Reducing Firearm Injury and Death: A Public Health Sourcebook on Guns

ISBN 10: 0813524202 / ISBN 13: 9780813524207
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There are few issues more explosive than guns. "Guns don't kill people, people kill people," is an often-heard response to calls for firearm control. But are there ways to make guns safer without placing further restrictions on gun owners? Can guns be engineered to reduce the number and severity of injuries?

This book is about guns and new solutions for addressing problems they create. Trudy Karlson and Stephen Hargarten, two experts in public health and injury control, show readers how guns are products, designed to injure and kill, and how changes in the design, technology, and marketing of firearms can lead to reductions in the number of injuries and fatalities.

Just as innovations in the design and technology of motor vehicles succeeded in creating safer cars, Karlson and Hargarten describe how responsible changes to gun products can reduce the number of serious injuries and fatalities. The injury control perspective illustrates how the characteristics of guns and ammunition are associated with their ability to cause injury and death. It also provides options for how guns can be re-engineered to ensure a greater degree of safety and protection. Reducing Firearm Injury and Death teaches basic facts about guns and gun injuries, and by reframing the problem of firearms as a public health issue, offers hope for saving lives.


From The New England Journal of Medicine: Trudy Karlson is an injury epidemiologist and Stephen Hargarten an emergency medicine physician, both public health professionals who have turned their attention to firearms in the belief that the science of injury control could be usefully applied to reducing the number and severity of gunshot injuries. They offer this work as "the book we wished we had had when we were starting out -- a primer on how guns work, how they cause injury, and on strategies based on the public health perspective for change."

Their faith in this approach is based on an analogy with motor vehicle safety. The injury-control field claims as its greatest success the series of federal regulations requiring motor vehicles to be equipped with passive-restraint devices and other safety features. These regulations follow the teachings of William Haddon, Jr., and other pioneers of this field, who mapped out a comprehensive approach to injury control, moving beyond attempts to improve drivers' performance to include systematic attention to vehicle design and the driving environment. Perhaps in part because of these regulations, the motor vehicle fatality rate (adjusted for age) has declined by 40 percent since 1970. Meanwhile, the firearm fatality rate -- the sum of the rates of homicide, suicide, and fatal firearm accidents -- has been trendless, and firearms now kill nearly as many Americans as motor vehicles.

Skeptics might wonder about the usefulness of this analogy, since most deaths due to firearms are intentional, whereas most highway deaths are unintentional. Requiring trigger locks and load indicators on handguns might cut into the annual toll of about 1600 fatal gun accidents, but these requirements could have no noticeable effect on the more than 30,000 intentional deaths caused by firearms. But the skeptics should read on. Although suicide is probably beyond the reach of product-design regulation, the authors do suggest regulations that could conceivably reduce the homicide rate.

The evolution of small arms is a story of increases in their power, range, accuracy, and firing rate, of the development of projectiles that produce more extensive wounds, and of innovations to make guns easier to conceal and to aim. The fact that there is no government agency with jurisdiction over the manufacture of firearms has left this area to the ad hoc whims of Congress. Congress has at one time or another banned plastic guns, large-capacity magazines, and armor-penetrating bullets, but it has so far left untouched (with minor exceptions) the recent development of cheap powerful handguns that fit into the palm of a hand, and the marketing of laser sights and fiendish flesh-ripping ammunition to civilians. The design of toy guns is regulated by the Consumer Product Safety Commission, but no agency has the authority to regulate the manufacture of real guns.

The authors suggest that litigation may eventually accomplish what congressional action has not, imposing standards on the design of firearms. Plaintiffs have come forward under a variety of legal theories, challenging the marketing of Saturday-night specials, assault weapons, and so forth, though with few and modest successes to date. Another hopeful approach is to sell buyers on personalized guns, ones that will fire only when the shooter is wearing a special ring. Such guns protect the owner from being shot with his or her own gun (a real problem for law-enforcement officers) while eliminating the possibility that an unauthorized person will use the gun. The theft of such a gun (without the ring) would pose no threat to the community.

Most of the book is devoted not to a discussion of policy but to the background necessary to engage in the policy debate. This "primer" on firearms and gun violence provides a quick, well-written review of the firearms-injury problem, of how guns work and how they do their damage, of gun manufacture and sales, and of current gun regulations. The book includes photos and useful details such as prices and characteristics of specific models of guns and ammunition. Interspersed with this factual presentation are brief commentaries providing the "public health implication," explaining why we should care about the prices of guns or the length of their barrels. And there are lighter asides as well, on the etymology of such phrases as "lock, stock, and barrel," "flash in the pan," "going off half cocked," and "hair trigger."

Although the authors' main motivation is to help those who want to promote safer product designs, they are not limited to that approach; true to the injury-control framework, their agenda is quite comprehensive. One theme is that there are a variety of ways to make guns (of any design) harder for dangerous people to obtain: "Our injury control training teaches us the fallacy of the slogan, `Guns don't kill people, people kill people.' As Professor Susan Baker said, `People with guns kill people, people without guns injure people."'

This book should find an audience among advocates, educators, health care workers, and concerned citizens. It is an efficient and interesting introduction for newcomers to the field, and a useful sourcebook for veterans.

Reviewed by Philip J. Cook, Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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