so it's erroneous to take say, Great Britain, and try to compare it to the US. There are different population densities, cultural beliefs and a million other factors that makes this an invalid way to look at the stats. So what do you do? You compare the same geographical location to itself before and after gun control laws are enacted.

So now we look at TOTAL murder rates because we have to see how many lives the deterrant effect of having guns i talked about above is saving. Because what we're trying to do is see how we can save the most amount of lives. It doesn't matter how a murder is committed....if a gun is used or a baseball bat....the person is dead. So what does Lott find? These stats compare the SAME area to each other before and after gun control laws. When gun control laws are lifted and people are allowed to carry firearms....murder goes down, rape goes down, and aggravated assault goes down. Lott then takes it to the extreme and factors in a bunch of different variables that are known to cause shifts in murder rates, such as arrest rates. What does he find? The same conclusion.

So if we're really trying to save the most amount of lives, we should want guns around. Yes, more people die by GUN RELATED deaths when they're around....but when guns are around you SAVE THE MOST AMOUNT of lives because of the deterrant effect that guns have. Total murder rates drop when guns are around...meaning we save the most amount of lives.

[Dimity]

I had to return this to the library unfinished but plan on checking it out to complete it. I find some of the concepts about how gun manufacture could include safety measures and his comparisons to other consumer safety movements more fascinating than the number-soup side of it. Easily accessible read, despite his heavy use of statistical analysis.

[Brian · Rating 4 out of 5]

I can't say enough good things about this book. It's well-written, persuasive, and chock full of relevant data. My only knock against it is that his policy recommendations are pure fantasy (gun registration, one-gun-per-month laws, etc.); though perhaps this is the author making suggestion from a public health perspective without consideration of politics. I can highly recommend this book.

[Dylan · Rating 5 out of 5]

One of the best discussions of science and reason, without propaganda and balderdash. Some of the data is out of date due to its publication in 2016, but for anyone interested in this topic, especially those trying to better understand the landscape of this scientific literature, this is an important read.

[Fred Kohn · Rating 4 out of 5]

Although a bit out of date, still a useful read for anyone interested in the debate about guns in the U.S. The main message I took away from this is that regardless of what you think of gun rights, it is impossible to divorce the discussion about guns from public health.

[Kelly · Rating 5 out of 5]

Great concise review of research on guns & public health