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Commentary: Handguns and health

JUN 2008

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Commentary

 

Handguns and health

On March 18, 2008, the U.S. Supreme Court heard oral arguments in the case District of Columbia v. Heller. The suit, brought by a District resident who wants the right to keep a gun at home for self-defense, challenges the District's very restrictive gun-control laws. The Supreme Court decision is likely to be a landmark.

At the core of the legal case is the ambiguous language of the Second Amendment of the U.S. Constitution. It reads, "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed." In its decision, the Supreme Court has an opportunity to answer two questions. First, does the Second Amendment give individuals a right to own guns, or does that right belong only to members of "a well regulated Militia?" Second, if each person has a right to "keep and bear Arms," then how far can the government go to regulate the ownership and use of firearms?

In addition to the legal issues, the case pits gun rights advocates against the public health community. The case is so important to public health that The New England Journal of Medicine published three editorial perspectives on it on April 3, 2008. All three supported public policies to reduce gun-related death and suffering.

Public health experts are rightfully worried about gun ownership in the United States. Almost 40% of American households contain at least one firearm. About one in six adults owns a handgun. In many states, there are few if any requirements for the training and licensing of gun owners and the registering of firearms that are similar to those, say, for drivers and motor vehicles.

More than half of suicides and homicides in the United States are carried out with firearms. When a gun is in the home, the risk of someone in that household committing suicide or becoming a victim of homicide rises two- to fivefold. Research shows that after a gun purchase, the risk of harm goes up and stays elevated for up to five years. Such statistics are consistent with the experience of mental health clinicians, who know that any individual is capable of becoming impulsive in response to intense emotion or stress. Tragically, action taken with a gun is impossible to take back.

Each year approximately 30,000 Americans die by firearms. The rate is more than 10 per 100,000 people per year, which is the highest in the developed world. It is at least 10 times the firearm death rate in Britain, where gun access is strictly controlled. Hundreds of thousands of Americans have endured nonfatal firearm injuries requiring extensive and costly medical and psychological care.

Most people are never direct victims of gun violence, but many are exposed to news and dramatizations of violent crimes. A common emotional response is to fear becoming a victim and to underestimate the risks of having a gun at home. Thus, the vast majority of gun owners say they have a gun for protection, rather than for sport or as part of a collection. But, unlike police officers or military personnel, many of those looking to protect themselves with a handgun do not have the training or experience to make good judgments in a crisis.

Gun rights activists are deeply attached to their autonomy, and feel they have the skill, the prerogative, and even the responsibility to look out for themselves and to resist paternalism in government. These values are reasonable.

The data indicate, however, that owning a gun is not — on average — a particularly effective way to attain those values.

Whether or not the Supreme Court makes a decision that is in the interest of public health, clinicians will need to continue to study the impact of gun policies and to educate Americans about what it really takes to be safe.

— Michael Craig Miller, M.D.Editor in Chief, Harvard Mental Health Letter