Gun Control: A Constitutional(?) Public Health Problem

When I was in medical school a fellow med student and I rented a house together with two law students whom we had known as undergraduates. During a discussion in about 1968 one of the law students said, “The Constitution says what nine old men in dresses say it says.” Today there are women on the court so the statement would have to be modified. In fact, in this age of 5:4 decisions, one might say that the Constitution says what Anthony Kennedy says it says since he is almost always in the majority of any 5:4 decision. The recent ruling on gun control that basically struck down a community’s authority to prohibit handguns was such a 5:4 decision. The Second Amendment 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.” Until now this has been interpreted to mean that the federal government shall not infringe the right of the states to have militias. Now it means that private citizens may not have their right to keep and bear arms infringed by local communities. Recall the gunfight at the OK Corral in Tombstone, Arizona in the 19th century. That was a fight over a local community’s right to regulate gun possession within city limits. Had that fight occurred today, the Earp brothers and Doc Holliday would have been judged to have violated the rights of the Clantons when they went to enforce a local ordinance and disarm them.

So private citizens have a constitutional right to have guns and, in fact, have kept guns at home ever since the United States was founded. Let’s look at the public health consequences. Here are some numbers readily obtainable from the internet. Statistics on gun deaths are spun many different ways by people with different points of view but these numbers are probably close to the truth.

Gun death rate per 100,000

United States: 11.66 (4) Homicide 3.72 (5) Suicide 7.35(1) Accidents 0.59 (3)

US children <15yrs: 1.66(1) Homicide 0.94(1) Suicide 0.32(1) Accidents 0.36(1)

Mexico: 12.07 Homicide 9.88 Suicide 0.91 Accidents 1.27

England: 0.38 Homicide 0.15 Suicide 0.20 Accidents 0.03

The numbers in parentheses indicate the world ranking of the USA in these categories. Mexico has one of the highest murder rates in the world, probably due to drug wars (using American-made weapons, by the way). England has one of the lowest gun death rates in the world at least partially due to their policies restricting gun ownership. England also has a very low non-gun murder rate so maybe the English are now just nicer people than Americans and Mexicans.
To give an idea of the magnitude of gun deaths as a public health problem in the USA, murder by shooting ranks at the same level as a cause of death as drunk driving. Examining the numbers more closely, one can see that, although many people argue that they have guns at home or that they carry guns for protection, the high rate of suicide suggests that guns most often kill their owners. It is also well-known that the most likely person to be killed when there is a gun in a house is someone who lives in that house. Additionally the statistics for gun deaths in children don’t look much like they are being protected. If guns are to be useful for protection, they need to be loaded and easily accessible, the precise condition that makes them more likely to be used in suicide or to cause death by accident or homicide. Although the National Rifle Association publishes lots of stories where gun owners claim that their gun protected them, and incidents such as this undoubtedly happen, the net result of such wide availability of guns appears to be a very high death rate that looks preventable. Notice again the rates of homicide, suicide, and accidents in England. While England is the best, all of Western Europe and Scandinavia have much lower rates in all these categories of gun deaths than the USA. Gun possession is much more carefully regulated in these countries compared to the USA. It is much harder to kill someone with a knife or bat or rolling pin than with a gun.

Some more demographics may be informative. The worst regions in the USA for gun murder rates are essentially the old Confederacy: the east and west Deep South. Nevada, Arizona, and California are also among the ten worst states for gun murders. New England is the best region although South Dakota, Iowa, Hawaii, Idaho, North Dakota, and Oregon are also among the ten safest states. Some people have also pointed out that a lot of gun murders are black on black. Is this supposed to make the problem more understandable or “better?” Whether one takes a racist view of such an observation or notes that poverty is a significant risk factor for untimely death, the wide availability of guns as a critical factor for rich and poor alike cannot be ignored. And, although there are both regional differences and ethnic differences in deaths due to guns, the fact remains that the USA has a very high rate compared to the rest of the world. This is a significant public health problem and, constitutional or not, if we want to ameliorate this problem, we need to make guns of all types, particularly handguns, significantly less available.

Someone once said that a sure mark of insanity was to keep doing what you are doing and expect a different result. Our present views and practice of gun ownership cost us about 30,000 lives per year. This won’t get better unless we change what we are doing.


NRA Lullaby
© Stephen M. Baird, MD 1986, 1987, 2008 (see this version on blog), 2010
(Sung to the tune “God Rest Ye Merry Gentlemen”)

God rest ye merry citizens.
Let nothing you dismay.
Society’s protected by your local NRA.
The guns that should be well-controlled
Are free to circulate,
And Bin Laden could buy one in your state;
In your state;
Even Bin Laden could buy one in your state.

Our Congressmen have passed a bill,
The best you ever saw.
Now just machine guns and bazookas
Are against the law.
So now we can protect ourselves
From every enemy.
But, please tell me who is the enemy,
Could it be that it is folks like you and me?

Think not that you’re protected by
That gun next to your bed.
It only makes it probable
Someone will wind up dead.
For shadows creeping while you’re sleeping
Make you draw your gun
And shoot first then go see what you have done,
You have done.
Who’s the prowler? You’ve just killed your only son.