Troubling Trends: Observations Made While Preparing A Presentation for the American Public Health Association Annual Conference

A Message from the President of Americans Against Gun Violence

October 29, 2020


I had the honor and privilege of being invited to speak on the topic of preventing gun violence at the annual conference of American Public Health Association (APHA) on Monday, October 26, 2020. The APHA, founded in 1872, is the country’s oldest, largest, and most diverse organization of public health professionals. The 2020 annual conference was initially scheduled to be held in San Francisco but was moved to a virtual format because of the ongoing Covid-19 pandemic.

In preparing for my presentation, in addition to consulting many other sources, I read the amicus curiae (friend of the court) brief that the APHA had filed in conjunction with three other medical organizations in the 2008 Supreme Court case of District of Columbia v. Heller. In its brief, the APHA presented extensive evidence in support of the public health benefit of Washington DC’s partial handgun ban and safe storage law. A narrow majority of Supreme Court justices apparently ignored this evidence, though, along with evidence submitted in amicus briefs from numerous other organizations concerning the constitutionality of the District of Columbia’s handgun law. In a 5-4 decision that reversed over 200 years of prior legal precedent, including four prior Supreme Court decisions, the majority ruled  that the partial handgun ban and safe storage law violated the Second Amendment.

In preparing for my talk, I also consulted a gun violence prevention “fact sheet” entitled, “Gun Violence is a Public Health Crisis,” that is currently posted on the APHA’s website. In comparing the APHA’s current fact sheet with its 2008 amicus brief, I noted a troubling trend that I have also observed with many of our country’s other best known gun violence prevention organizations. Even as the epidemic of gun violence in our country has grown worse, the measures proposed by these organizations to address the epidemic have grown more timid.

Americans Against Gun Violence is currently the only national gun violence prevention organization that openly advocates overturning the rogue 2008 Heller decision and adopting stringent gun control laws in the United States comparable to the laws in the other high income democratic countries of the world – countries in which mass shootings occur rarely, if ever, and in which the rate of gun deaths is, on average, one tenth the rate in the USA. Unlike most other entities that hold monopolies, we would be delighted if the APHA and other gun violence prevention organizations would break up our monopoly by joining us in advocating that we follow the examples of these other countries.

Here’s the gist of the talk I gave at the APHA’s annual conference, plus some additional comments concerning the troubling trends I noted in preparing this talk. You can click on this link for an expanded, fully referenced version of my talk in PDF format.


Gun violence is a serious public health problem in our country

The problem of gun violence receives the most public attention following horrific mass shootings. Since 1983, the number of mass shootings has been steadily increasing, and the number of people killed and injured in mass shootings has been rising even more steeply as the perpetrators have employed increasingly deadly weaponry to carry out their crimes. But mass shootings account for only a tiny fraction of all U.S. gun deaths. On an average day, more than 100 Americans are killed with guns, and two to three times this many people suffer non-fatal but often devastating, life changing gunshot wounds. Since 1968, more Americans have died of gunshot wounds than all the U.S. soldiers killed by any means in all the wars in which our country has ever been involved.


Rates of gun deaths and injuries are far higher in the United States than in other high income democratic countries

This rate of gun related deaths in the United States is 10 times higher than the average rate in other high income democratic countries. The overall U.S. homicide rate is seven times higher, driven by a gun homicide rate that is 25 times higher. For U.S. teenagers, the gun homicide rate is a staggering 82 times higher than the rate for teens in other high income democratic countries. If it weren’t for a U.S. gun suicide rate that is eight times higher, the United States would have one of the lowest suicide rates of any democratic country. When access to guns is restricted, people don’t generally substitute other highly lethal means to attempt suicide or commit assaults. Instead, overall rates of suicide and homicide go down.


Many factors contribute to gun violence, but the most significant factor is also the one that is least discussed – our lax gun control laws and the easy access to guns

Many factors have been cited as contributing to our country’s extraordinarily high rate of gun violence. These include: a culture of violence in the United States and pandering to violence in the popular media; socio-economic disparity and institutional racism; drug and alcohol abuse; and mental illness. While these are all important issues that need to be addressed, the United States is not an extreme outlier in any of these areas as compared with other high income democratic countries. The factor that is least discussed, but the area in which the United States is an extreme outlier, is our lax gun control laws and easy access to guns.


U.S. gun laws are fundamentally different from the laws in all other high income democratic countries

In all other high income democratic countries, the burden of proof is on the potential gun buyer to show that he or she has a legitimate need to have a gun and can handle one safely. And recognizing that there’s no net protective value in owning or carrying a gun, many high income democratic countries don’t accept “self defense” as a legitimate reason for having a gun. In the United States, anyone of a certain age who seeks to acquire a gun can legally do so unless the government can prove through a rudimentary background check that he or she falls into one or more narrow categories of persons being prohibited from owning firearms. The U.S. background check system is so flawed that even most individuals who have gone on to commit mass shootings have been able to pass background checks and legally purchase the guns they used in their crimes.


The U.S. response to mass shootings has been dramatically different from the responses of other high income democratic countries.

It took the Australian government just 12 days to decide to ban civilian ownership of all automatic and semi-automatic firearms after the 1996 Port Arthur mass shooting, and there were no further mass shootings in Australia for the next 22 years. New Zealand reacted in a similarly swift and definitive manner following the 2019 Christchurch mosque mass shootings. Great Britain already had a ban on civilian ownership of automatic and semi-automatic rifles, but after the mass shooting committed with handguns at the elementary school in Dunblane, Scotland in 1996, it took the British government less than two years to decide to ban all civilian handgun ownership. There have been no further school shootings since the ban went into effect, and the gun death rate in Britain is currently 1/60th the U.S. rate.

In the United States, by contrast, it would be too kind to say that our federal government has done nothing since 1996 to prevent mass shootings. When the CDC supported studies in the 1990’s documenting the seriousness of the gun violence epidemic in our country, Congress cut the CDC’s funding and placed a prohibition on the use of federal funds to advocate gun control. That prohibition was renewed every year through 2018. In 2004, instead of strengthening the 1994 federal assault weapons ban, Congress allowed it to expire. In 2005, Congress passed a bill giving gunmakers unprecedented protection from products liability lawsuits.


The main obstacles to adopting stringent gun control laws in the United States are four widely accepted myths

Myth #1: The Second Amendment was intended to confer an individual right to own guns.

Few people realize that first time in U.S. history that the Supreme Court ever ruled that the Second Amendment conferred any kind of individual right to own a gun unrelated to service in a “well regulated militia” was in the 2008 Heller case. The Supreme Court had ruled in four previous cases that the Second Amendment did not confer such a right, including in the 1980 case of Lewis v. United States, in which the Court stated:

The Second Amendment guarantees no right to keep and bear a firearm that does not have “some reasonable relationship to the preservation or efficiency of a well regulated militia.”

The majority opinion in the Heller decision, which was written by the late Supreme Court Justice Antonin Scalia, has been publicly condemned by respected constitutional authorities as a “radical departure” from prior legal precedent, an example of “snow jobs” produced by well-staffed justices, and as “gun rights propaganda passing as scholarship.” In his book, The Making of a Justice, the late Supreme Court Justice John Paul Stevens wrote, “Heller is unquestionably the most clearly incorrect decision that the Court announced during my

[35 year] tenure on the bench.” Stevens also noted that the proper interpretation of the Second Amendment had been “so well decided” prior to Heller that the late Supreme Court Chief Justice Warren Burger had called the gun lobby’s ongoing misrepresentation of the Amendment “One of the greatest pieces of fraud – I repeat the word, ‘fraud’ – on the American public by special interest groups that I have ever seen in my lifetime.”

The Heller decision is worse, though, than even these harsh criticisms might indicate. In creating a constitutional obstacle, where none previously existed, to the adoption of stringent gun control laws in the United States comparable to the laws in all the other high income democratic countries of the world, Heller is literally a death sentence for tens of thousands of Americans annually. We should not be timid about openly stating that Heller was wrongly decided and must be overturned.


Myth #2: Honest, law-abiding people should own guns “for protection”

There is overwhelming evidence that guns in the homes and communities of honest, law abiding people are far more likely to be used to harm them than to protect them. The APHA cited representative examples of this evidence in its amicus brief in the 2008 Heller case. Since 2008, a large body of additional evidence has been amassed, including FBI crime data that show that guns are used in criminal homicides 34 times more often than they’re used to kill someone in self defense. Surprisingly, though, the current APHA “fact sheet” doesn’t mention the well-established fact that a gun in the home is an independent risk factor for a homicide, suicide, or accidental death in the home. There is also little information on this topic on the websites of other gun violence prevention (GVP) organizations. All public health advocates and GVP organizations should be actively involved in dispelling the myth of “guns for protection.”


Myth #3: We can stop our country’s epidemic of gun violence without substantially reducing the number of privately owned guns in circulation.

When we talk about stopping the epidemic of gun violence in our country, we should be talking, at a minimum, about reducing rates of gun deaths to levels at or below the average for the other high income democratic countries of the world. In the graph below, individual high income democratic countries are represented by circles, plotted according to their rates of gun deaths on the horizontal axis and their per capita gun ownership on the vertical axis. The graph also includes a computer generated “best fit” line that emphasizes the direct relationship between rates of gun deaths and per capita gun ownership. Clearly, the United States is an extreme outlier in both categories.


The APHA pointed out the direct relationship between lax gun laws, high rates of gun ownership, and high rates of gun deaths in its amicus brief in the 2008 Heller case. In that brief, the APHA stated:

It’s not that Americans are necessarily more violent. Nonfatal violent crime rates in this country are similar to those in most other high-income, developed countries, but every other high-income country has fewer guns (especially handguns), stronger gun control regulations, and much lower homicide rates.

In its current gun violence prevention “fact sheet,” though, despite declaring that gun violence is a “public health crisis,” the APHA doesn’t advocate any steps that would measurably reduce the pool of privately owned guns in our country. One of our country’s best known GVP organizations has gone so far as to ridicule the idea of reducing the pool of privately owned guns. In 2017, the Giffords Law Center published a pamphlet entitled Truth About Gun Violence. Under the heading, “Slippery Slope to Confiscation,” the pamphlet stated:

Nevermind that no serious organization advocates for mass firearm confiscation…or that collecting America’s 357 million firearms would be a logistical impossibility….In reality, smart gun laws are about saving lives and ensuring responsible gun ownership, not taking away guns.

Like the contradiction between the APHA’s current “fact sheet” and its 2008 amicus brief, the Truth About Gun Violence pamphlet contradicts an earlier statement published by the same organization. The Giffords Law Center grew out of the merger of the Law Center to Prevent Gun Violence, formerly known as the Legal Community Against Violence, and Americans For Responsible Solutions, founded by former Arizona Congresswoman Gabrielle Giffords and her husband, Mark Kelly. Ten years earlier, the Legal Community Against Violence had published another pamphlet, 10 Myths About Gun Violence in America, in which it had noted that the rate of gun violence, including firearm-related deaths in children, was far higher in the United States than in other industrialized nations, and that:

The reasons for this great disparity are clear: Americans own far more civilian firearms – particularly handguns – than people in other industrialized nations, and U.S. gun control laws are among the most lax in the world.

Americans Against Gun Violence is currently the only national GVP organization that advocates the adoption of stringent gun control laws that would reduce the number of guns per capita in the United States to levels comparable to those in other high income democratic countries. Specifically, we advocate the adoption of a complete ban on civilian ownership of handguns, comparable to the ban that Great Britain adopted after the 1996 Dunblane Primary School mass shooting, and a complete ban on civilian ownership of automatic and semi-automatic rifles, comparable to the ban that Australia adopted after the 1996 Port Arthur mass shooting. It’s inappropriate to refer to these laws as “mass firearm confiscation.” Both Great Britain and Australia required individuals who owned the banned weapons to surrender them in return for monetary compensation, and the vast majority of gun owners in both countries peacefully complied.

The GVP organizations that argue – either directly, as the Giffords Law Center has done, or indirectly, by exaggerating the likely effectiveness of limited firearm regulations – that we can stop the epidemic of gun violence in our country without substantially reducing the pool of privately owned guns are essentially arguing that we can ignore the best fit line on the graph above and instead move the USA circle in the right upper corner of this graph horizontally to the left on the gun death rate axis without moving it downward on the guns per capita axis. If we were to accomplish such a remarkable shift, we would be the only country in the world that has even been able to achieve a low rate of gun deaths despite high per capita gun ownership.

Joshua Sugarmann, executive director of the Violence Policy Center, summed up the limited measures advocated by other GVP organizations in his book, “Every Handgun is Aimed at You: The Case for Banning Handguns,” in which he wrote:

America’s gun lobby would be on the run, if only the gun control advocates would bother to chase them. Instead, trapped by their perception of the politically achievable, gun control advocates are always on the defensive….They nibble around the edges of half-solutions and good intentions dramatically out of sync with the reality of gun violence in America.

As the APHA has correctly stated, gun violence is a public health crisis in our country. Rather than continue to “nibble around the edges of half-solutions and good intentions,” we should take definitive steps to address this crisis.


Myth #4: We need more research

In its current gun violence prevention “fact sheet,” the APHA states, “We must expand the collection of data and research related to gun violence and other violent crime deaths in order to better understand the causes and develop appropriate solutions.” Similar statements can be found on the websites of most of our country’s best known GVP organizations. But few organizations state specifically what additional research is needed. To its credit, the APHA lists some specific examples. In its “fact sheet,” it calls for more research concerning “right to carry laws;” “violence prevention programs for children;” “the link between firearms policy and suicidal behavior;” and “the effects of different gun safety technologies.” The “fact sheet” fails to acknowledge, though, that there is already extensive evidence showing that liberal “right to carry laws” not only do not reduce crime, but are associated with increased rates of gun violence; that so-called “gun safety” programs for children and youth don’t prevent firearm related deaths and injuries but are used by the gun lobby and the associated gun industry to build their future customer base; that lax gun control laws and easy access to guns are independent risk factors for suicide; and that “gun safety technologies” are largely ineffective because, as the National Research Council has pointed out, “Firearms, after all, are designed to injure.”

As an example of the value of more research, Brady – formerly known as the Brady Campaign to Prevent Gun Violence, and before that, Handgun Control, Inc, and before that, the National Council to Control Handguns  – issued a press release in June of this year entitled, “New Stanford Study Shows That Handgun Ownership Correlates To Higher Risk of Death By Suicide,” with the subheading, “The study is the largest of its kind….” The fact that a handgun in the home increases the risk of suicide has been known for decades. And the fact that handguns are the type of firearms used in most gun related crimes has been known even longer. That’s one of the reasons why Brady’s predecessor, the National Council to Control Handguns, was founded in 1974. And with the rising rate of gun suicide, it’s little surprise that the Stanford study was the “largest of its kind.”

It was shameful for Congress to cut the CDC’s budget for gun violence research back in the 1990’s after the CDC funded studies showing that a gun in the home was 43 times more likely to be used to kill a household member than to kill an intruder; that children under the age of 15 in the United States were being killed by guns at a rate that was 12 times higher than in the other high income democratic countries of the world; and that gunshot wounds were the fourth leading cause of years of potential life lost before age 65 in our country. This being said, at this point in time, more research, in the absence of the adoption of stringent gun control laws, will only document more senseless, preventable firearm related deaths and injuries.

There was already enough research in 1968 for the late Senator Thomas Dodd of Connecticut to state on the floor of the U.S. Senate:

Pious condolences will no longer suffice….Quarter measures and half measures will no longer suffice….The time has now come that we must adopt stringent gun control legislation comparable to the legislation in force in virtually every civilized country in the world.


In Conclusion 

Prior to the Covid-19 pandemic, when I used to give presentations like this one in person, someone would usually come up to me at the end of the talk and say something like, “That was nice and all, but we’re never going to adopt gun control laws like those other countries.”  I would reply that I’m confident that some day we will. The only question is, how many more innocent Americans will be killed and maimed with guns before that day arrives. I hope you’ll join me in committing to do everything within our power to help make that day come sooner rather than later.


Thank you.



Bill Durston, M.D.

Note: Dr. Durston is a board-certified emergency physician and a former expert marksman in the United States Marine Corps, decorated for “courage under fire” during the Vietnam War.