Treat owning and using a gun like owning and using a car

In spite of the growing chorus demanding action, it’s difficult to imagine Congress moving soon on firearm safety. Our inability to identify safety measures acceptable to all ideologies assures gridlock, but with Americans 10 times more likely to be killed by guns than people in other developed countries, we simply cannot wait. We must address gun violence as a public health crisis.

The number of deaths from gun violence should erase any doubt that a real epidemic is underway. In 2016, more than 38,000 Americans died — 4,000 deaths more than 2015 — and an additional 80,000 were injured in gun violence, according to the Centers for Disease Control and Prevention. It’s an epidemic, but we lack public consensus on acceptable treatment.

{mosads}An idea has gained traction recently: Treat owning and using a gun like owning and using a car. It seems logical. We need to pass competency and safety tests to get a driver’s license; we need to register and insure our car, as well as pass periodic inspections.

It could work. Like guns, cars are inherently dangerous. In the 1920’s, traffic laws didn’t exist, stoplights and road signs were uncommon except in cities and pedestrians were regularly killed in intersections and roadways.

A combination of traffic codes, civil liability laws, insurance policies and administrative requirements made cars incrementally safer by World War II. Had the traffic death rate remained unchanged since America’s worst year, 1937, we would have had nearly 100,000 traffic deaths in the U.S. in 2016 instead of 38,000. 

Since 1937, safer vehicles, smarter roadways, safety devices such as seat belts (which saved 255,000 lives in the U.S. between 1975 and 2008) and airbags and public safety education programs continue to lessen deaths. Every American adult has the right to own a motor vehicle, but can’t operate one that doesn’t meet safety requirements, including seat belts, functioning directional and running lights, safety glass and more.

On May 2nd, the Department of Transportation began requiring all new cars in the U.S. to be sold with backup cameras, an example of a safety improvement brought about through data, not ideology. Adopting safety requirements wasn’t always easy. Seat belts were first greeted with indifference or opposition.

It wasn’t until Congress passed legislation in 1966 requiring them that people began to use them. Subsequent public information campaigns and local laws have promoted buckling-up. Seat belts now save nearly 15,000 lives annually.

Incentivizing safety has also worked. Anti-lock brakes, airbags, rear-window brake lights and automatic seat belts can lower insurance premiums. Incentives also can be effective in helping pass and support state level laws. Federal grants were instrumental in states’ adoption of the national 0.08 blood alcohol concentration.

Similarly, in 2009, the National Highway Traffic Safety Administration (NHTSA) released hundreds of millions in federal funds to the states for highway-related projects, but only if those states enforced primary safety belt laws.

These measures were effective in decreasing deaths while not infringing on car ownership. A similar approach can be used to decrease the number of shooting deaths.

You cannot start a car without keys: You should not be able to fire a gun without first unlocking it from a secure state. Trigger locks and lock boxes for firearms are very effective in preventing unauthorized use and accidental shootings.

We have the advantage of innovation. We have fingerprint locks that work for cell phones; why not for guns? Smart gun technology does this, rendering guns useless to all but owners and authorized users. Pin-enabled locks are available. Fingerprint-activated barrel and trigger locks are also just being introduced. Beyond gun safes are high-tech gun vaults that encase the trigger and magazine of a rifle.

We can also take best practices from the world over. Australia received much attention for its assault weapon ban and other answers to the 1996 Port Arthur killing of 35 people. Australians still own guns, but their gun death rate declines steadily, 47 percent in the decade 1991 to 2001. That downward trend continues, with no mass shootings taking place in the last 22 years.

Following Port Arthur, Australia adopted a holistic approach to safety, with measures including safe storage requirements — keeping firearms unloaded in gun safes and storing ammunition separately; regular police safety inspections; standard licensing and permit criteria; regular safety courses for owners and users; and weapon training.

The result is a network of steps that educate, instill responsible ownership and mandate safety training and compliance with common sense safety measures. Canada and New Zealand have enacted similar firearm safety measures.

I concede the U.S. is not Australia, Canada or New Zealand, but there’s a lot we can learn from them. We need to: despite being home to 4.4 percent of the global population, the U.S. owns 42 percent of the world’s firearms. It’s not too much to require responsible Americans to register and safely store their weapons, get licensed, take safety training and undergo regular safety inspections. It’s sane. When it comes to car ownership, most of us already do these things without even thinking about them.

While the debate in America’s town halls and on Capitol Hill grinds on, we can and must pursue all available options to fight gun violence. Treating gun deaths as an epidemic has the advantage of putting us into a different mindset — that of public health advocates, not as debaters defending ideological positions. In public health, we undertake everything that works and cannot afford to pass on good solutions while waiting for the “perfect” solution to present itself — not when public safety is at risk. We don’t have that luxury: we must work with all approaches that can save lives.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at UCLA.