There has been another mass shooting, this one in El Paso, where at least 18 people were killed. This essay originally ran in 2017, after a shooting in Texas church killed 26 people, but the issue is still tragically relevant — and will remain so until America tightens its gun safety policies.

America Has More Guns Than Any Other Country

The first step is to understand the scale of the challenge America faces: The U.S. has more than 300 million guns – roughly one for every citizen – and stands out as well for its gun death rates. At the other extreme, Japan has less than one gun per 100 people, and typically fewer than 10 gun deaths a year in the entire country.

Guns per 100 people The United States stands alone among developed countries: It has by far the highest rate of firearms ownership. 88.8 United States 45.7 switzerland 31.6 Sweden 31.2 france 30.8 canada 30.3 germany 15.0 Australia 11.9 italy 10.4 spain 6.2 England, wales 0.6 Japan Gun murders per 100,000 people America’s private arsenal is six times as lethal as Canada’s, and 30 times worse than Australia’s. 3.00 United States 0.7 Italy 0.5 Canada 0.3 Sweden 0.2 Germany 0.2 Switzerland 0.1 Australia 0.1 England, Wales 0.1 france 0.1 Spain 0 Japan Guns per 100 people The United States stands alone among developed countries: It has by far the highest rate of firearms ownership. 88.8 United States 45.7 switzerland 31.6 Sweden 31.2 france 30.8 canada 30.3 germany 15.0 Australia 11.9 italy 10.4 spain 6.2 England, wales 0.6 Japan Gun murders per 100,000 people America’s private arsenal is six times as lethal as Canada’s, and 30 times worse than Australia’s. 3.0 United States 0.7 Italy 0.5 Canada 0.3 Sweden 0.2 Germany 0.2 Switzerland 0.1 Australia 0.1 England, Wales 0.1 france 0.1 Spain 0 Japan The New York Times | Sources: United Nations Office on Drugs and Crime (gun murders); Small Arms Survey (guns per 100 people) | Murder data for U.S., Canada, Sweden, Switzerland, Australia and Spain from 2015 and latest available for other countries; 2007 data for guns per 100 people.

We Have a Model for Regulating Guns: Automobiles

Gun enthusiasts often protest: Cars kill about as many people as guns, and we don’t ban them! No, but automobiles are actually a model for the public health approach I’m suggesting.

We don’t ban cars, but we work hard to regulate them – and limit access to them – so as to reduce the death toll they cause. This has been spectacularly successful, reducing the death rate per 100 million miles driven by 95 percent since 1921.

Take a look at the history of motor vehicle safety since World War II:

Deaths per 100 million vehicle miles traveled 1946 9.35 8 1968 First federal safety standards for cars 6 4 2016 2 1.18 ’50s ’60s ’70s ’80s ’90s ’00s ’10s Deaths per 100 million vehicle miles traveled 1946 9.35 1950 1968 First seatbelt offered in an American car First federal safety standards for cars 8 1974 55 m.p.h. national speed limit 1993 Car safety ratings introduced 6 1978 Tennessee is first to require child safety seats 1999 Airbags, invented in 1951, become mandatory 1984 4 New York is first to require seat belt use 2000 Mandatory reporting of defects by carmakers 2016 2 1.18 ’46 ’50s ’60s ’70s ’80s ’90s 2000s ’10s ’16 The New York Times | Source: National Highway Traffic Safety Administration

The Liberal Approach Is Ineffective. Use a Public Health Approach Instead.

Frankly, liberal opposition to guns has often been ineffective, and sometimes counterproductive. The 10-year ban on assault weapons accomplished little, partly because definitions were about cosmetic features like bayonet mounts (and partly because even before the ban, such guns were used in only 2 percent of crimes).

The left sometimes focuses on “gun control,” which scares off gun owners and leads to more gun sales. A better framing is “gun safety” or “reducing gun violence,” and using auto safety as a model—constant efforts to make the products safer and to limit access by people who are most likely to misuse them.

What would a public health approach look like for guns if it were modeled after cars? It would include:

Background Checks 22 percent of guns are obtained without one. Protection Orders Keep men who are subject to domestic violence protection orders from having guns. Ban Under-21s A ban on people under 21 purchasing firearms (this is already the case in many states). Safe Storage These include trigger locks as well as guns and ammunition stored separately, especially when children are in the house. Straw Purchases Tighter enforcement of laws on straw purchases of weapons, and some limits on how many guns can be purchased in a month. Ammunition Checks Experimentation with a one-time background check for anybody buying ammunition. End Immunity End immunity for firearm companies. That’s a subsidy to a particular industry. Ban Bump Stocks A ban on bump stocks of the kind used in Las Vegas to mimic automatic weapon fire. Research ‘Smart Guns’ “Smart guns” fire only after a fingerprint or PIN is entered, or if used near a particular bracelet.

If someone steals my iPhone, it’s useless, and the same should be true of guns. Gun manufacturers made child-proof guns back in the 19th century (before dropping them), and it’s time to advance that technology today. Some combination of smart guns and safe storage would also reduce the number of firearms stolen in the U.S. each year, now about 200,000, and available to criminals.

We also need to figure out whether gun buybacks, often conducted by police departments, are cost-effective and help reduce violence. And we can experiment more with anti-gang initiatives, such as Cure Violence, that have a good record in reducing shootings.

Fewer Guns = Fewer Deaths

It is true that guns are occasionally used to stop violence. But contrary to what the National Rifle Association suggests, this is rare. One study by the Violence Policy Center found that in 2012 there were 259 justifiable homicides by a private citizen using a firearm.

Estimated Percent of Households With Guns, by State Hawaii Mass. U.S. AVERAGE: 32% OF HOUSEHOLDS HAVE GUNS R.I. N.J. N.Y. Del. Conn. Ill. States in red have gun death rates above the national average of 10.5 per 100,000 people. Calif. Fla. Md. Wash. N.H. Ind. Ohio Co. Pa. Iowa Minn. Ariz. Nev. N.D. Mich. Va. Ore. N.M. N.C. Tex. S.C. Neb. Kan. Ga. Mo. Okla. Wisc. La. Ky. Utah Ala. Maine Tenn. S.D. W. Va. Ark. Alaska Vt. Miss. Idaho Mont. Wyo. 20% 40% 60% 80% Estimated Percent of Households With Guns, by State Hawaii Massachusetts Rhode Island U.S. AVERAGE: 32% OF HOUSEHOLDS HAVE GUNS New Jersey New York Delaware Connecticut Illinois California States in red have gun death rates above the national average of 10.5 per 100,000 people. Florida Maryland Washington New Hampshire Indiana Ohio Colorado Pennsylvania Iowa Minnesota Arizona Nevada North Dakota Michigan Virginia Oregon New Mexico North Carolina Texas South Carolina Nebraska Kansas Georgia Missouri Oklahoma Wisconsin Louisiana Kentucky Utah Alabama Maine Tennessee South Dakota West Virginia Arkansas Alaska Vermont Mississippi Idaho Montana Wyoming 20% 40% 60% 80% Note: There are no hard data on gun ownership in the United States. This household gun ownership proxy was created by taking a weighted average of the percentage of suicides committed with a firearm — a widely used proxy for firearm ownership — and the hunting license rate in ​each state. ​It improves upon ​earlier models by accounting for the prevalence of hunting rifles, which are typically not used in suicides. The new proxy ​improves the correlation with survey-measured gun ownership from ​​0.80 to 0.95​, ​suggesting increased accuracy. Source: Michael Siegel, Boston University School of Public Health

Gun Law ‘Grades’ and Gun Death Rates The Law Center to Prevent Gun Violence finds that states where guns are more regulated tend to have lower gun death rates. In its grading system, the strongest gun regulations get an “A;” the weakest, an “F.” States in red have death rates above the national average of 10.5. GUN DEATH RATE PER 100,000 U.S. RATE: 10.5 GRADE A Hawaii 2.7 Mass. 3.1 N.Y. 4.2 Conn. 4.9 N.J. 5.3 Calif. 7.4 Md. 9.0 B R.I. 3.0 Ill. 9.0 Wash. 9.6 Del. 10.9 C Minn. 6.6 Iowa 7.4 Wis. 8.2 Pa. 10.4 Mich. 11.0 Ore. 11.7 Colo. 12.2 D N.H. 8.6 Neb. 9.4 Va. 10.3 Ohio 10.3 N.C. 11.8 Ind. 12.3 F Maine 9.4 Vt. 10.2 S.D. 10.3 Texas 10.6 Kan. 11.3 Fla. 11.5 N.D. 12.0 Utah 12.4 Idaho 13.2 Ariz. 13.4 Ga. 13.6 Ky. 13.9 W. Va. 14.5 Nev.* 14.7 Tenn. 15.1 Mo. 15.2 S.C. 15.4 Okla. 15.6 N.M. 15.8 Mont. 16.1 Wyo. 16.3 Ark. 16.5 Ala. 16.8 Miss. 18.3 La. 19.0 Alaska 19.1 Gun Law ‘Grades’ and Gun Death Rates The Law Center to Prevent Gun Violence finds that states where guns are more regulated tend to have lower gun death rates. In its grading system, the strongest gun regulations get an “A;” the weakest, an “F.” States in red have death rates above the national average of 10.5. GUN DEATH RATE PER 100,000 GRADE A F Maine Hawaii 9.4 2.7 Vermont Massachusetts 10.2 3.1 South Dakota New York 10.3 4.2 Connecticut Texas 4.9 10.6 Kansas New Jersey 11.3 5.3 Florida California 11.5 7.4 U.S. RATE: 10.5 North Dakota Maryland 12.0 9.0 Utah 12.4 Idaho 13.2 B Rhode Island 3.0 Arizona 13.4 Illinois 9.0 Georgia 13.6 Washington 9.6 Kentucky 13.9 Delaware 10.9 West Virginia 14.5 Nevada* 14.7 C Minnesota 6.6 Tennessee 15.1 Iowa 7.4 Missouri 15.2 Wisconsin 8.2 South Carolina 15.4 Pennsylvania 10.4 Oklahoma 15.6 Michigan 11.0 New Mexico 15.8 Oregon 11.7 Montana 16.1 Colorado 12.2 Wyoming 16.3 Arkansas 16.5 Alabama 16.8 D New Hampshire 8.6 Mississippi 18.3 Nebraska 9.4 Louisiana 19.0 Virginia 10.3 Alaska 19.1 Ohio 10.3 North Carolina 11.8 Indiana 12.3 *Nevada’s grade of F would improve to a C-minus if a recently passed ballot initiative mandating universal background checks is implemented. So far, the state has failed to do so. Source: Law Center to Prevent Gun Violence.

But the problem is that lax laws too often make it easy not only for good guys to get guns, but also for bad guys to get guns. The evidence is overwhelming that overall more guns and more relaxed gun laws lead to more violent deaths and injuries. One study published in the Annals of Internal Medicine found that a gun in the house was associated with an increased risk of a gun death, particularly by suicide but also apparently by homicide.

In 2015, Gov. Greg Abbott of Texas tweeted that he was “embarrassed” that his state was ranked second (behind California) in requests to buy new guns, albeit still with one million requests. “Let’s pick up the pace Texans,” he wrote. Abbott apparently believes, along with the N.R.A., that more guns make a society more safe, but statistics dispute that. Abbott should look at those charts.

Mass Shootings Are Not the Main Cause of Loss of Life

Critics will say that the kind of measures I cite wouldn’t prevent many shootings. The Las Vegas carnage, for example, might not have been prevented by any of the suggestions I make.

That’s true, and there’s no magic wand available. Yet remember that although it is mass shootings that get our attention, they are not the main cause of loss of life. Much more typical is a friend who shoots another, a husband who kills his wife – or, most common of all, a man who kills himself. Skeptics will say that if people want to kill themselves, there’s nothing we can do. In fact, it turns out that if you make suicide a bit more difficult, suicide rates drop.

Here are the figures showing that mass shootings are a modest share of the total, and the same is true of self-defense – despite what the N.R.A. might have you believe.

EACH SYMBOL REPRESENTS 500 GUN DEATHS IN 2016 AN ESTIMATED 22,000 GUN SUICIDES ABOUT 11,760 HOMICIDES OTHER CAUSES DEATHS IN MASS SHOOTINGS: 456 VICTIMS KILLING PERPETRATORS IN SELF-DEFENSE: 589 1.6% 1.2% SHARE OF ALL GUN DEATHS: EACH SYMBOL REPRESENTS 500 GUN DEATHS IN 2016 AN ESTIMATED 22,000 GUN SUICIDES ABOUT 11,760 HOMICIDES OTHER CAUSES VICTIMS KILLING PERPETRATORS IN SELF-DEFENSE: 589 DEATHS IN MASS SHOOTINGS: 456 1.6% 1.2% SHARE OF ALL GUN DEATHS: The New York Times | Source: Gun Violence Archive

Tightening Gun Laws Lowered Firearm Homicide Rates

For skeptics who think that gun laws don’t make a difference, consider what happened in two states, Missouri and Connecticut. In 1995, Connecticut tightened licensing laws, while in 2007 Missouri eased gun laws.

The upshot? After tightening gun laws, firearm homicide rates dropped 40 percent in Connecticut. And after Missouri eased gun laws, gun homicide rates rose 25 percent.

Connecticut after 1995 law tightening licensing requirements Estimated change in rate of gun homicide –40% Estimated change in rate of gun suicide –15% Missouri after 2007 repeal of license requirements Estimated change in rate of gun homicide +25% Estimated change in rate of gun suicide +16% Connecticut after 1995 law tightening licensing requirements Missouri after 2007 repeal of license requirements Estimated change in rate of gun homicide –40% +25% Estimated change in rate of gun suicide –15% +16% The New York Times | Source: Johns Hopkins School of Public Health

One of the lessons of gun research is that we often focus just on firearms themselves, when it may be more productive to focus on who gets access to them. A car or gun is usually safe in the hands of a 45-year-old woman with no criminal record, but may be dangerous when used by a 19-year-old felon with a history of alcohol offenses or domestic violence protection orders.

Yet our laws have often focused more on weapons themselves (such as the assault weapons ban) rather than on access. In many places, there is more rigorous screening of people who want to adopt dogs than of people who want to purchase firearms.

In these two states, the laws affected access, and although there’s some indication that other factors were also involved in Connecticut (and correlations don’t prove causation), the outcomes are worth pondering.

There Is a Shocking Lack of Research on Guns

There’s simply a scandalous lack of research on gun violence, largely because the N.R.A. is extremely hostile to such research and Congress rolls over. When the Centers for Disease Control and Prevention did try to research gun violence, Congress responded by cutting its funding.

Here is the American toll from four diseases and firearms over the years 1973-2012 – and the number of National Institutes of Health research grants to explore each problem over that same time.

N.I.H. research awards Disease Number of cases Rabies 65 56 Polio 266 212 Cholera 400 129 Diphtheria 1,337 89 Firearms injuries 3 >4 million Number of cases Disease N.I.H. research awards Rabies 65 89 Polio 266 129 Cholera 400 212 Diphtheria 1,337 56 Firearm Injuries 3 >4 million The New York Times | Source: University of Chicago Crime Lab

The Right Type of Training Could Go a Long Way

One approach that could reduce the abuse of guns is better training. As a 13-year-old farm boy in Oregon, I attended a N.R.A. gun safety class (which came with a one-year membership to the N.R.A., making me an N.R.A. alum who despises what that organization has become). These classes can be very useful, and audits found that more than 80 percent cover such matters as checking the gun to see if it’s loaded, keeping one’s finger off the trigger until ready to fire and being certain of the target.

Yet the audits also suggest that trainers are more likely to advocate for the N.R.A. or for carrying guns than for, say, safe storage. This is a missed opportunity, for all classes should cover the risks of guns and alcohol, the risks of abuse with suicide and domestic violence, the need for safe storage, and so on. Here’s what researchers found that the gun classes they audited actually covered:

NOT DISCUSSED PERCENT OF CLASSES WHERE DISCUSSED Trainers encouraged gun carrying 81% 19 Encouraged gun ownership 76 24 Prevent unsupervised access by children 70 30 Encouraged gun use for self-defense 69 31 60 40 Ricochet 60 40 Theft prevention Encouraged membership in gun-rights group 56 44 Legal ramifications of shooting in self-defense 55 45 53 47 Child access laws Recommendation: when not in use, store unloaded 50 50 Recommendation: use gun only as last resort 45 55 Young children and gun accidents 55 45 70 30 Decision-making in crises Theft is important source of firearms used in crime 80 20 Techniques for de-escalating threats 85 15 Recommendation: report stolen firearms 90 10 Watch for signs of suicide in household members 90 10 90 10 Domestic violence risk Topic discussed Percent of classes where discussed Not discussed Trainers encouraged gun carrying 19 81% Encouraged gun ownership 24 76 Prevent unsupervised access by children 30 70 Encouraged gun use for self-defense 31 69 Ricochet 40 60 Theft prevention 40 60 Encouraged membership in gun-rights group 44 56 Legal ramifications of shooting in self-defense 45 55 Child access laws 47 53 Recommendation: when not in use, store unloaded 50 50 Recommendation: use gun only as last resort 55 45 Young children and gun accidents 55 45 Decision-making in crises 70 30 Theft is an important source of firearms used in crime 80 20 Techniques for de-escalating threats 85 15 Recommendation: report stolen firearms 90 10 Watch for signs of suicide in household members 90 10 Domestic violence risk 90 10 The New York Times | Source: David Hemenway, Injury Prevention | The classes studied, some of which were required by law, took place in 7 Northeast states.

A Way Forward: On Some Issues, Majorities Agree

It may sometimes seem hopeless to make progress on gun violence, especially with the N.R.A. seemingly holding Congress hostage. But I’m more optimistic.

Look, we all agree on some kinds of curbs on guns. Nobody believes that people should be able to drive a tank down Main Street, or have an anti-aircraft gun in the backyard. I’ve been to parts of northern Yemen where one could actually buy a tank or an anti-aircraft gun, as well as fully automatic weapons — and that area’s now embroiled in a civil war – but fortunately in America we have agreed to ban those kinds of weaponry.

So the question isn’t whether we will restrict firearms, but where to draw the line and precisely which ones to restrict.

Check out these polling numbers as a basis for action on gun safety:

Agree with the following: Households with no guns Gun households 50% Background checks for all gun buyers 93% 96% Preventing mentally ill from buying guns 89 89 Nationwide ban on the sale of guns to people convicted of violent crimes 88 85 Barring gun purchases by people on no-fly or watch lists 82 84 Background checks for private sales and at gun shows 77 87 Federal mandatory waiting period on all gun purchases 72 89 Ban on modifications that make a semi- automatic gun work like an automatic gun 67 79 A ban on the sale of guns to people convicted of violent crimes would reduce gun violence 61 75 New gun laws will not interfere with the right to own guns 57 71 Congress is not doing enough to reduce gun violence 56 81 Creating a federal database to track gun sales 54 80 A ban on the sale of high-capacity magazines (10+ bullets)* 52 77 Households with no guns Gun households Agree with the following: 50% 93% Background checks for all gun buyers 96% 89 Preventing the mentally ill from buying guns 89 Nationwide ban on the sale of guns to people convicted of violent crimes 88 85 Barring gun purchases by people on no-fly or watch lists 82 84 Background checks for private sales and at gun shows 77 87 Federal mandatory waiting period on all gun purchases 72 89 A ban on modifications that make a semi- automatic gun work like an automatic gun 67 79 A ban on the sale of guns to people convicted of violent crimes would reduce gun violence 61 75 New gun laws will not interfere with the right to own guns 57 71 Congress is not doing enough to reduce gun violence 56 81 Creating a federal database to track gun sales 54 80 A ban on the sale of high-capacity ammunition magazines (10+ bullets)* 52 77 The New York Times | Sources: Pew Research Center survey conducted in March and April (questions on mental illness, no-fly lists, background checks for private sales and federal database); Quinnipiac University National Poll conducted Oct. 5-10 (all other questions) | *A Pew Research Center survey found only 44 percent of gun owners favored such a ban.

Looking ahead, I’m optimistic that there can be progress at the state level, and some of the necessary research funding will come from private foundations. Maybe some police departments will put in orders for smart guns to help create a market.

But the real impetus for change will come because the public favors it. In particular, note that 93 percent of people even in gun households favor universal background checks for gun purchases.

This is the blunt, damning truth: The latest shooting was 100 percent predictable.

After each such incident, we mourn the deaths and sympathize with the victims, but we do nothing fundamental to reduce our vulnerability.

Some of you will protest, as President Trump and others have, that the immediate aftermath of a shooting is too soon to talk about guns, or that it is disrespectful to the dead to use such a tragedy to score political points. Yet more Americans have died from gun violence, including suicides, since 1970 (about 1.4 million) than in all the wars in American history going back to the Revolutionary War (about 1.3 million). And it’s not just gang-members: In a typical year, more pre-schoolers are shot dead in America (about 75) than police officers are.

Yes, making America safer will be hard: There are no perfect solutions. The Second Amendment is one constraint, and so is our polarized political system and the power of the gun lobby. It’s unclear how effective some of my suggestions will be, and in any case this will be a long, uncertain, uphill process.

But automobiles are a reminder that we can chip away at a large problem through a public health approach: Just as auto safety improvements have left us far better off, it seems plausible to some gun policy experts that a sensible, politically feasible set of public health steps could over time reduce firearm deaths in America by one-third – or more than 10,000 lives saved each year.

So let’s not just shed tears for the dead, give somber speeches and lower flags. Let’s get started and save lives.