Examination of raw data as well as multiple academic studies support the link between widespread gun ownership and increased gun violence across both countries and states. The US exhibits by far the largest per capita gun ownership and gun-related death rate of any other industrialized Western democracy. With US citizens already in possession of nearly 300 million firearms, the current debate should include the broad-based interpretation of the Second Amendment, promulgated by the gun lobby, regarding our country’s current size, urbanization, and technological advancements in weaponry.

The very first stopping point in the assessment of product safety is a summary of deaths. It is considered a hard endpoint, readily measurable, and is the penultimate negative outcome associated with product use. My career was spent in generating and evaluating data regarding the benefit/risk of products in a regulated healthcare industry; progressed into senior executive positions, consulted for multiple corporations in the area, was paid well for the work, and have been before government regulators on multiple occasions regarding issues of product safety and analyses of what is known as benefit/risk assessment, i.e., do the benefits of a product outweigh the risks and what do we need to do to minimize risk. It is from the perspective of gunfire death and injury being a public health issue that I engage on the topic of gun regulation. These products carry a death rate associated with ownership and hospitalize people due to injury, some experiencing life-long debilitation, physical and/or psychological. So despite claims by the NRA to the contrary, gun ownership, even legal gun ownership, has been shown to impact public health.

Regarding guns, the data are overwhelming that the US experiences a grossly disproportionate loss of life to gunfire than other wealthy industrialized countries. This holds true whether we look at the general population or the subset of children. Yet guns are virtually the only consumer product not regulated for health and safety. And frankly, had I taken a team before government regulators and stated that the solution we proposed to the gunfire death and injury issue in this country is not to impose regulation, but rather increase public exposure to the product (as is the direction of the NRA), we would have been laughed out of the room. Actually, the response would have been one of indignation to such a suggestion.

In large part the gun debate in America revolves around the issue of protecting/defending oneself. But there is much loss of life reported in America that is outside of that intended purpose. In the trade, that falls under what is known as product abuse potential. These deaths include non-self defense killings and suicides. Additionally, a high rate of accidental deaths have also been reported for the product, including in children. Whereas it is easy to measure the deaths from product abuse and accidental events, it is difficult to measure the intended benefit of the product – protection. Even if such benefit exists, it would have to be enough to offset the considerable number of unintended deaths. And assuming such a level of benefit exists, there is a high price being paid in our country, a price that is not incurred in other wealthy industrialized countries.

What has reignited the gun debate in this country are the deaths and injuries associated with several mass shootings this past year, especially one where 20 youngsters aged 5-6 lost their life while attending their school. But the safety issue with guns goes beyond just mass shootings. Such incidents are but a small contributor to the overall loss of life to gunfire in this country – deaths from mass shootings are but a subset. So the point becomes how do we reduce deaths from gun violence overall. Unless we address the larger issue we will likely keep the door open for additional mass shootings.

The one piece of information that stands out, whether we look at the raw data or the academic literature, is that there is a link between the level of gun ownership and gun violence across both countries and states. More guns have not made us safer. This will be reviewed below. And where this is important is that if we are considering legislation intended to reduce the number of deaths and injuries from gunfire in this country, such decisions should be data driven, not speculative, and hopefully more than just a bandaid. Will placing a ban on assault weapons, high capacity ammunition clips, and requiring mandatory background checks be effective in markedly reduce gun violence in America? Wayne LaPierre (NRA CEO) claims that measures like a weapons ban has not worked before. But the direction he would have us go, increasing firearm exposure, is in exactly the opposite direction of what the data say. In effect, he may be talking his way right out of his claimed inalienable right to keep and bear arms to defend oneself; or least he should be.

Raw Data

The data displayed below comes from time periods in the 1990s to more recent years. Despite not finding an integrated summary for any one specific year, the data regarding level of gun ownership and firearm death rates across countries are compelling.

Number of Guns per Capita by Country

A chart displaying the number of guns per capita (number of privately owned small firearms divided by the number of residents per country) is provided here and graphically depicted below. As some individuals may possess multiple weapons and others possess none, the numbers do not represent the percentage of people who own guns in these countries. The margins of error in this reporting are said to be considerable. But the US being ranked for having the highest number of guns per capita is said to be unambiguous. The US possesses 88.8 guns per 100 residents. For purposes of later discussion, countries that imposed tight restrictions on gun ownership exhibit, not unexpectedly, much lower gun per capita figures than that of the US: Japan (0.6/100, US rate being 148 times larger); England/Wales (6.2/100, US rate being 14 times greater), and Australia (15/100, US rate being 6 times greater) – see chart in above link for complete display of countries.

Firearm-Related Death Rate by Country

A historical list of countries by firearm-related death-rate per 100,000 population in one year is provided here. The US rate of firearm deaths (10.2/100,000) is ten times that of Australia (1.05/100,000), 40 times that of the United Kingdom (0.25/100,000), and 145 times that of Japan. Although this source did not graphically depict these data, a graph of such data follows.

This disproportionate loss of life to gunfire in the US general population holds true for children as well. The following depicts gunfire deaths (homicides, suicides, accidental) in US children less than 15 years of age from 26 industrialized countries.

Granted that correlation does not necessarily imply causation. So we move to academic studies on the matter.

Academic Studies

Credit to Ezra Klein’s work on mass shootings for directing me to the information provided from the Harvard Injury Control Center (Harvard School of Public Health). Summaries of various studies have been excerpted and provided below.

Relationship Between Homicide and Gun Availability

1. Where there are more guns there is more homicide (literature review).

Our review of the academic literature found that a broad array of evidence indicates that gun availability is a risk factor for homicide, both in the United States and across high-income countries. Case-control studies, ecological time-series and cross-sectional studies indicate that in homes, cities, states and regions in the US, where there are more guns, both men and women are at higher risk for homicide, particularly firearm homicide.

Hepburn, Lisa; Hemenway, David. Firearm availability and homicide: A review of the literature.Aggression and Violent Behavior: A Review Journal. 2004; 9:417-40.



2. Across high-income nations, more guns = more homicide.

We analyzed the relationship between homicide and gun availability using data from 26 developed countries from the early 1990s. We found that across developed countries, where guns are more available, there are more homicides. These results often hold even when the United States is excluded.

Hemenway, David; Miller, Matthew. Firearm availability and homicide rates across 26 high income countries. Journal of Trauma. 2000; 49:985-88.



3. Across states, more guns = more homicide

Using a validated proxy for firearm ownership, we analyzed the relationship between firearm availability and homicide across 50 states over a ten year period (1988-1997).

After controlling for poverty and urbanization, for every age group, people in states with many guns have elevated rates of homicide, particularly firearm homicide.

Miller, Matthew; Azrael, Deborah; Hemenway, David. Household firearm ownership levels and homicide rates across U.S. regions and states, 1988-1997. American Journal of Public Health. 2002: 92:1988-1993.



4. Across states, more guns = more homicide (2)

Using survey data on rates of household gun ownership, we examined the association between gun availability and homicide across states, 2001-2003. We found that states with higher levels of household gun ownership had higher rates of firearm homicide and overall homicide. This relationship held for both genders and all age groups, after accounting for rates of aggravated assault, robbery, unemployment, urbanization, alcohol consumption, and resource deprivation (e.g., poverty). There was no association between gun prevalence and non-firearm homicide.

Miller, Matthew; Azrael, Deborah; Hemenway, David. State-level homicide victimization rates in the U.S. in relation to survey measures of household firearm ownership, 2001-2003. Social Science and Medicine. 2007; 64:656-64.

1. Across states, more guns = more violent deaths to children

We analyzed the relationship between firearm availability and unintentional gun death, homicide and suicide for 5-14 year olds across the 50 states over a ten year period. Children in states with many guns have elevated rates of unintentional gun deaths, suicide and homicide. The state rates of non-firearm suicide and non-firearm homicide among children are not related to firearm availability.

Miller, Matthew; Azrael, Deb; Hemenway, David. Firearm availability and unintentional firearm deaths, suicide, and homicide among 5-14 Year Olds. Journal of Trauma. 2002; 52:267-75.

2. Child firearm suicide appears more impulsive than suicide by other means (Arizona).

We analyzed data from the Arizona Childhood Fatality Review Team comparing youth gun suicide with suicide by other means. Children who use a firearm to commit suicide have fewer identifiable risk factors for suicide, such as expressing suicidal thoughts. Gun suicides appear more impulsive and spontaneous than suicide by other means.

Azrael, Deborah; Hemenway, David; Miller, Matthew; Barber, Catherine; Schackner, Robert. Youth suicide: Insights from 5 years of Arizona child review team data. Suicide and Life Threatening Behavior. 2004; 34:36-43.



3. Guns are rarely used in infant homicides

This article uses data from various locations to describe the circumstances of infant homicides. Guns are almost never used to kill infants. The perpetrator is virtually always caught, and often is the one calling the police.

Fujiwara, Takeo; Barber, Catherine; Schaechter, Judy; Hemenway, David. Characteristics of infant homicides in the U.S.: findings from a multi-site reporting system. Pediatrics. 2009; 124:e210-17.



4. Parents incorrectly believe their children have not handled the family gun

At family practice clinics in rural Alabama, over 400 parents were separated from their children, and both were asked questions about guns in the home. We found that over 1/3 of parents who reported that their son had not handled a household gun were contradicted by the child.

Baxley, Frances; Miller, Matthew. Parental misperceptions about their children and firearms. Annals of Pediatric and Adolescent Medicine. 2006; 160:542-47.

(Note: The NRA backed legislation that would make it illegal for a physician to question a patient about guns in the home under threat of actually losing the license to practice. Such law went into effect in Florida but was overturned by a federal court as being a violation of First Amendment rights).



5. Unsupervised firearm handling by adolescents often involves shooting the gun

We analyzed data from a telephone survey of over 5,800 California adolescents conducted in 2000-01. We found that one-third of adolescents reported handling a firearm, 5% without adult supervision or knowledge. Smoking, drinking and parents not knowing the child’s whereabouts in the afternoon were associated with unsupervised gun handling. These events usually occur away from home, with friends. Half involve shooting the gun.

Miller, Matthew; Hemenway, David. Unsupervised firearm handling by California adolescents. Injury Prevention. 2004; 10:163-68.

Additional Studies

The Violence Policy Center has provided a compilation of studies linking gun possession and greater availability of guns to increased homicide. (Note: The first study below by Kellerman is the one cited that caused the gun lobby to move on having lawmakers cut off federal funding for firearms research).

1. Gun Ownership as a Risk Factor for Homicide in the Home, Arthur L. Kellermann, MD, MPH; Frederick P. Rivara, MD, MPH; et al, The New England Journal of Medicine, Vol. 329, No. 15, October 7, 1993, pp. 1084-1091.

Using data from three U.S. counties, this study examines risk factors that can lead to homicide in the home. These include firearms availability, illicit-drug use, alcohol consumption, and domestic violence.

Key Fact: The presence of a gun in the home makes it nearly three times more likely that someone will be murdered by a family member or intimate partner.

2. Handgun Regulations, Crime, Assaults, and Homicide: A Tale of Two Cities, John Henry Sloan, MD, MPH; Arthur L. Kellermann, MD, MPH; et al, The New England Journal of Medicine, Vol. 319, No. 19, November 10, 1988, pp. 1256-1262.

This classic study compares the rate of homicides, assaults, and other crimes in Seattle and Vancouver from 1980 through 1986 to determine the effect of handgun regulations on the crime rate. Although similar to Seattle, Washington, in many ways, Vancouver, British Columbia, has a more restrictive approach to handgun possession. This study found that restrictions on handgun access reduce the rate of homicide.

Key Facts:

Although the assault rate was only slightly higher in Seattle than Vancouver, the rate of assault involving firearms was seven times higher in Seattle.

The risk of death from homicide was found to be significantly higher in Seattle than in Vancouver. This excess risk was explained by a nearly five-fold higher risk of being murdered with a handgun in Seattle as compared with Vancouver.

Rates of homicide involving means other than guns were not substantially different in the two cities.

3. Trends in Rates of Homicides in the United States, 1985-1994, MMWR (Morbidity and Mortality Weekly Report), Vol. 45, No. 22, June 7, 1996, pp. 460-464.

Covering a 10-year period (1985 to 1994), this study shows that the increase in homicide from 1985 to 1991 was driven by a jump in firearm homicides among young people aged 15 years to 24 years old. From 1992 to 1994 homicides among persons aged 15 years to 24 years old increased and then stabilized, but remained at record-high levels.

Key Facts:

During the years 1985 to 1994, the percentage of firearm-related homicides among all homicides in the total population increased from 60% to 72%.

In the same period, firearms homicides increased from 67% to 87% among persons aged 15 years to 24 years old.

These increases illustrate that changes in overall homicide rates primarily reflect changes in firearm-related homicides.

Discussion

It is not unusual to find articles speaking against the efficacy of tightening gun ownership in other countries. One such article appeared recently in the Wall Street Journal questioning steps taken by both Great Britain and Australia that markedly tightened gun ownership. In that article terms like an increase in ‘gun crime’, or an example of another mass murder, or police now having to carry firearms in Great Britain for the first time because of armed gangs, are all given as examples of gun regulation not having the desired effect. But it is death that is the very first stopping point in the assessment of safety. If one compares levels of gun ownership across the US, Great Britain, and Australia (the ones discussed in that article) to the reported overall death rate in those countries, it becomes difficult to make the argument that tighter restrictions on gun ownership has not had an impact on substantially lowering gunfire-related deaths. As reviewed above, this observation is supported by multiple academic studies on the matter.

Additionally the argument is made that gun deaths in the US are decreasing. That claim reminds me of Jon Stewart’s statement to Bill O’Reilly that being the sanest individual at Fox News was like being the thinnest kid at fat camp. Yes, gunfire homicides have fallen in the US over the past decade from over 10,000 to a little over 9000. But compare that to the 39 gunfire homicides being reported by Great Britain.

And there are the often cited examples of Switzerland and Israel as being examples of gun toting utopias. But that is largely myth. Switzerland has been moving away from having widespread guns and the laws are determined canton by canton (a canton being like a province). Everyone serves in the military in Switzerland and the cantons used to allow guns to be kept in the home – they are now moving to keep them stored in depots. In Israel it used to be that the military allowed soldiers to take their guns home with them – now they are required to leave them on base. This has resulted in a 60% decrease in suicides on weekends among IDS soldiers.

And the gun lobby cries that if we are to ban certain weapons, why not ban automobiles that claim so many lives, including children. I have extensively considered that argument in other articles (ref) (ref). Automobile and gun-related fatalities are now roughly equivalent in the US, with at least 10 states now reporting a higher number of gunfire-related deaths than auto fatalities. When one considers the disparity of ownership and usage between the two products, guns are actually considerably more unsafe than cars these days. The reason that auto fatalities have so notably decreased? Regulatory intervention and technological improvements – initiatives that have been resisted with guns.

If we are to address the issue of gun violence in this country, we need to understand the underlying precipitating factors. And one is clearly the link between level of gun ownership and gun-related violence. The US has, by far, the largest number of guns per capita and the highest death rate of other industrialized nations.

But the issue this author continually comes back to is what is happening, on a comparative basis, to children in this country. That should be a defining issue in this matter. Children are a protected class and numerous laws exist to their benefit. And the disproportionate loss of life in US children to gunfire has been known for quite some time. Rather than working to curb the effects of gun violence on children, our lawmakers (some, not all) have actually worked to obstruct the generation and availability of information on the matter while expanding public exposure. In doing so, there is little doubt that they have been derelict in their responsibilities as lawmakers regarding the well being of our children.

I am on the side of gun control, not because of ideology, but rather what the data say. I place a higher value on the life of our children, friends, family, etc., than ideologically-driven widespread gun ownership. No doubt advocacy groups will take what they can at this point after years of effort on their part and lack of action by lawmakers. But with upwards of 300 million firearms being held by citizens of this country, will the type of controls being considered by VP Biden’s team (universal background checks, national databases on gun ownership, stiffer penalties for carrying guns near school) bring to parity gun-related fatalities in this country to that in peer nations, including the loss of our children? The data would argue ‘no’.

Part of the debate that the horrific mass shootings last year have reignited, should be consideration of the broad interpretation of the Second Amendment, promulgated by the NRA and the gun lobby, regarding our country’s current size, urbanization, and advancements we have seen to weaponry. To not make that part of the debate is playing ostrich to the much broader issue of gun violence in our country.