Woman mourns at memorial

A woman kneels in front of crosses at a makeshift memorial near the scene of a mass shooting at a shopping complex Aug. 6 in El Paso, Texas.

AP Photo/John Locher

Nation & World

Want to stop mass shootings?

long read

A public-health prescription: Tougher laws, an NHTSA for guns, and politicians who look more like America

The mass shootings over the weekend in El Paso, Texas, and Dayton, Ohio, killed at least 31 people and wounded scores more. Those incidents were just the latest such deadly attacks in the United States, which has tallied more than 250 since Jan. 1, according to a new report by Gun Violence Archive. The group defines a mass shooting as one that claims the lives of at least four victims. David Hemenway, professor of  health policy at Harvard T.H. Chan School of Public Health, director of the Harvard Injury Control Research Center, and author of the 2006 book “Private Guns, Public Health,” has spent much of his career studying gun violence. He spoke with the Gazette recently about what can be done to stop mass shootings. 


David Hemenway

GAZETTE: How do other countries, where mass killings are less common, handle gun issues differently?

HEMENWAY: First, it’s important to recognize the other high-income countries start off with many fewer guns and much stronger gun laws. Second, often when there is a mass shooting in another country it’s a time when everyone is thinking about guns, and it becomes an opportunity to think about what kinds of gun laws are needed. Typically it is a time when countries improve their gun laws, making them stronger, not solely to prevent mass shootings but to also to help prevent other firearm-related problems, such as homicides, suicides, gun robbery, gun intimidations, and gun accidents.

GAZETTE: How do you respond to the suggestion that shooters would be dispatched more quickly and inflict fewer injuries if more people carried weapons?

David Hemenway, professor of health policy at the Harvard School of Public Health, explores ways forward in the wake of two mass shootings in the U.S.

Rose Lincoln/Harvard Staff Photograher

David Hemenway

HEMENWAY: Too many of us watch television shows and movies where guns are the solution to so many problems. The good guy with the gun is the big hero. One huge problem is that so many people in the U.S. are armed who really aren’t well trained. Going to a gun range and shooting a few times does not make you well equipped to deal with violent situations where your adrenaline is going like crazy, your heart is beating a mile a minute, and you have seconds to make the right decision. It takes good training — repetition, practicing over and over — to react to that kind of situation. You can’t, on the fly, suddenly think you are going to be this great hero; instead you could shoot the wrong person, or you could get in the way of the police or others who are well trained and trying to figure out what’s going on. Most people, unless they are with the armed services or a member of the police force, never encounter such violent scenarios. So it’s going to be incredibly rare for you to be in a situation where you could actually do something. Do we really want continuously to train millions of people for an event that virtually almost none of them will ever encounter? Even for something as simple as CPR, continued training is needed. I was taught CPR 10 years ago, but I don’t feel at all confident that I would really know what to do if I was alone and had only seconds to respond effectively. For mass shootings you would have to keep training over and over for the training to be at all effective.

GAZETTE: Some gun control opponents have pointed to mental health issues and violent video games as major factors in the number of mass shootings in the United States. Are those two things more prevalent here than in other countries with lower rates of gun violence, and, if so, why?

HEMENWAY: There are a whole range of things that could play a role in prevention, including better parenting, less racism, better education, more job opportunities. All of these things might have some effect on reducing shootings in the U.S. We should improve all those things. But the most cost-effective interventions involve doing something about guns. For example, as far as we can tell, virtually all developed countries have violent video games and people with mental health issues. There’s no evidence that I know of that shows that people in the U.S. have more mental health issues, especially violent mental health issues. Compared to other high-income countries we are just average in terms of non-gun crime and non-gun violence. The elephant in the room, the thing that makes us stand out among the 29 other high-income countries, is our guns and our weak gun laws. As a result, we have many more gun-related problems than any other high-income country. Every other developed country has shown us the way to vastly reduce our problems. Our guns, and our permissive gun laws, are what make us different than France, Italy, the Netherlands, South Korea, New Zealand, you name it.

GAZETTE: Why does it seem many law-abiding American gun owners fear restrictions like background checks and the elimination of high-capacity magazines, bump stocks, and assault rifles? How would most gun owners be affected by such changes?

“The elephant in the room, the thing that makes us stand out among the 29 other high-income countries, is our guns and our weak gun laws.”

HEMENWAY: The overwhelming majority of American gun owners favor universal background checks, at least that is what they say on survey after survey. Most favor the elimination of military weapons in everybody’s hands. If you asked them whether they feel comfortable with some of the people in this country who own guns legally, they would say “no.” Just as there are some bad drivers, there are also some irresponsible gun owners. A problem is that responsible gun owners have been convinced that there are people out there trying to take away their guns. The U.S. gun lobby has been very effective in preventing changes that might reduce gun sales, regardless of the effect on public health and public safety.

In our work at the School of Public Health we are making gun owners part of the solution. My colleague Cathy Barber is working with gun owners, gun advocates, gun trainers, and gun shop owners. Together they are finding common ground and developing solutions. The first area where they have found much common ground is around suicide. The evidence is overwhelming that a gun in the home increases the risk of suicide. More people die from gun suicide than gun homicide, and the people dying are gun owners and their families. Cathy has helped get gun shops in 20 states to play a role in reducing suicide. One grass-roots education effort includes guidelines on how to avoid selling or renting a firearm to a suicidal customer. To activate gunners, you need the right message and the right messenger. And the right messenger isn’t Harvard or public health professionals, it is responsible gun owners themselves. She is hoping to expand her focus to work on preventing guns from moving from the licit to the illicit market. Gun advocates have great ideas; they know about guns; and they are big into safety, so there are large potential benefits to get them to work together with public health professionals. That’s the goal.

GAZETTE: Will it require some especially savage mass shooting to change the political equation?

HEMENWAY: It doesn’t look like any one mass shooting is going to make the difference. In other countries where there has been a mass shooting, enough conservatives have sometimes been willing to step up and say, “Enough is enough.” That is what happened in Australia. The conservative government said, “Even if we get voted out by our conservative colleagues, we just can’t stand this anymore.” In this country, after mass shootings, very few people on the conservative side are willing to stand up. In public health there have been many great victories, but typically they take a long time. Fortunately, eventually there’s a tipping point.

“You can’t just do one thing. That’s the whole point. It’s like asking what’s the one thing you can do to reduce cancer in the U.S.? There are many things.”

One scenario for a tipping point is if the Republican Party suffers a big enough election defeat. That would be one way that you might see real change. There are also other ways, and there are a lot of things happening since the Parkland high school shooting in 2018 that suggest we may be nearing a tipping point. At least we are finally moving in the right direction. For example, we now have three states that are funding gun research (New Jersey, California, Washington). I used to only talk to reporters after mass shootings; now they call all the time to talk about many other various aspects of the gun issue. We now have The Trace, a daily journalism outlet devoted to gun-related issues in the U.S. There are also many new researchers who have begun studying gun issues. This year I am getting at least two requests a week to review journal articles about guns — because there are so many new researchers writing about it, so that’s a real plus. And, for the first time in 20 years we have Democrats who want to talk about guns. Finally, there is also the sense that gun violence is hitting home more in white suburbia, and I think that could push change forward. Interpersonal gun violence is still focused in cities in the U.S., and often involves underrepresented communities who have little political or social power. But with the increase in public mass shootings, often it’s white people and upper-middle-class children who are at risk. Getting more women involved in trying to help reduce gun violence is a way forward. Women are so much better at understanding gun issues than men, because for men it’s somehow bound up with notions of virility and masculinity and protecting the home.

GAZETTE: What is the one most important thing to do?

HEMENWAY: You can’t just do one thing. That’s the whole point. It’s like asking what’s the one thing you can do to reduce cancer in the U.S.? There are many things. Some might say you could ban smoking, but there is a lot of cancer among nonsmokers, and banning smoking wouldn’t stop smoking and will create black markets. It’s a bad policy. Instead the public health approach is focused on harm reduction. So if we are going to have lots of guns — which we clearly are for the next 50 years at least — we have to do lots of things. One of the many big success stories in injury prevention has been the reduction in the rate of motor vehicle deaths. Years ago, when I worked for Ralph Nader, if you had asked me for the one big thing to improve motor vehicle safety I would have said the airbag. The airbag is great, but it only reduced motor vehicle deaths by about 10 or 11 percent — it doesn’t save pedestrians or bicyclists and hasn’t been effective in rollovers. Yet overall, since I got my first driver’s license, motor vehicle deaths per vehicle mile have fallen over 85 percent — because we did lots and lots of things. And if we are going to have lots of guns, that’s what we need. If I were required to pick one thing we should do that’s semi-feasible I would say licensing of gun owners and all that entails, including strong background checks, and only allowing firearm sales to a licensed owner. More broadly, we need something like a National Highway Traffic Safety Administration for guns, which would address the issue in a range of ways.

GAZETTE: Are you hopeful things can change?

HEMENWAY: I am always hopeful. I am in public health, and there have been so many success stories in public health through the years. The world is safer than it used to be thanks to efforts by people in public health and many others. In so many of the successes there was strong opposition. When I wrote my book about 64 successes in injury prevention [“While We Were Sleeping”], in virtually every one there were people fighting against the advance, tooth and nail. And yet somehow, over time things tipped, and lives were saved and continue to be saved. In the 1980s one of the few scholars doing public health injury-prevention work wrote that the U.S. would never have seat-belt laws and that we would never get seat-belt use over 20 percent. Then 10 years later it was at 90 percent. Things change; beneficial change can happen. One thing that will make a difference is when the federal and state legislatures look much more like the people in this country. Right now they look like gun owners, largely white males. And that’s who runs the country. The people who are more reasonable about guns are women and minorities and others, but they aren’t as well represented. I think when that changes, we may see real changes in gun policies and social norms, and real reductions in violent death.

Interview was edited for clarity and condensed.