TOKENS PODCAST: S4E5
The United States, says Harvard Prof. David Hemenway, does not have a “violence problem” in comparison to other high-income countries. In terms of robbery, assault, burglary, the U.S. is average. But, he contends, we have many more homicides and gun-related problems. One example of the way the US is an outlier: “A child in the United States is much more likely to be murdered with a firearm than children in these other countries. And it's not like we're 50% higher than average, or twice as high or five times as high. We are twenty-nine times higher.” As an economist and researcher in public health, he does not play the blame game or refuse to accept that we have, and will continue to have, a lot of guns in our society: instead, he asks a simple but profound sort of question: what can we do, what sorts of social practices can we put into play that reduce death and destruction? Due to the gruesome nature of the conversation, listener discretion is advised.
Should you or a loved one be considering suicide, please seek help. You may call the National Suicide Prevention Lifeline at 800 273 8255, or visit suicidepreventionlifeline.org.
ABOUT THE GUEST
David Hemenway, Ph.D., is an economist and Professor at the Harvard T.H. Chan School of Public Health (HSPH) and a former James Marsh Visiting Professor at the University of Vermont. He is Co-Director of the Harvard Injury Control Research Center, former director of the Harvard Youth Violence Prevention Center and former President of the Society for the Advancement of Violence and Injury Research. He received the Excellence in Science award from the American Public Health Association and a Commissioner’s Commendation from the Boston Police Commissioner for exemplary services to the people of Boston. He received fellowships from the Pew, Soros and Robert Wood Johnson foundations and is currently (2020-21) a Radcliffe fellow.
Dr. Hemenway has been Principal Investigator on more than 45 grants from NIH, CDC, NIAAA, NIJ and other federal and state agencies, and private foundations. He has written five books, including Private Guns Public Health and over 250 articles in peer-reviewed journals—more than 125 on gun violence, in such journals as JAMA, Nature, and the New England Journal of Medicine. He has received ten Harvard teaching awards and in 2018 won the inaugural Community Engagement award given by HSPH students. In 2012 Dr. Hemenway was recognized by the CDC as one of the twenty “most influential injury and violence professionals over the past 20 years.”
ABOUT TOKENS SHOW & LEE C. CAMP
Tokens began in 2008. Our philosophical and theological variety shows and events hosted throughout the Nashville area imagine a world governed by hospitality, graciousness and joy; life marked by beauty, wonder and truthfulness; and social conditions ordered by justice, mercy and peace-making. We exhibit tokens of such a world in music-making, song-singing, and conversations about things that matter. We have fun, and we make fun: of religion, politics, and marketing. And ourselves. You might think of us as something like musicians without borders; or as poets, philosophers, theologians and humorists transgressing borders.
Lee is an Alabamian by birth, a Tennessean by choice, and has sojourned joyfully in Indiana, Texas, and Nairobi. He likes to think of himself as a radical conservative, or an orthodox liberal; loves teaching college and seminary students at Lipscomb University; delights in flying sailplanes; finds dark chocolate covered almonds with turbinado sea salt to be one of the finest confections of the human species; and gives great thanks for his lovely wife Laura, his three sons, and an abundance of family and friends, here in Music City and beyond. Besides teaching full-time, he hosts Nashville’s Tokens Show, and has authored three books. Lee has an Undergrad Degree in computer science (Lipscomb University, 1989); M.A. in theology and M.Div. (Abilene Christian University, 1993); M.A. and Ph.D. both in Christian Ethics (University of Notre Dame, 1999).
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TRANSCRIPT
Lee: This is Tokens. I'm Lee C. Camp.
A warning: Today we're discussing guns and public health, our second of two episodes on this issue this season. The topic is heavy; and for many of you listening it may be personal, in more ways than one. The statistics are bleak. The realities around this topic in American culture are gruesome, and much of this discussion inevitably falls right into the middle of the ongoing culture wars.
I will say that our recent podcast episode God and Guns, with Professors Hays and Crouch, elicited more pointed responses than normal. One wrote in to say: "If our Lord were to walk the streets of [Birmingham, Alabama] after dark He had better be armed. God forbid him moving about in Chicago." Another objected that the statistics regarding the deaths of children by guns were lies, and pointed us to the NRA for alternate statistics. And yet another, a career epidemiologist, wrote in saying he believed the episode was the best description of the problem ever by a theologian, and yet, he went on, that we had committed a serious mistake: namely that the problem is, the statistics are, much -worse- than indicated, and that this is due to restrictions placed on the CDC by the U.S. Congress. He said, "Compared to all other disorders, conditions and phenomena on which the CDC studies and reports data to protect the public (e.g., motor vehicle crashes and drownings), gun violence is different. The U.S. Congress prevents the CDC from treating the public health threat of gun violence, whereas the same U.S. Congress does not restrict the same reporting on problems like drownings and motor vehicle crashes. In fact, motor vehicle crash reports from CDC are regulated the same way as reports on COVID by the CDC. Only gun violence is different."
Consequently, estimates of death related to guns are thought by many to be under-estimates.
With that lengthy introduction, I suggest: Listener discretion is advised; thoughtful and gracious engagement is requested.
David: compared to all the other high-income countries a lot of people think we have a violence problem. But it doesn't seem to be the case. We're sort of an average high income country in terms of robbery, in terms of assault, in terms of burglary, you know, you name most of the crimes.
Lee: That's Dr. David Hemenway, Professor at Harvard and esteemed public health expert, debunking the assumption that we have more violent crime in the United States than elsewhere.
But: he does say we are an outlier in one area.
David: Compared to these other high income countries, we have lots of guns. We have easy gun laws and we have so many more homicides. We have so many more gun related problems. We are just an outlier and all these other countries just don't understand why we're not doing more to try to prevent these gun-related problems.
Lee: Heart-breaking problems. Like this:
David: A child in the United States is much more likely to be murdered with a firearm than children in these other countries. And it's not like we're 50% higher than average or twice as high or five times as high. We are 29 times higher.
Lee: Here's one of the fascinating things about my interview with the Harvard economist and Professor of Public Health: unlike us ethicists, he has zero interest in playing a blame-game, and had little interest in discussing social policy that places its hopes in what he sees as unrealistic gun control policy. He is, one might say, a pragmatist. That is, he has spent his life teaching public health, which is an altogether different approach than a theological one, or one informed by moral philosophy. Instead, the prevalence of gun violence is examined from the perspective of public health: that is, it is a problem seen as an epidemic. Or by some, it's considered an -endemic-, that is, a _persistent_ grave matter of public health that _belongs to_ a particular community: in this case, the United States. Then, from the perspective of public health, he asks different sorts of questions, namely, how may we minimize risk?
David: There are people out there who we don't know who are dying because of inaction. Let's try to make it easy to be healthy and let's make it difficult to be sick or injured or unhealthy.
Lee: Our interview with Dr. David Hemenway, coming right up.
INTERVIEW
Lee: Dr. David Hemenway is a Professor of Health Policy and the director of the Harvard Injury Control Research Center. He teaches classes on injury and on economics at the Harvard School for Public Health. He’s won 10 teaching awards, the author of five books, has written widely on injury prevention. He added the pilot for the national violent death reporting system, which provides detailed and comparable information on suicide and homicide. He's been recognized by The Centers for Disease Control and Prevention as one of the 20 most influential injury and violence professionals over the past 20 years.
Welcome Dr. Hemenway. Would you begin the work that you've done on gun violence, giving us a description of the problem as you see it today, whether statistics or some sort of description of the problem?
David: Yeah. Well, I, I would say compared to all the other high-income countries, so France and Germany and Japan and Canada and so forth, a lot of people think we have a violence problem. But it doesn't seem to be the case. We're sort of an average country, an average high income country in terms of robbery, in terms of assault, in terms of burglary, you know, you name most of the crimes. Uh, we are average, but where we are different is in terms of gun crime. And guns are very lethal. So compared to these other high income countries, we have lots of guns. We have easy gun laws and we have so many more homicides. We have so many more gun related problems. We have so many more police killing civilians. We have so many more civilians killing police. We are just an outlier and all these other countries just don't understand why we're not doing more to try to prevent these gun-related problems.
Lee: Could you give us any particular statistics or examples of numbers that would help highlight that?
David: Sure. Sure. So let me give you a numbers for the five to 14 year olds. And I just pick them that's K-8, because it's hard to blame the victim when you're talking about a fourth grader. And there's so much victim blaming in the area of guns. So compared to the other high-income countries. So this is, again, these are the other like 30 countries or pure countries.
A child in the United States is much more likely to be murdered with a firearm than children in these other countries. And it's not like we're 50% higher than average or twice as high or five times as high. We are 29 times higher.
Lee: Oh my.
David: 29 times. So if you took all the children in all the developed countries, Germany and, France and Spain and, Japan, and you lined up all the bodies of the five to 14 year olds, who've been murdered with a gun, something like 95% of those would be American children. Uh, our non-firearm homicide rate, we're an average country in terms of killing our children. In terms of our children getting killed. In terms of suicide for this age group. So, you know, a 13 year old a 14 year old, they, fail an exam. They supposed girlfriend breaks up with them. They come home, they find their dad's semiautomatic. They’re dead.
In the United States our suicide rate for these children is nine times higher than average our non-gun suicide rate. We're an average country. Our unintentional firearm death rate is 20 times higher for these children.
And you look across the board and sort of every age and group it's true for our whites, our whites, we have really a high, suicide firearm, suicide rates, firearm accident rates. Blacks in the United States have very, very high, firearm, homicide, victimization rates, but even whites in the United States have much higher firearm victimization rates than virtually any other.
Lee: Hmm.
David: Yeah. That's just the tip of the iceberg. That's just the deaths then it's all the non-fatals, that you have to worry about. Then it's all the intimidation with guns. We have a lot of intimate partner violence where guns really intimidate. And even in a public health issue, we have, you know, things like lead poisoning and people who shoot guns a lot, get hearing problems and so forth.
But it's uh, homicides, and the, just the deaths.
Lee: I think I, had heard, of our other interviewees had said that, there's research that indicates that if you have a gun in your home, you're 2.5 times more likely to die of suicide. And if it's a loaded gun, you're like eight times more likely to die of suicide.
David: Right. And it's not only you, but your whole family is risk. You brought a gun in the home and it increases. Now that doesn't mean that you bring the gun in the home and somebody is going to commit suicide. That just means not on average. If there's a gun in your home, instead of say over the next 40 years that somebody in your family will die with suicide.
There's, I'll say one half of 1% of a chance. Now there's one and a half percent of a chance. It’s basically three times higher it's just because guns are so deadly and there's no going back.
Lee: Yeah.
David: The case fatality rate for guns is like 90%.
Lee: Hmm, as opposed to other potential forms of suicide, which are much less fatal.
David: Yeah, maybe, two or 3%.
Lee: Hmm. So in your approach in public health, I think it might be helpful if you first described, for folks who are unfamiliar with even what public health approaches and methodologies mean what is your field entail?
David: Yeah. It truly, again, is trying to make, people healthier groups. Now physicians try to make individuals healthier. We’re really focusing on the whole population. And so here's what I would say, like the public health approach and a one sentence description. It's, let's try to make it easy to be healthy and let's make it difficult to be sick or injured or unhealthy.
So for example, we have a big obesity problem in the United States. The public health approach says let's make it easy for you to get really healthy fruits. Uh, let's make it difficult for you to get junk foods. Let's make it really, really easy for you to exercise. Let's make it a little difficult for you just to be a couch potato. In the United States, we do just the opposite. We make it easy to get junk food. It's hard for a lot of people to get really healthy foods, easy to be a couch potato hard for a lot of people to get good exercise. And then we have a big obesity problem and people are surprised that there's no. The public health approach, really is about prevention. Rather, we spend a lot of time trying to differentiate the public health approach, safe on the medical approach with a criminal justice approach, which is largely after the fact something that happens. And you know, medicine jumps in and, police, come to the rescue, public health approach is let's try to prevent the problem from happening in the first place. And I talk about that a lot. And then, what we've found is that you know, there's so many ways to prevent problems and you try to do all variety of ways, but typically by far, the most cost-effective way is to go upstream rather than waiting till the last second, trying to prevent somebody from shooting somebody just that the moment they were about to shoot, or just when they're about to get sick, or just when they’re about to do something stupid.
Uh, if you go upstream and change the product, if you change the environment, uh, you can very effectively reduced the problem without really sort of blaming anybody. Public health approach, I mentioned, is about populations.
Lee: So, perhaps an example from another field before we talk about, gun violence and public health.
David: Yeah, so, the example which, we love to use, and because it seems to resonate with people, is motor vehicles. So the centers for disease control said one of the at the end of the 20th century, what are some of the great public health achievements of the 20th century? You know, one was vaccinations in terms of getting rid of measles and mumps and so forth for most people, but one was what happened in motor vehicles. And so here's the story about motor vehicles. Uh, this is the story, indeed. I teach injury prevention. We tell our graduate students over the campfire, this story, and then which can be passed on from generation to generation. So, when I was young in the fifties and early sixties, we were told that virtually all motor vehicle crashes were due to, were caused by, bad driving. If people never made mistakes, if they were never tired, there’d be virtually no accidents and that's true. If people always obeyed the law, if they never sped, if they never drive drunk, there'd be virtually there's so few, deaths in terms of motor vehicles.
So the motor vehicle lobby, they all said, it's the drivers fault. And you see, one of the things we'll talk about is we try to get away from fault, but they said it's the driver's fault. We ought to do something about drivers. So they said, what we ought to do is enforce the traffic laws. Let's have lots of police out there.
And also lets have driver's ed. I was in a cohort where everybody in my cohort had to take driver's ed, and the evidence now shows that taking driver's ed doesn't help at all in terms of fatalities. And let’s us drive younger and die sooner. It wasn't until in the fifties that public health physicians asked a different question rather than who caused the accident. They said, what caused the injury?
Lee: Please allow me the liberty to insert a parenthetical here: for years, one of my favorite soap-box lectures to give my college students is the one about how they ought not construe their education primarily in terms of getting answers to their currently unanswered questions. Instead, I then suggest--and I do so, as you might guess, with a dramatic crescendo-- I suggest they might learn a lot more in life, and have a much more interesting life, if they were to learn new and better questions to ask. Being -more curious- about the questions we are carrying around: this might make for more fascinating lives, and may make us of more useful service to the world.
So, I was fascinated to learn here from Professor Hemenway that many thousands of lives had been saved--by asking different questions.
David: It wasn't until in the fifties that public health physicians asked a different question rather than who caused the accident. They said, what caused the injury? Just asking that different question. What caused the injury? It was like, all right. A lot of drivers being speared by steering columns, which go right through their chest and head on collisions. A lot of people in the front seat were being, their faces were being lacerated than they would die by windshields, uh, which weren't made of safety glass.
Many many people were being thrown from the car, during the crash. And they would hit their heads on the cement or on the car. And they would die. People were leaving the road for just one second and they were hitting trees and lampposts, which had been planted right along the sides of major highways and public health physicians were saying, well, couldn't we make the roads safer?
Couldn't we make the car safer? Couldn't we make the emergency medical system safer?
So fast forward, say 60 years. Nobody thinks drivers are any better than they were when I was young. On average drivers today are much worse in terms of distracted driving. They're much better in terms of, alcohol and driving.
But overall they're sort of the same as we were, but fatalities per mile driven have fallen over 85%. So for every 20 of my contemporaries who would have died now only three die.
Why? Because we changed the system, we made it much harder. The two things we really want to do, we make it, much harder to make mistakes.
So here's an example. It used to be, if I was driving along the highway and I was sorta so tired, then I fell asleep, you know, the car would go off the road or hit another car. And crashed into a tree planted along the side of the highway and I would die.
And people would say, it's your fault. You shouldn't have, you shouldn’t have. Why did you drive? It's your fault, it’s your fault. Now, we make it hard to do that. We have in California, you have these bots dots along the sides of the road. And so you start getting out of your lane and go, bah, bah, bah, bah, bah.
And it’ll wake you up and you say, oh, okay. And nothing bad happened. So now in a lot of new cars, you got beep, beep, beep, beep. And it says wake up stupid and you wake up, you go back and lay and nothing bad happens. And there's nobody to blame because the system worked. You made it hard to make mistakes. That's what you're trying to do. You're trying to also make it hard to behave in appropriately. So it used to be, in areas where there were children crossing the road, you'd put up signs, drive a little slower. You you'd have police you'd have a run. Sometimes that works a little, there's so many ways though, that you can reduce speeding and protect children, crossing the street without any enforcement at all.
Lee: Hmm.
David: All you have to do is change the road design. You can put into these little speed bumps. You can change the road, little changes and configurations of the road, neck downs. There's, I love this. There's two dozen ways of just making tiny changes in the road, which automatically lead to drivers driving much slower. That's one of the reasons why, it's not the only reason, but it's one of the reasons why fatalities to children, like zero to six have fallen something like 85, 90% in the past 40 years two pedestrians. So there's so many successes that you can do with that. Changing people changing people. You want to change people if you can, but changing people is the hardest thing to do.
It's typically the least cost effective. So yes, you want to try to do that, but there are so many other ways which are so much more cost-effective. Let me give sort of another example. When I was in Washington, DC, when they built the DC metro. And what they did there when they built, they deliberately tried to make it. So they say, you know, there are all these crimes committed in subway systems. And people get robbed, they get attacked. What can we do to make this new subway system so it is less likely? And so they studied all the subway systems around the world and they created the DC Metro is a system which is very hard for criminals to take advantage of you. There's no sort of back ways that you can be by yourself going down long corridors in the dark. It's hard for people to wait around. There's no reason to be loitering, there’s cameras every place and on and on. So there is 75% less crime in the DC Metro than there is say in Chicago or Boston or New York or London. And it's not because the people are better. It's not like, oh, these people in Washington, DC, they are so much nicer. They are. It's just that we changed the system. We made it hard to be a criminal. So they're making it easy to be a criminal, you know, make it hard to act badly. And so fewer people act badly. That's basically the first law of economics. It's the first law of psychology and it’ll make it a little harder to do things. Fewer people do it. They get a little easier, more people do it.
Lee: Yeah.
David: And that's sort of part of the public health approach.
Lee: Yeah, that's terribly helpful, a great overview. So what then has that looked like with regard to your working gun violence?
David: Oh, so we're going to have lots of guns. There's just no question. So the question is how can we live with guns? Right? We're not doing a good job. We're doing a terrible job. We have lots of guns. And so many people are dying. So many people are being seriously injured. So many people were being intimidated.
How can we have lots of guns and still reduce the problem a great deal? Because a lot of public health is harm reduction. Now there are so many aspects of the problem. So just as there are so many aspects of the motor vehicle problem, and there's still, there's so many more things we can do, but we, you know, reducing fatalities by 85% is good, but there are so many problems that there were rollovers, what are we going to do about rollovers?
There were, people who were speeding, there were little kids in the car. What are we going to do? There were fires from cars. What are we going to do? And there's all different things, but we want to have a lot of motor vehicles. So in terms of the gun area, there's so many problems.
There's unintentional firearm deaths. What are we going to do about that? There's mass shootings. There's gang shootings. There's intimate partner violence intimidation. There's suicide. So there’s lots of things and so different aspects of the approach, focus on different things and motor vehicles.
I actually worked for Ralph Nader in the late 1960s, and we pushed for the airbag and the airbags, this wonderful thing, just incredibly useful, but it only saves overall motor vehicle fatalities by about 11%. And you know, it's very good in the front seat, in head-on collisions, it doesn't help very much in rollovers. Doesn't help pedestrians. It doesn't help bicyclists and so what I'm going to say is there's not like, oh, here's the way, here's the one thing that's going to solve everything. So there's lots of things you can do. And there's two ways to thinking about it. One is broadening.
The public health approach is getting everyone to agree that there's a problem. And that’s not as easy as it seems. I think it's pretty clear this round, but a lot of people think, ah, yeah.
And then secondly, get everyone involved to try to help reduce the problem. What can gun manufacturers do? What can journalists do? What can, universities do? What can various parts of the government do? And it turned out there’s so many different things that different leaders can do. The surgeon general can do things. We need better data systems for gun violence than we have. We don't know nearly enough about non-fatal.
We need more research. For 25 years, we've had an effective ban on government funding of research. So there's so many things we don't know, but if we knew more, we could do a lot. Government is a big buyer. One of the reasons we have airbags in the United States is because the government was the first big purchaser of airbags. Government in the United States could start doing research on and buying smart guns. Which would make it, so, there’s 250,000 or 300,000 guns a year stolen, which is one of the many ways guns get into the wrong hands. So let me tell you some examples, two examples. I’ll talk about unintentional firearm deaths, and I'll talk about suicide. Unintentional firearm deaths.
So we've just done some studies on that. And one of the things we find is that, we were looking at children, and this is not the only problem in gun violence or the biggest problem, but it is an important problem, is that, most children were killed by either themselves or other children.
So we were looking at kids zero to 14, this is unintentional. So one of the things we noticed is that, two thirds of the time, the kids who were killed were shot by somebody else. But in the third of the time, they shot themselves unintentionally. And a group that was very common to do this where the two to four year olds and still are.
So two to four year olds have higher rates of unintentional firearm deaths, then 5, 6, 7, 8, 9 or 10 year olds. And they are shooting themselves. So what can be done? Well, we had a public health problem 30 years ago, that a lot of little kids, two to four year olds were finding aspirin bottles and opening the aspirin bottles and taking 30 aspirin pills and dying. And so what to do? Well, the approach, the public health doesn't like is let's blame somebody let's blame the kids, they weren't trained right.
There were three years old, their parents and let's blame the parents. Why did they leave? Why wasn't the mom, watching the kid 24, 7 every second of the day to make sure he didn't crawl into.
And it was like, come on, what is the most cost-effective way? And we figured it out, which is let's make childproof, aspirin bottles. And the numbers of kids dying, you know, fell in what, 80, 90%. It was an incredible success story. We can make childproof, guns. Smith and Wesson. Wesson of Smith and Wesson fame, like 130 years ago something like that, said, I'm worried about kids. Kids, you know, they can shoot these guns. We don't want, three-year-olds finding their dad's guns and killing themselves or killing them. So he made a childproof gun. It was really easy to do. We can do much better now. The way he did it, but this, much better technology. The way he did it, he just said, in order for the gun to fire, I'm going to make it so you have to do two things. You have to not only pull the trigger, but you have to put a little pressure on the handle of the gun. That's all you have to do. And three-year-olds, can't figure out how to do that. The same way they can't figure out how to push that on the asprin bottle and turn it.
Lee: Right, remarkable.
David: We find that a whole lot of the most common way that these kids are dying unintentionally the zero or the 14 year olds, is that, a lot of people are killed by their older brothers who were, say, 14, you're killing ten-year-old you find your dad's semiautomatic pistol. You take out the magazine. You have all the bullets, here's the bag. And then you have all the bullets. You think the gun is unloaded. You have all the bullets and then you play with the gun, but there's a bullet left in the chamber. And in most of these semiautomatics you pull the trigger, it fires and the bullet goes and you can kill somebody. Now again, what can we do? Let's blame the kid. He's 13 years old. Doesn't he know why didn't know he trained let's blame the parent. Why didn't the parent? And the answer is, yeah. We can do that. And the parents should have locked up their gun. Maybe the parents shouldn't have had a gun, but they're going to have a gun. They probably should have locked up, but it's hard to do. What's a better way to do it? Make it so it's easy to stay healthy, hard to get injured, make it so when you take out the magazine, whether or not there's a bullet left in the chamber, the gun will not fire. All you have to do. Another thing to do is to make it so, you know, it's very clear. There's a little sign that jumps out and says, there's a bullet in the chamber. It's going to shoot don't point it at your best friend and kid around and pull the trigger. This is the approach that public health wants to do. Make it hard to behave inappropriately. Make it hard to make mistakes. You can also focus on the kid and you ought to do that to some extent, but that's typically not the most cost effective when you have to try and do all the approaches.
Lee Camp: You're listening to Tokens: public theology, human flourishing, and the good life. We’re most grateful to have you joining us.
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This is our interview with Dr. David Hemenway, Harvard University Professor of Health Policy and the Director of the Harvard Injury Control Research Center.
Coming up, we'll hear more about the troubling statistics surrounding the gun crisis in the United States, as well as some possibilities for hope in the midst of such bleak realities.
Part two in just a moment.
Part Two:
Lee Camp: Welcome back to Tokens and our interview with Dr. David Hemenway.
A reminder that listener discretion is advised. Professor Hemenway is about to discuss in matter-of-fact ways the prevalence of certain methods of suicide, and the manner in which public health approaches have reduced the prevalence of some of those methods. The "matter of factness" with which these methods are described may be distressing and unnerving.
Should you or a loved one be considering suicide, please seek help. You may call the National Suicide Prevention Lifeline at 800-273-8255.
Lee: Given how commonsensical your approach seems. And given that the argument you're making is basically fiscal conservatism, right? It's a sort of, you're taking seriously return on investment and reducing costs, affiliated with guns.
David: Yup. I'm an economist. So I feel, I always…
Lee: And so I don't hear you. I hear you being very pragmatic about the fact that there are lots of guns and they're not going away anytime soon.
David: Yeah. Public health is all about pragmatism. Public health, it's not a discipline. It's not like public health-ology. It's not what public health really, really cares about is people's health. Now, there are other things that matter in life. There's no question, you know, people's entertainment matters and these are the things, but public health focuses on something that everyone I think thinks is pretty important which is health. And it says, what we're trying to do is figure out ways which very cost-effectively can improve health. Let me talk about suicide for a second, to give you one more example, because as a teacher, I can tell you people don't remember platitudes. What I, what they remember is some examples. So, they remember stories. So here's another story. In the United States there's no question that a gun in the home, as we mentioned really increases the likelihood that someone would die in a suicide.
At least half, if not more than all suicides in the United States are gun suicides, even though only a tiny percentage of suicide attempts are with guns. In the United States, the common way of buying is with guns. Now it turns out probably the greatest success stories in the world in suicide prevention have had nothing to do with mental health. The great success stories in reducing suicide in the 20th century have had nothing to do with changing mental health.
Lee: Huh.
David: What, what? How is that possible? All right. So let me give you, um, in England, in the 1950s, the most common way of committing suicide was to put your head in the oven. That was the way Sylvia Plath died.
Lee: So not, not a hot oven. An oven because of the gas, right?
David: Yeah. The gas, right. Some like 40, 45% of all suicides in England were gas suicides by putting your head in the oven. Then they changed the gas. They got north sea gas, which was cheaper. They put the north sea gas in the ovens, north sea gas wasn't toxic like old gas was. People still put their heads in the ovens. But then after a while you got tired and took your head out of the oven. And you didn't die. Suicide by putting your head in the oven went down to zero. Suicides by other means virtually didn't change at all. So this is like a 40% reduction in suicides just by getting rid of this easily available, common, very lethal method of suicide.
Sri Lanka in the 1990s, Sri Lanka for a while, had the highest rates of suicide in the whole world. There, what did they do? They drank liquid pesticides, horrible, horrible, horrible way of dying. They had very toxic pesticides for agriculture. Finally, the government said, we're going to ban these pesticides.
There are going to be pesticides, but there aren't going to be these terrible ones. So they did, people still drank the pesticides. They didn't die. The suicide rate fell, I don't know, 40%, 50%. Felt a huge amount. Agricultural output didn't change. Suicide attempts didn't change. They just save people.
Another example is a gun one in terms of successes is the Israeli defense forces. It turns out, about 20 years ago, it was very common for these young men and women. These 20 year olds, 21 year olds to take their guns home. Um, mostly, Israel has pretty strong gun control laws, but they have a lot of military. And so the kids would take their guns home with them and some of them would commit suicide over the weekend. Cause it's a pretty stressful job. And so finally they said, all right, here's what we're gonna do. We’re not going to allow anyone to take their guns home with them on the weekends.
And so the rates of gun suicide over the weekend fell dramatically. The rates of other suicide on the over the weekend, didn't change at all the rates of other suicide during the week didn't change. And those a dramatic reduction in suicides have saved a lot of young people's lives.
In the United States the common method is with guns. So most people think about suicide, they focus on why, why did you commit suicide? What was the reason? That's fine. That's a really good way. We're one of the few groups that focus on how, how did you commit suicide? Cause that matters.
So in the United States, you know, what we're trying to do is make sure everyone understands that a gun in your home really increases the risk for suicide.
It increases it at certain times. So like we understand for example, that when somebody is first sent to prison, often you put somebody on a suicide watch, right? For a few days. You’re put in prison, why did you put on a suicide watch? Because you know, they're at risk for suicide over these next three days or four days.
So you make sure there's nothing around for suicide. So you don't have to do this, put out this person on a suicide watch for 10 years, right? You just want to sort of, and then it gets over this. So we've been trying to find common ground with the gunners, I call them; people who love guns and shoot guns. Who's at most risk for suicide in the United States?
It turns out it's people with guns. There've been people who've done studies, looking at a gun in the home that increased the risk for suicide. We've been looking at what explains the why differences in suicide rates across states? Some states have high suicide rates.
Some states have low suicide rates. Rates are much different than say the rates of heart disease, death, or motor vehicle deaths or, cancer deaths. And it turns out it is virtually nothing to do with mental health. It’s not really that people in the states with high suicide rates are more depressed or, have more suicidal ideation or even a more suicide attempts across the United States.
Non suicide gun rates don't change very much. They're not that different from one state to another. What's really different is the gun suicide rates.
Lee: Hm.
David: And where there's high rates of gun ownership, there's high rates of gun suicide in this high rates of overall suicide. In New England, for example, there's three states we have, which have a lot of guns. Vermont, Maine, New Hampshire. There are three states with very few guns, Rhode Island, Massachusetts, and Connecticut. We all six states we have about the same non non-gun suicide rates. Gun suicide rates are very different. The three Northern states with guns, they have a highest gun suicide rate. So they have high overall suicide rates.
So what can you do? Well, we've been working with the gunners, to try and do something. And who's been doing this is my colleague, Kathy Barbara, who's been doing this great job, trying to find common ground. First she worked with a lot of gun shops. Now gun shops is not the most common way people commit suicide, but one way people commit suicide is, people who don't own guns and they want to commit suicide. They go to a gun shop, they buy a gun and then they off themselves that day. And gun shops could do something. Not hard. They can do a little bit, they can't solve the whole problem, but they can do a little bit. You know, a woman comes into your shop and says, I want to buy a gun. And you say, okay. what kind of gun does she want? She says, I don't care. You said, okay how about this gun? She says fine. She says, now how many bullets do you want? Oh, one's enough. It's like, no, you don't need that. You don't need that sale. You don't need the sell. You can try to figure out how to help that woman as opposed to just let her right? In the United States who is a really high risk for suicide? It's older white males, because those are the ones who have the guns and when things go bad, what do they think to use? They use the guns. And so they have very high rates of suicide.
And their wives and their children have higher rates of suicide also because the gun’s around. So one of the things to do is working with gun trainers. Gun trainers typically never even talk about suicide. Even though that's the common way for the gun to be used in a death. People don’t understand this. There's many more suicides than homicides in United States. There's always many, many more gun suicides than gun homicides.
If you're talking just. That's from guns, it's the suicide and we can do a lot. So one of the things is you trying to make it. So, in the motor vehicle area, one of the somewhat successful approaches about alcohol was this friends don't let friends drive drunk. You try to get everybody involved with trying to reduce drunk driving.
So friends don't let friends drive drunk. And so you have the designated driver, program. You have different ways to try to help people who are drunk, not drive a car. We're trying to do the same thing with guns, as being called by the gun groups. The now the 11th commandment of gun safety, which is if your friend is going through a bad patch, say he's getting divorced. He's drinking, he's talking crazy. It should be your role as his friend and he should understand that it's your role. And to quote, babysit his gun for a while, until things get better.
He gets a new girlfriend, he gets his gun back. And just by that little change, you can reduce gun suicide among the group, which is at highest risk for suicide, which is these people with guns. These mostly middle-aged and older white males often in suburban rural areas. And, we've been working with some gun trainers who really think this is a good thing. And so now in Utah, this really red state, they made it mandatory so that if you take a concealed carry class, there has to be a module about gun suicide. So people understand here are the risks. There are benefits potentially, but there are also risks and you should understand these risks. And the biggest risk to you by far is going to be suicide.
And anybody can go through these bad periods. Everybody has ups and downs and there are people at higher risk and lower risk, but you don't want a highly lethal technology right around you that you know all about and can use and have used when things are going bad. Get it away from you for a while.
Lee: So given the commonsensical nature of these things and the pragmatic nature of them, the non-ideological and even non-partisan approach to the question about guns. Are you finding that to use your term gunners or the gun lobby or gun manufacturers are supportive of these efforts?
David: Not as much as one would hope, unfortunately. You know, the whole gun area is part of the cultural wars in the United States. The same way, and it's just so sad, the same way vaccinations. I mean, public health just cannot. It's just so sad. We have these miracle drugs now that, I mean, it really is a miracle that we have these good vaccines that 20 years ago we couldn't wouldn't have had for this disease. And yet because of the culture wars so many people aren't getting the vaccine and it's not only hurting them and their families, but it's hurting the whole society. And so, we have to figure out a way get it away from these sort of cultural wars. And it's also misinformation. Even though I would say all now, suicide experts understand that in the United States, that gun in the home increased the risk for suicide. Uh, we did a study a couple of years ago and only something like 30% of physicians believe that. And only one, five, 15% of the average citizens understood that. So many people think if you want to commit suicide, you will, there's nothing that can stop you. And that's just, you know, if that were the case, there wouldn't have been as great success stories in England or in Srilanka or. That's just not true.
And what's sad is, is sort of misinformation campaigns that work is that it's harder now than it used to be, I think, to get scientific information to people that they will believe. I mean, science too much now has been drawn into the cultural war since so people have their own science or something. It doesn't mean it doesn't matter. It matters. It's just a little disheartening is that it doesn't have a bigger effect quicker.
But one of the things to recognize is that all of the successes in public health, all the great successes have had people fighting against them over and over and over. It's incredible. You just look through all the motor vehicle stuff has had people fighting against it. Uh, first, I think, one of the major public health successes in the 1800 was the sanitation revolution was getting, poop out of the cities. It was like, all right. Let's uh, let's, you know, get your defecation put it someplace where we can sanitize it and get rid of it. And it's like, people fought against that. You know, we want our poop here, you can't take away. What are you doing? You know, the government doesn't realize that it's like, come on, come on, please. And I think in part, some of the, not all of the public health, but some of the public health issues, you really want collective action, which means, you know, sort of government or groups of citizens or something.
And some people don't like that. But a lot doesn't a lot is just, you know, education and changing people's beliefs and whatever it doesn't need government to change social norms. You know, one of the great success stories for me in health in my lifetime has been living in a city is dog poop. When I was young, there was dog poop everywhere. You know, you, you walked around and you came into your house and your mom said, you have dog poop on your foot. And you would say well, probably, you know. And now, everybody, at least where I live picks up their dog poop, not because it's a law really, but because, other people are watching, you know, we pick up after our dogs, you pick up after your dog. You know, social norms have changed.
Lee: Do you think? I guess this is moving beyond the field of public health, but. It certainly is clearly related to your efforts. But you know, in, in the world, say of, moral philosophy or moral theology we're very aware that since the time of the enlightenment, the focus of, moral philosophy became highly individualized as opposed to thinking systemically or communally.
David: Right.
Lee: And in what ways do you see that sort of individualism at play in your work or inhibiting your work?
David: Yeah, I think that matters a lot. I think, you know, the notion that, I'm only in it for myself is a very bad one. A lot of things in public health are, what you really want is community spirit to understand that your success or your failure is not only because of you and it's not only because of your family, it's because of society.
You know, if you are a tailor in the United States, you make 10 times as much as if you are a tailor in, uh, low income country. And it's not just you, who is so great, it's it's society. And the whole enlightenment, you know, the reason we have lived so long now and live such healthy and, better lives than we use to. It’s not cause oh I deserve this because I did it. No, it's the whole society that, you know, we've been figuring out we've been working together, in all these areas. And one of the things I would say religion and economics cause I'm an economist.
So we talk a lot about externalities. And externalities is alright. You can look out for yourself and sometimes the invisible hand works, but a lot of times just looking out for yourself, you're harming other people to a great extent. And if you just look out for yourself and if everyone looks out for themselves, you end up in an outcome, which is terrible for the society. That's what's happened about global warming. And everyone's looking out for themselves and they don't recognize that, oh, I'll put a little more carbon into the air, I'll do this. And the answer is we're destroying so much of what we love over time. My limited understanding of religion is one of the things that religion tries to do is that you just don't look out for yourself.
You try to, you know, worry about how do my actions affect other people. And if they affect them really negatively, that's. We shouldn't be, we shouldn't be doing that. And so that's what I think, you know, in public health, we want everyone to be vaccinated. Why? Yes, it's in your interest for most people, but you know, initially before the Delta variant, it was sort of clear if you are 22 year old, it wasn't really in your interest but it was certainly in your interest of your parents and your grandparents and the rest of the society that used to help stop this epidemic. You do want to have some community spirit. I was born just at the end of world war II. When we're fighting world war II, we want people to be volunteering and say, yes, you know, you can die in this. If you just weigh your own costs and benefits, maybe you shouldn't be volunteering to go fight the battle of the bulge you know. But, if you care about other people the answer is yeah. And so that public health I think has part of that.
Lee: Yeah, we've been talking to Professor David Hemenway, director of the Harvard Injury Control Research Center. Thank you so much Dr. Hemenway for your, your work And your, uh, very helpful explanation of, public health and, gun violence in American society.
David: Right. Yeah. I can tell, I got a little over excited about it. This field you know, there are people out there who we don't know who are dying because of inaction. And what I tell my students too is that so many people in public health have done so much and you're not going to get any reward, at least on this earth. People don't know who you are. I think Fauci is the first public health person who's ever been known in the whole United States. Uh, and you're not going to get money typically. But you know, you're, you're on the side of the angels. What you're doing is gonna make a real difference in people's lives, who will never know that that's what you did though.
Lee: Oh, we're thankful for your work on the side of angels.
David: It's not me. It's, my students who are, I'm just teaching, they're going out and doing things.
Lee Camp: You've been listening to Tokens: public theology, human flourishing, the good life.
If you would like to hear more about America's unique obsession with guns, you're in luck: in typical Tokens fashion, we staged the issue in a theological light in our recent episode entitled "God and Guns" featuring Chris Hays and Carly Crouch.
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Thanks for listening, and peace be unto thee.
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