In 2009 (the most recent year available in the mortality data base), an estimated 31,000 deaths (about 1.2% of all deaths) were firearm related.  This compares to about 35,000 deaths in car accidents (a tragic number, but one that has declined with improved auto safety), and about 90,000 deaths that have alcohol as a contributing factor. Alcohol is often in a supportive role, assisting both guns and motor vehicles in upping their death totals.  (About 30% of fatal traffic accidents involve drivers with a Blood Alcohol Content of .08 or more. As for guns, studies have found as many as two thirds of suicide victims, using guns, had consumed alcohol (sometimes binging) before shooting themselves, and that alcoholics are at much higher risk of suicide than the general population.)

Alcohol, though, is dwarfed by that other behavioral factor, tobacco use. According to the CDC, more than 400,000 deaths each year have tobacco as a contributing factor, a number which should soon begin to decline with the decades-long decline in smoking.

Guns, then, are one of life’s hazards, but they don’t rise to the level of alcohol or cigarettes in the toll taken, but they do represent a particularly tragic toll on young life and they do place the United States in an outlier position on the gun death rate. The number of gun deaths in the US is tragically and unnecessarily high; for example, the US rate is 25 times the rate in England and about 300 times the rate in Hong Kong. When a death rate is an outlier of that magnitude, it should be considered a public health emergency. (See tables at end of article for statistical details.)

I think that in response to such a high death rate, we need a response comparable to the tobacco crisis identified two generations ago with the 1964 Surgeon General Report.  We need a new statement by the surgeon general, this time on guns, that reads something like the following:

“Gun ownership is harmful to your health. It increases the risk of death or injury in your household by suicide, by homicide and by accidents. As a result, with the full authority of the federal government, I am launching a broad campaign to lower the risks posed by guns to public health, particularly the health of our children and young adults.”

What would be the model of such a campaign?  Again, I think the approach used against tobacco should be the one used against guns.  Such an approach acknowledges how tough the campaign will be, given an industry group dead set against any initiatives that might hurt gun sales, plus the many gun owners who think gun possession is protective of (rather than harmful to) life and limb.

Because of the second amendment, the gun death prevention program would not have as its goal the outlawing of guns, but rather of making gun ownership less ubiquitous and more “targeted.” Gun ownership would be made to seen as unnecessary (for defense of home) and uncool as an urban toy (play sports rather than with guns). But use of guns in hunting or for marksmanship would not be targeted by the campaign.

The results of the anti-smoking campaign

Consider the results of the anti-smoking campaign. When I came of age in the early 60s, about 42% of the adult population smoked, including over 50% of men.  My parents, who did not smoke, thought it impolite to ask house guests not to smoke in their home, and so guests did smoke there.  I recall riding to track meets in a car with the track coach puffing away on one cigarette after another (windows shut) as we drove the 20 or 30 miles to the track meet in the next town.  At the church I attend, in the early 1970s, people were not allowed to smoke in the pews, but could light up in the social area behind the pew—during the service. Even if you didn’t personally smoke, tobacco smoke polluted every public space.

Over the past 50 years the culture has changed decisively against tobacco.  The use of cigarettes has declined from 42% of the adult population being “current smokers” to 21%. The rate is now down to 13% of the population in California, which tends to be a pace setter on social norms.  The educational gradient is quite strong, with smoking now concentrated among those with the least education. Tobacco has become “uncool” and tolerated, if at all, only in strictly defined spaces (outside and over heat vents during cold weather).

The campaign against smoking is and was a broad one: annual reports by the surgeon general, research on strategies to reduce smoking, bans on advertising, anti-smoking advertisements, health warnings on cigarette packs, the big payouts in the tobacco lawsuits which served as a tax on smoking, and actual taxes.

One of several tools used to reduce smoking, then, has been tobacco taxes or their equivalent (the class action settlement), with the result that the average price for a pack of cigarettes has risen sharply relative to inflation and that funds have become available (tobacco mitigation funds) for anti-smoking campaigns targeting youth.

Funding Police Protection for Schools

So how does this apply to guns? The NRA proposed that there should be either armed guards (volunteers) at all schools or that teachers should be armed to help prevent such tragedies in the future.  Given the level of violence in America and the likelihood of additional mass murders while guns remain ubiquitous, I think we should take the NRA suggestion and run with it. But, instead of volunteers (vigilantes), we should use police officers. Police officers, of course, cost money, and the NRA didn’t address funding with their focus on volunteers.

Congress, however, can do funding, if there is a will.  It could fund something like the NRA proposal to defend schools, but using police officers instead of volunteers, by imposing a tax on gun sales and gun ownership sufficient to provide armed police officers at every school in the nation and, in addition, to provide reduced response times to shootings in other public places. That is, the tax could be sufficient to add something like 250,000 to 300,000 extra police officers assigned to guard schools and other public places, but as additions to the local police force.  That many police officers (at a cost of say $75,000 per officer) would run about $20 billion, or maybe $600 per gun-owning household (assuming about 35%-40% of US households own a gun). (The actual tax could be tailored based upon the number of guns owned and their firepower.)

Local officials would be charged with deciding how to deploy the newly hired officers, given some legislative guidelines around response times to emergency situations.

Mitigation Fund

In addition, given that mass murders and shootings in schools are only a small part of the gun death total, an additional tax could be levied to provide a mitigation fund to be used in the Surgeon General’s gun safety campaign.  That fund could be set based upon the number of firearm deaths and wounds in the previous year, and an estimate of the cost of those deaths and injuries to the victims and to the nation (using standard economic models). The mitigation fund would be distributed to municipalities based upon their own contribution to the total, and used to fund gun death risk reduction programs approved at the state or federal level and victim compensation.

As an example, assume the externalities of a gun death (suffering, lost years of life) amount to an average of $100,000 per death victim, and given 31,000 gun deaths (the majority being suicides), then the total raised each year would be somewhere around $3.1 billion a year, or less than $100 per year per gun-owning households.  The two funds would total about $23 billion a year and would grow or shrink based upon perceived need for armed guards, response times, gun deaths, and the like.

Education efforts funded by the campaign would promote gun safety and highlight the risks of gun ownership. Advertising of guns would be restricted, particularly ads that promote guns being used in a “military” way by civilian buyers.  Taxes would make the cost of guns go up, limiting access to young people, but not sufficiently to affect one’s second amendment right.

This approach is unlikely to gain traction at the federal level, but could begin as a state initiative, say in Connecticut. There it would be given a trial run.

The tax initiative would supplement the other types of legislation being proposed, including bans on assault weapons, expansion of background checks to all sales, and tighter requirements for reporting of mental illness.  Over time, gun deaths from homicides, suicides and accidents should decline, without any need to overturn the second amendment.

From the US mortality data base published by the CDC.

                                                        1999                       2009

Gun deaths

Unknown cause                                  324                         232

Legal (law enforcement)                      299                         333

Unintentional                                      824                         554

Homicide                                      10,828                     11,493

Suicide                                         16,599                     18,738

Gun total                                     28,874                     31,350

Motor vehicle total                      40,965                     34,485

From the OECD data base

Annual Homicides per 100,000 residents:

Firearm         Other than firearm     Total    Permissive

gun laws

U.S.                   2.97                        1.58                4.55        Yes

Canada               0.54                        1.04               1.58        No

Switzerland          0.56                        0.40              0.96        Yes

Germany             0.47                        0.70               1.17        Yes

England/Wales    0.12                        1.33                1.45        No

Singapore            0.02                        0.90               0.92         No

Hong Kong          0.01                        0.55               0.56          No

Mexico               3.66                        10.45            14.11         Yes

Columbia          51.77                       10.97            62.74          Yes