A Public Health Approach
to Firearms Policy
An American who dies before the age of forty is more likely to succumb to an injury rather than a disease. The leading cause of injury death in the United States is motor vehicles. The second leading cause of injury death is firearms. In 2001 some 29,500 Americans were killed with firearms in non-war-related events, and about three times that number were wounded seriously enough to be hospitalized. Gun shot injuries are one of the leading causes of both traumatic brain injury and spinal cord injury.
The United States has more firearms in civilian hands than any other highincome nation. About 25 percent of adults in the United States personally own a firearm. Many gun owners have more than one firearm; some 10 percent of adults own over 75 percent of all firearms in the country. The percentage of households with a firearm has declined in the past two decades; about one in three households now contains a firearm.
Among the two dozen or so high-income countries (as classified by the World Bank), the United States is exceptional not only because of the number of firearms in civilian hands but also because so many of our guns are handguns. Our firearm regulations are also relatively permissive. For example, unlike most other industrialized countries, the United States does not have a national firearm licensing or registration system, or laws mandating that all gun owners receive firearm training.
U.S. crime and violence rates—including burglary, robbery, car theft, and assault rates, as assessed in victimization surveys—are comparable to those of other industrialized nations. What is not comparable is our rate of lethal violence, and the majority of our homicides are firearm homicides. Studies show that highincome nations that have more guns have more homicides because of higher rates of firearm homicide (Hemenway and Miller 2000; Hepburn and Hemenway 2004).
Studies comparing U.S. regions, states, or cities also find that areas with more firearms have more homicides, primarily because of higher rates of firearm homicide. The association between guns and homicide holds even after controlling for levels of violent crime, unemployment, poverty, urbanization, and alcohol