Opinion A Smarter Way to Reduce Gun Deaths Credit...Aaron Kehoe/Associated Press Give this article

749 Nicholas Kristof By Nicholas Kristof Opinion Columnist Jan. 24, 2023 Graphics by Nathaniel Lash and Stuart A. Thompson Once again the United States is seared by screams, shots, blood, sirens and politicians’ calls for thoughts and prayers. Two shootings in California since Saturday have claimed at least 18 lives, leaving Americans asking once again: What can be done to break the political stalemate on gun policy so that we can save lives? For decades, we’ve treated gun violence as a battle to be won rather than a problem to be solved — and this has gotten us worse than nowhere. In 2021 a record 48,000 Americans were killed by firearms, including suicides, homicides and accidents. So let’s try to bypass the culture wars and try a harm-reduction model familiar from public health efforts to reduce deaths from other dangerous products such as cars and cigarettes. Harm reduction for guns would start by acknowledging the blunt reality that we’re not going to eliminate guns any more than we have eliminated vehicles or tobacco, not in a country that already has more guns than people. We are destined to live in a sea of guns. And just as some kids will always sneak cigarettes or people will inevitably drive drunk, some criminals will get firearms — but one lesson learned is that if we can’t eliminate a dangerous product, we can reduce the toll by regulating who gets access to it. That can make a huge difference. Consider that American women age 50 or older commit fewer than 100 gun homicides in a typical year. In contrast, men 49 or younger typically kill more than 500 people each year just with their fists and feet; with guns, they kill more than 7,000 each year. In effect, firearms are safer with middle-aged women than fists are with young men. We’re not going to restrict guns to women 50 or older, but we can try to keep firearms from people who are under 21 or who have a record of violent misdemeanors, alcohol abuse, domestic violence or some red flag that they may be a threat to themselves or others. Homicides using a firearm

Male perpetrators Female perpetrators 5k 25 to 49 18 to 24 4k 3k 2k 12 to 17 1k 50+ 25 to 49 18 to 24 50+ 0 1980 1990 2000 2010 2020 1980 1990 2000 2010 2020 Source: National Center for Juvenile Justice There is one highly successful example of this harm reduction approach already in place: machine guns. It’s often said that machine guns are banned in the United States, but that’s not exactly right. More than 700,000 of these fully automatic weapons are in the United States outside of the military, entirely legally. Most are owned by federal, state or local agencies, but perhaps several hundred thousand are in private hands. With a background check and permission, members of the public can buy an Uzi submachine gun or a mounted .50-caliber machine gun made before 1986 — even a grenade launcher, howitzer or mortar. To buy a machine gun made before 1986, you need a background check, a clean record and $200 for a transfer tax — a process that can take several months to complete. Then you must report to the authorities if it is stolen and get approval if you move it to another state. To buy a machine gun made after 1986 is more complicated and onerous. None of this is terribly onerous, but these hoops — and stiff enforcement of existing laws — are enough to keep machine guns in responsible hands. In a typical year, these registered machine guns are responsible for approximately zero suicides and zero homicides. So let’s begin with a ray of hope: If we can safely keep 700,000 machine guns in America, we should be able to manage handguns. Keeping Guns Away From Risky People In many facets of life, we’re accustomed to screening people to make sure that they are trustworthy. For example, consider the hoops one must jump through in Mississippi to vote or adopt a dog: How to vote 1. Have your Social Security number or driver’s license 2. Print and complete six-question voter registration form 3. Mail or hand deliver 4. Do this at least 30 days before Election Day 5. Go to polls 6. Produce a photo ID 7. Vote How to adopt a dog 1. Fill out 64-question application 2. If renting, landlord is contacted 3. In-person meeting with entire family 4. Yard fencing and security assessed 5. Sleepover visit with pet 6. Pay $125 adoption fee 7. Adopt the dog And now consider what someone in Mississippi must do to buy a firearm. For a private purchase from an individual, nothing is needed at all, except that the buyer not be obviously underage or drunk. For a purchase from a gun store, here’s what’s required: How to buy a gun 1. Pass a 13-question background check 2. Buy a gun Note: Question counts exclude basic demographic details and contact information. Sources: Mississippi Secretary of State’s Office and Vote.org (voting); Desoto Animal Rescue (adoption); Bureau of Alcohol, Tobacco, Firearms and Explosives (gun purchase) Why should it be easier to pick up military-style weapons than to adopt a Chihuahua? And why do states that make it difficult to vote, with waiting periods and identification requirements, let almost anyone walk out of a gun shop with a bundle of military-style rifles? If we want to keep dangerous products from people prone to impulsiveness and poor judgment, one screening tool is obvious: age. We already bar people from buying alcohol or cigarettes before they turn 21, because this saves lives. The same would be true of imposing a minimum age of 21 to buy a firearm, even in private sales. This may be more politically feasible than some other gun safety measures. Wyoming is one of the most gun-friendly states in America, but it establishes a minimum age of 21 to buy a handgun. Federal law already bars felons from owning guns, and we should go a step further and bar those convicted of violent misdemeanors from possessing guns. Stalking, domestic violence and alcohol abuse are particular warning signs; sadly, only 10 states bar someone from obtaining a gun after conviction of a stalking offense, according to the Giffords Law Center. To keep ineligible people from buying firearms, we need universal background checks. (One study found that 22 percent of firearms are obtained without a background check.) But the even bigger problem is that there is no comprehensive system to remove guns from people who become ineligible. If someone is convicted of stalking or becomes subject to a domestic violence protection order, that person should be prevented from owning or having access to firearms — but that rarely happens in fact. California has some of the better policies in this area, and its overall smart gun policies may be one reason — despite the recent shootings — its firearms mortality rate is 38 percent below the nation’s overall. A pillar of harm reduction involving motor vehicles is the requirement of a license to drive a car. So why not a license to buy a gun? Some states do require a license before one can buy a gun, and researchers find this effective in reducing gun violence. In Massachusetts, which has one of the lowest gun mortality rates in the country, an applicant who wants to buy a gun must pay $100 for a license, be fingerprinted, undergo a background check and explain why he or she wants a gun. If the permit is granted, as it typically is after a few weeks, the bearer can then go to a gun store and buy the firearm. There is then an obligation to store it safely and report if it is stolen. In effect, Massachusetts applies to firearms the sort of system that we routinely use in registering vehicles and licensing drivers to save lives from traffic deaths. Gun registration unfortunately evokes among some gun owners alarm about jackbooted thugs coming to confiscate firearms, which is another reason to work to lower the temperature of the gun policy debate. Learning to Live With Guns Harm reduction will feel frustrating and unsatisfying to many liberals. To me as well. It means living with a level of guns, and gun deaths, that is extremely high by global standards. But no far-reaching bans on guns will be passed in this Congress or probably any time soon. Meanwhile, just since 2020, an additional 57 million guns have been sold in the United States. So as a practical matter to save lives, let’s focus on harm reduction. That’s how we manage alcohol, which each year kills more than 140,000 Americans (often from liver disease), three times as many as guns. Prohibition was not sustainable politically or culturally, so instead of banning alcohol, we chose to regulate access to it instead. We license who can sell liquor, we tax alcohol, we limit who can buy it to age 21 and up, we regulate labels, and we crack down on those who drink and drive. All this is imperfect, but there’s consensus that harm reduction works better than prohibition or passivity. Likewise, smoking kills 480,000 Americans a year, about 10 times as many as guns do, including 41,000 people by secondary smoke. You’re twice as likely to be killed by a smoker as by a gunman. So we regulate tobacco, restrict advertising, impose heavy cigarette taxes, require warning labels, ban sales to those under 21 and sponsor public education campaigns warning young people against cigarettes: “Kissing a smoker is like licking an ashtray.” All this has cut smoking rates by more than two-thirds since 1965; this graphic demonstrates the progress: Long arc of smoking-related deaths Smoking deaths have declined as cigarette warnings, taxes and public health restrictions have reduced tobacco use.

Female Male 90 deaths per 100,000 70 Lung and bronchus cancers 50 30 10 1946 1962 1978 1994 2010 1946 1962 1978 1994 2010 Source: American Cancer Society Likewise, we don’t ban cars, but we impose safety requirements and carefully regulate who can use them. Since 1921, this has reduced the fatality rate per 100 million miles driven by about 95 percent. Alcohol, tobacco and cars are obviously different from firearms and don’t have constitutional protections — but one of the most important distinctions is that we’ve approached them as public health problems to make progress on incrementally. Historically, cars killed more people each year than firearms in the United States. But because we’ve worked to reduce vehicle deaths and haven’t seriously attempted to curb gun violence, firearms now kill more people than cars: Deaths from firearms versus traffic accidents

25 deaths per 100,000 20 Motor vehicle deaths 15 10 Firearm deaths 5 0 1980 1985 1990 1995 2000 2005 2010 2015 2020 Source: C.D.C. Wonder How to Work With Gun Owners One advantage of the harm reduction model is that done right, it avoids stigmatizing people as gun nuts and makes firearms less a part of a culture war. I’m writing this essay on the Oregon farm where I grew up. As I write this, my 12-gauge shotgun is a few feet away, and my .22 rifle is in the next room. (Both are safely stored.) These are the kinds of firearms that Americans traditionally kept at home, for hunting, plinking or target practice, and the risks are manageable. Rifles are known to have been used in 364 homicides in 2019, and shotguns in 200 homicides. Both were less common homicide weapons than knives and other cutting objects (1,476 homicides) or even hands and feet (600 homicides). In contrast to a traditional hunting weapon, here’s an AR-15-style rifle. The military versions of these weapons were designed for troops so that they can efficiently kill many people in a short time, and they can be equipped with large magazines that are rapidly swapped out. They fire a bullet each time the trigger is depressed. It’s sometimes said that the civilian versions, like the AR-15, are fundamentally different because they don’t have a selector for automatic fire. But troops rarely use automatic fire on military versions of these weapons because they then become inaccurate and burn through ammunition too quickly. In one respect, the civilian version can be more lethal. American troops are not normally allowed to fire at the enemy with hollow-point bullets, which cause horrific injuries, because these might violate the laws of war. But any civilian can walk into a gun store and buy hollow-point bullets for an AR-15; several mass shootings have involved hollow-point rounds. Now here’s what in some sense is the most lethal weapon of all: a 9-millimeter handgun. It and other semiautomatic pistols have the advantage of being easily concealable and so are more convenient for criminals than assault rifles are. In addition, there has been a big push toward carrying handguns, concealed or openly — and that, of course, means that increasingly a handgun is readily available when someone is frightened or furious. As this chart shows, handguns have steadily been overtaking long guns in the United States, and that’s one reason guns are killing more people:

Long gun sales used to outpace handgun sales, but that trend reversed around 2014 Coronavirus outbreak Firearm background checks, seasonally adjusted 1.4 million 1.2 Sandy Hook Elementary School shooting Trump’s election 1.0 800k Handguns Obama’s election 600k Long guns 400k 200k 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Source: National Instant Criminal Background Check System. Based on work by Keith Collins and David Yaffe-Bellany. Here’s a look at what kinds of guns are recovered from crime scenes — overwhelmingly handguns. Guns recovered at violent crime scenes

Handguns No caliber recorded .38 cal. .45 cal. 9 mm. .357 cal. .22 cal. .25 cal. .32 cal. .40 cal. .380 cal. Other calibers Shotguns Rifles .22 cal. 12 gauge Assault-style 7.62 .223 Other calibers Other calibers No caliber recorded No caliber recorded Source: The Trace, “Missing Pieces” database on stolen and recovered firearms·Data from the Atlanta, Baltimore, Dallas, Seattle and Wichita police departments, 2010 to 2016. Limited to guns recovered from scenes where offenses were noted as homicides or aggravated assaults. Five of the most common American guns are hunting rifles: the Remington Model 700, the Ruger 77 series, the Winchester Model 70, the Marlin Model 1894 and the Savage Model 11. Yet one study of crime guns recovered by police departments found that only five out of 846,000 were identified as one of these hunting rifles. Thus we should reassure gun owners that we’re not going to come after their deer rifles or bird guns. That makes it politically easier to build a consensus on steps to keep dangerous people from lethal weapons like 9-millimeter handguns. There’s also evidence that gun owners with a military or police background strongly believe in safety training and other requirements for people carrying handguns; any coalition for gun safety needs to work with such moderate gun owners. What About Ammunition Checks, Gun Warning Labels, Insurance Requirements? Public health mostly is not about one big thing but about a million small things. To reduce auto deaths, seatbelts and airbags helped, and so did padded dashboards, crash testing, streetlights, highway dividers, crackdowns on drunken driving and zillions of tiny steps such as those bumps in the highway to help keep dozing drivers from drifting off the road. Likewise, we need countless other steps to address gun violence, and many of these have been under discussion for decades. One promising approach is background checks to purchase ammunition, and this should be possible without creating burdens for gun owners who have already gone through background checks to buy weapons. California under Gov. Gavin Newsom has led the way in this, and early results are encouraging. People often have tried to buy ammunition when they weren’t allowed to own guns, suggesting that plenty of unauthorized people have firearms and that ammunition controls may impede them. Red flag laws are also promising, particularly for reducing gun suicides — which get less attention than homicides but are more common. Red flag laws allow the authorities to remove a gun temporarily from those who appear to be a threat to themselves or others. One academic study found that over 10 years, the Indiana red flag law reduced gun suicides by 7.5 percent. There’s less evidence that red flag laws reduce homicides. Waiting periods and limits on how many guns one can purchase at a time may also help. We also need to crack down on untraceable ghost guns and on firearms made by 3-D printers; ghost guns are already a growing source of weapons for criminals. Another harm reduction approach is graphic warning labels for guns and ammunition. “Health warning labels on tobacco products constitute the most cost-effective tool for educating smokers and nonsmokers alike about the health risks of tobacco use,” the World Health Organization said, so let’s apply the lessons to firearms. One proposed ammunition label has a photo of a bloody face and states that a gun increases the risk of someone in a home being killed. Cigarette taxes reduced demand for tobacco, especially among young people, so how about gun taxes, particularly for 9-millimeter Glocks and other deadly handguns? There’s some evidence that gun demand is very price sensitive: A 1 percent increase in handgun prices historically reduced demand by 2 to 3 percent. So let’s raise handgun prices to cover some of the externalities that firearms impose on society. One study found that each murder costs society about $17.25 million in policing, courts, incarceration, lost productivity and insecurity. If each handgun and AR-15-style weapon had an additional 20 percent sales tax, that would significantly reduce demand and would begin to pay for some of the costs of crime. Or what about insurance? Automobile owners must buy insurance, and pool owners and trampoline owners may pay higher premiums, so why shouldn’t gun owners pay higher rates for higher risks? And why should the gun industry be protected from many liability suits? Economists have proposed one clever idea to raise firearms prices that gun manufacturers might applaud: Impose heavy duties on imported guns and simultaneously give domestic manufacturers immunity from antitrust liability so they could collude and set prices. All this would enable American gun manufacturers to engage in monopolistic price gouging that would reduce sales — and deaths. Given the difference in impact between long guns and handguns, it may also make sense as a harm reduction measure to advise homeowners to trade in their Glocks for shotguns. As vice president in 2013, Joe Biden encouraged homeowners to rely for self-defense on a shotgun rather than an assault weapon, and he said he had advised his wife to respond to an intruder in an old-fashioned way: “Put that double-barreled shotgun and fire two blasts outside the house.” He was denounced on left and right, but he had a point: We would be far better off if nervous families sought protection from a shotgun rather than from an assault rifle or 9-millimeter handgun. For similar reasons, maybe we should ease restrictions on pepper spray. Hikers understand that bear spray is more effective than guns to protect against grizzly bears, and perhaps homeowners could learn the same principle about protecting themselves from criminals. No single approach is all that effective. But gun safety experts think that a politically plausible harm reduction model could over time reduce gun mortality by perhaps one-third. That would be more than 15,000 lives saved a year. What Liberals Got Wrong About Guns I think that it’s primarily conservatives who have been on the wrong side of history in resisting gun safety legislation. But I also think those of us on the progressive end of the spectrum have gotten important things wrong on firearms in ways that have frightened gun owners and impeded progress. First, while the National Rifle Association’s claim that a gun makes households safe is nonsense, it’s also true that some liberals exaggerate the additional risk. Any given car is more likely to kill someone than any given gun. Second, there was too much focus on the guns themselves and not enough on who used them. It’s not that the N.R.A. was exactly right when it said that “guns don’t kill people, people kill people.” But the person matters at least as much as the gun, and the person may be somewhat easier to regulate. “All guns are not the problem,” Thomas Abt writes in “Bleeding Out,” his study of urban violence. “Guns in the hands of the most dangerous people and places are. Consider concealed-carry permits. In the 1990s, when conservative states increasingly allowed gun owners to carry concealed handguns, there was widespread hand-wringing on the left that this would be a bloody catastrophe. The New York Times published a Page 1 article in 1995 citing critics warning of “modern-day Dodge City scenarios in which routine fender-bender accidents could escalate into bloody duels among gun-toting motorists.” False alarm, for the most part. Concealed-carry permits didn’t turn communities into Dodge, because those who went through the permit process were often middle-aged adults with no criminal history and pretty good self-control. (That said, it is a problem when the Supreme Court encourages gun proliferation and when some states now issue permits to almost everyone, but the court still allows some room for regulation.) Third, liberals have focused too much on banning assault weapons rather than on the whole panoply of interventions that may help. What we call assault rifles probably account for fewer than 7 percent of guns used in crimes and only a small share of suicides, and they have repeatedly proved difficult to define. California banned assault weapons, for example, yet manufacturers promptly designed and began selling California-compliant weapons that are almost the same as those that are banned but are technically legal. In any case, even if it were possible to get a new assault weapon ban through the Senate, the ban wouldn’t affect the possibly 20 million or more such rifles already in circulation. The last assault weapon ban, from 1994 to 2004, didn’t slow the sale of such weapons (because of bad definitions) and may have been counterproductive by turning them in some circles into icons of American manhood. Indeed, there are probably now more assault rifles in private hands in the United States than in the armories of the U.S. military. We liberals have become champion marketers for the firearms manufacturers. I still believe in tightly restricting AR-15-style weapons and large-capacity magazines, because they play a significant role in mass shootings, but we shouldn’t lose sight of the reality that handguns kill far more people — and of the need for a broad public health strategy based on evidence. Fourth, we liberals haven’t adequately pursued approaches to reduce firearms violence that have nothing to do with guns. Curbing lead exposure in infants today appears to reduce violent crime 20 years later. Violence interrupters working for initiatives like Cure Violence can sometimes break cycles of revenge shootings. Youth programs like Becoming a Man help as well by producing more mature young men who do better in school and are less inclined to settle an argument by reaching for a .38. Research finds that even better street lighting and conversion of vacant lots into green areas seem to reduce shootings. Counseling and intervention strategies reduce suicides, which constitute a majority of gun deaths. Fifth, we haven’t been as evidence-driven as we should have been. One problem with gun research today is that it’s frequently pursued by people with strong agendas, either pro-gun or anti-gun. Liberals sometimes leap on poorly designed studies if they support our conclusions, in ways that discredit our side. The liberal impulse has sometimes also been to delegitimize all policing because of a history of racism and abuses; in fact, law enforcement contains multitudes, and some police strategies such as focused deterrence, targeting those most likely to use illegal guns, have reduced violence. So let’s learn lessons, for gun violence is at levels that are unconscionable. Just since I graduated from high school in 1977, more Americans appear to have died from guns (more than 1.5 million), including suicides, homicides and accidents, than perished in all the wars in United States history, going back to the Revolutionary War (about 1.4 million). We can do better, and this is not hopeless. North Carolina is not a liberal state, but it requires a license to buy a handgun. If we avoid overheated rhetoric that antagonizes gun owners, some progress is possible, particularly at the state level. Gun safety regulation can make a difference. Conservatives often think New York is an example of failed gun policy, but New York State has a firearms death rate less than one-quarter that of gun-friendly states like Alaska, Wyoming, Louisiana and Mississippi. Gun safety works, just not as well as we would like. Harm reduction isn’t glamorous but is the kind of long slog that reduced auto fatalities and smoking deaths. If gun policy can only become boring, that may help defuse the culture war over guns that for decades has paralyzed America from adopting effective firearms policies. The latest shootings were tragically, infuriatingly predictable. So let’s ask politicians not just for lowered flags and moving speeches but also for a better way to honor the dead: an evidence-based slog that saves lives. 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