Inconsolable grief recently filled ten thousand square feet of US Capitol lawn. In that area, people had placed 7,000 pairs of empty shoes, each pair representing a child killed by a firearm in the approximately six years since the massacre at the elementary school in Sand Hook, Connecticut.(1) The recent mass murder in Parkland, Florida and the reactions to it, such as the deeply saddening display of those empty shoes on the Capitol lawn, bring our society’s response to firearm deaths into the heart of public discourse yet again.

Throughout this commentary, note that I use the term “firearm safety.” When pursuing legislation to reduce injuries from auto accidents, no one considered those efforts “car control” or “driver control.” Instead the focus was on “highway safety.” The same holds for other areas of injury prevention; airplane safety was not called “airplane control.” The primary issue in public health is always “safety,” not control. I follow that tradition here by discussing the public health challenge of enhancing firearm safety in our nation.

The phrase “gun control” is a deceptively misleading phrase too often used to describe the goal of firearm safety advocates. Control is a term that, thanks to the red-meat rhetoric and seemingly tireless efforts of the National Rifle Association, seems to carry with it implications of government overreach and overtones of the denial of citizens’ constitutionally protected rights. The term “gun violence,” which is sometime used, is inappropriate for this discussion in that it is less general than firearm safety, significantly downplaying the role of gun accidents and the large proportion of suicides involving firearms.

The Dimensions of the Firearm Safety Problem

Highway deaths have long been the leading cause of deaths from injury in America. But, by 2016, deaths due to firearms outnumbered highway deaths in 21 states and the District of Columbia.(2) During that same year, homicides and suicides (mostly by gun) ranked as the third or fourth most frequent causes of death for all those from one to 34 years of age. For those 35-44, they were the fourth and fifth leading cause of death.(3)

By the first 21 weeks of 2018, shootings, with death or injury, were spread across 23 schools in America.(4) In addition, years ago America passed the point where gun deaths in this country since 1968 significantly outnumbered the total number of American soldiers who died in all the wars fought by this nation. The common claim is that the difference is roughly 200,000 more firearm deaths. Snopes’ review of the data indicates that claim is mostly true, though Snopes fact-checking indicates the figure may be closer to 100,000.(5)

What this discussion and Snopes’s review fail to recognize is that the meaningful difference is even greater. All 1.5 million deaths due to firearms since 1968 clearly resulted from a discharged firearm. But, military deaths include literally hundreds of thousands of deaths in our wars that involved not hostile forces but deadly microbes.

In the Civil War, the best estimate of military deaths is roughly 750,000 soldiers.(5) Those deaths constitute about one-half of all deaths of American combatants. But, five-eighths of combatants’ deaths (62.5%) in the Civil War resulted from disease.(6) So, the meaningful difference between the number of soldiers who died since 1968 versus the number of firearm deaths in American for the same period is even more stark than those original claims. The difference is well over one-half million greater deaths from firearms in the USA in the last 50 years than from all deaths of military personnel since the beginning of the Revolutionary War in the last 18th century.

The Asymmetric Political Battlefield

The struggle for firearm safety, like much of injury prevention, involves a type of “asymmetric political warfare.” The dominant belligerent is a large industry represented by multiple organizations with considerable financial resources and some good measure of popular support, a portion of which is quite uncompromising. This powerful industry, whose products place the population’s health at risk, faces a less powerful and fragmented resistance movement composed of social activists with limited funds and varying levels of public support. Most problematic, much of the populace remains uninvolved politically in such struggles.

The Combatants

The resistance, in this instance, includes organizations seeking enactment of meaningful firearm safety legislation, such as The Brady Campaign to Prevent Gun Violence or Everytown for Gun Safety. These organizations continually work for greater firearm safety with their limited funds and relatively small staffs. Unfortunately, only in the wake of mass murders do these organizations garner wide public attention.

The dominant power on this asymmetric battlefield is the National Rifle Association (NRA) with its five million members. The NRA’s commitment to political action is evinced by its communication with its membership, lobbying, campaign contributions, funding of political action committees, and the activities of its Institute for Legislative Action (ILA). The ILA has 5.1 million likes on Facebook and 4.8 million followers. How inflated those numbers may be is debatable, nonetheless they do indicate that the NRA is spreading its message quite widely to its members. In addition, the NRA in the 2016 election year expended $140 million on legislative programs and public affairs. These expenditures included $30 million supporting Donald Trump’s campaign and roughly an additional $20 million spent on congressional races.(7)

While considerable NRA monies come from members, its financial links to the firearms industry are indisputable. These companies contribute millions to the NRA entities and buy millions in advertising in NRA publications. These multi-million-dollar ties to firearms industries include gun or firearm accessory manufacturers providing free NRA memberships with each sale or donating some amount of each sale to the NRA.(8)

The NRA, however, never presents its policy stances as efforts to protect the pecuniary interests of its industry supporters. Instead, the NRA clams to be shielding the rights of American gun owners. The NRA’s rhetoric carries messages far beyond the protection of gun owners’ rights when it is faced with the possibility of legislation enhancing firearm safety. According to Wayne LaPierre of the NRA, speaking just days after the massacre in Parkland, Florida, those seeking additional firearm safety legislation, “… hate the NRA; they hate the Second Amendment; they hate freedom.” He waved yet again NRA’s false flag warning of gun confiscation and creeping authoritarianism, “Their goal is to eliminate the Second Amendment and our firearm freedom, so they can eradicate individual freedom.”(9)

An Evolving Struggle

Recent evidence indicates the firearm safety battlefield may be changing. The NRA’s dominance may be waning, at least among some segments of the public. Quinnipiac’s poll of American voters fielded just a week after the Parkland massacre found only 38 percent of voters had a favorable view of the NRA. A majority in some subpopulations did, however, hold a favorable opinion of the NRA―Republicans, rural residents, gun households, those with no college degree, and white males. However, 60 percent of all voters believed the NRA has too much political influence. This was true among subpopulations based on party, race, gender, age, rurality, and gun ownership. Only those identifying as Republicans (66%) disagreed.(10)

A poll taken in Florida after Parkland showed the state’s voters deeply troubled by the Parkland massacre. A majority felt national and state governments were not doing enough to reduce gun violence and strongly supported additional firearm safety measures, including universal background checks, a ban on high-capacity magazines, and a ban on military-style assault rifles. When these voters were asked if they would still support a candidate with whom they agreed on other issues but not on gun laws. Two of every five indicated they would not support such candidates.(11)

The Parkland tragedy may also have added a new, potentially powerful, element to the firearm safety movement. The activism of students and their use of social media spawned the National Student Walkout in which thousands of students across the nation left school to demonstrate for sensible firearm safety legislation. The March for Our Lives, also a response to Parkland, included as many as 200,000 participants in Washington, DC and tens of thousands of marchers in over 800 sibling rallies spread across the United States. The march garnered substantial support from a variety of wealthy individuals, celebrities, and organizations, as well as raising as much as $3,000,000 on GoFundMe.(12)

These events may portend a long-needed change in the political landscape surrounding firearm safety. At the least, this wave of student activism was part of what forced the Florida State Legislature to pass legislation appropriately seen as “firearm safety lite,” focusing largely on raising the age for the purchase of firearms to 21, banning bump-stocks, and providing a three-day waiting period for gun purchases.(13)

Even that weak tea legislation, may be too much for other victims. The recent Santa Fe school shooting is not likely to result in any state legislation unacceptable to the NRA. Though the Governor of Texas has taken a major step (sarcasm here) to show his support for gun safety. His campaign website was sponsoring a contest for a $250 coupon for the purchase of a Texas-made shotgun. Now, the contest now simply offers a $250 gift certificate. Maybe someone will use it to buy an AR-15.(14) The Lt. Governor of Texas’s contribution to enhancing school safety is the suggestion that we would do best to reduce the number of exits and entrances to school for easier policing.(15)

In addition, Santa Fe, Texas is not Broward County, Florida. Few of the students there will be marching for their lives. Like the folks in Sutherland, Texas after their church shooting, they and their parents are more likely to go to a gun dealer, rather than a March for Our Lives. Also, that school district may even join the 170 other school districts in Texas that allow teachers to carry concealed handguns.(16)

While the voting population’s support for the NRA may be on the wane, the gun owning population may be changing as well. Gun Owners for Responsible Ownership and Gun Owners for Responsible Gun Control have joined the ranks of those seeking legislative reform.(17,18) Further evidence of change that may bode well for efforts to increase firearm safety comes in changes in the gun owning population. The percent of US households with firearms has fallen by 34 percent over the last four decades (47% to 31%).(19) Harvard’s most recent poll of those 18-29 years of age found 61 percent in favor of stricter gun control measures―a significant increase from the 49 percent indicating such support in 2013.(20)

Also, as the work by Wertz and his colleagues in their recent article in the
American Journal of Public Health indicate, “newer” gun owners differ from “long-standing” gun owners in some potentially important ways. Newer gun owners are more likely to be politically liberal than long-standing gun owners (27.9% to 12.8%), more likely to own fewer firearms, more likely to own only handguns, and more likely to store their firearms safely.(21) These differences may indicate growing diversity among the NRA’s potential membership, a diversity that may benefit the firearm safety movement.

The NRA, its hardcore members, and its industry backers will not change their response to mass murders. They will always claim the fault lies with the shooter or the lack of “good guys with guns,” rather than the use of the deadly weapons and high-capacity magazines these mass murderers so easily acquire. They will continue to vilify those seeking firearm safety legislation, mendaciously claiming their aim is to confiscate firearms and destroy Americans’ individual freedoms.

The Issue-Attention Cycle

Unfortunately, one expects the issue of firearm safety to continue following what Anthony Downs dubbed the “issue-attention cycle.” Downs observed this cycle in his study of issues related to ecology.(22) The cycle has five phases:

*“Pre-problem. This is the period when some highly undesirable social condition exists, but that condition has not captured much public attention.

* Alarmed Discovery and Euphoric Enthusiasm. Alarm and confidence mark this period. The public becomes aware of the problem and alarmed by its presence. At the same time, many express great confidences in the likelihood that the problem can be solved.

* Realizing the Costs of Significant Progress. The realization of the high costs (political, social, or economic) of solving the problem becomes evident. Recognition grows that the “problem” results from arrangements that provide significant benefits (psychological or monetary) to some segment of the society. This often makes any solution to the problem quite difficult without major social change.

* Gradual Decline of Intense Public Interest. Some people are discouraged by the magnitude of the changes required. Thoughts of the issue frighten others away, and others simply become bored and their attention wanes. However, some activism remains, and some changes made in earlier phase persevere.

* Post-Problem Stage. The public no longer see the issue as central and it is relegated to the periphery of the public spotlight. However, Downs recognizes that there will be “sporadic recurrences of interest.””

The history of the firearm safety movement seems a classic example of this cycle. Firearm safety is what one might call an “episodic issue.” A massacre occurs, and outrage follows. In the face of Columbine, Newtown, Las Vegas, and a plethora of other horrors, most politicians speak of sadness and prayers. That message clearly indicates that they recognize the potentially significant costs to their political careers of pursuing any truly meaningful progress in firearm safety that puts them at odds with the NRA.

Implications of Firearm Safety as an Episodic Issue

The good news, or somewhat good news, is that even though firearm safety is an episodic issue, progress can be made. The period after Newtown resulted in the enactment of new firearm safety legislation in during the period of alarmed discovery some legislative progress can be made. Prior to Stages 4 and 5 in the issue-attention cycle, President Obama signed 23 executive actions aimed at increased gun safety. In addition, California, Colorado, Connecticut, Delaware, Illinois, Maryland, New Jersey, and New York enacted some elements of meaningful firearm safety legislation.(23)

After the Parkland massacre, even the staunchly pro-gun Florida legislature passed their firearm-safety-lite legislation banning bump stocks, raising the age for gun purchases to 21, and adding a three-day waiting period for purchases, and a few of details. Though that legislation is the epitome of a weak tea response, the NRA immediately filed suit, it claims that it did so, allegedly, to protect the 2nd Amendment rights of those 18-21.(24) Young Floridians can’t buy alcohol until they are 21, but the NRA wants to make sure they have largely unfettered access to deadly weapons designed for the express purpose of taking human life.

That firearm safety is truly an episodic issue is also the bad news. No strong, constant countervailing force faces the NRA and the firearms industry. This means that reforms in times of heightened awareness may only address the latest manifestation of our failure to take firearm safety seriously. In Florida, the legislature voted to change the age for acquiring a firearm because the shooter was under 21. And, with any tragedy, gun advocates can point to the details of the incident and show how some element of the firearm safety agenda didn’t stop this or that incident. Which, of course, is true.

However, the process of enhancing firearm safety should be thought of as something like the highway safety movement. Seatbelts didn’t save everyone in a traffic accident. Annual auto safety inspections don’t keep all unsafe cars off the road. The movement to reduce deaths due to drunk driving didn’t stop all deaths related to driving while intoxicated. But, the accumulated effect of these reforms generated a significant and steady decline in highway deaths. Firearm related deaths have not exceeded highway deaths in many states because of the increase in firearm deaths; instead, the cumulative effect of highway safety measures has steadily decreased highway traffic deaths.

The episodic nature of public attention to firearm safety makes it difficult to generate a steady increase in firearm safety that results from the cumulative effect of an array of reforms, each of which contributes to firearm safety. Also, these tragedies that foreshadow episodes of reform tend to generate a “reform” only in the state or region affected by that tragedy. The highway safety movement was more of a national movement. With the NRA more deeply entrenched in the pockets of members of Congress, firearm safety will, I fear, continue to be a patchwork affair with each state moving at its own version of a snail’s pace to greater firearm safety.

However, the Parkland massacre, along with mobilizing students, has, contrary to historical patterns, induced some of the states to develop multi-state coalitions that serve as substitutes for federal action. Connecticut, New Jersey, New York, and Rhode Island have formed a coalition, States for Gun Safety.(25) Through this coalition, these states, all with relatively strong firearm safety legislation in place, will share data about those persons ineligible to possess firearms, monitor patterns of firearm trafficking, and designate universities to research gun safety issues. Given the paralytic response to gun safety that has characterized action, on inaction, in the US Congress, this effort may provide a model for other states with more progressive approaches to firearm safety.

The Future

It is difficult to predict what the future holds for the firearm safety in America. But, it is early times yet for the March for Our Lives movement and the States for Gun Safety coalition. It is unclear whether this moment in time represents the blossoming of a sustained movement toward greater firearm safety in this nation. This may, unfortunately, just be a passing moment destined to be swallowed up by the incessant drumming of everyday politics and the continually howling of the NRA.

Before one becomes too sanguine about what seems to be the brightening future of firearm safety legislation, one should note the recent uptick in efforts to pass firearm safety legislation in some states has generated a measure of backlash. In Illinois and Oregon, some rural counties are seeking the right to become what they are dubbing “gun sanctuaries” where local law enforcement would not be required to enforce state firearm safety measures championed by their more urban neighbors.(26)

Supporters of gun safety would do well to remember that some estimates indicate that we have more guns in this country than people. Gun culture has deep, strong roots in our society. The heightened awareness in the issue-attention cycle, rational argument, and compelling data have only occasionally managed to sever some of those pernicious roots.

But, as noted above, the nature and size of the firearm safety movement and its eventual success in procuring enactment of meaningful firearm safety legislation may be on the rise. The waning public support for the NRA, the blossoming activism of students, and changing nature of gun ownership may result in enactment of meaningful firearm safety measures. We can hope that we can reduce the number of empty shoes that might be placed on The Capitol lawn in 2024, six years after the mass murder at Parkland.

REFERENCES

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11.Quinnipiac Poll, Florida voters oppose teachers with guns, Quinnipiac University poll finds; support for ‘assault weapon’ ban almost 2-1. Available at: https://poll.qu.edu/images/polling/fl/fl02282018_fqlv16.pdf/. Accessed March 12, 2018.
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14.Pollock, C. Gov. Greg Abbott cancels shotgun giveaway after Santa Fe shooing. Texas Tribune, May 21, 2018. Available at: https://www.texastribune.org/2018/05/21/texas-gov-greg-abbott-cancels-shotgun-giveaway-after-santa-fe-shooting/. Accessed May 29, 2018.
15.Blad, E. Does limiting schools’ entrances make them safer? Education Week, May 27, 2018. Available at: http://blogs.edweek.org/edweek/rulesforengagement/2018/05/santa_fe_school_shooting_doors_safety.html. Accessed May 29, 2018.
16.NBC News. Available at : https://www.nbcnews.com/news/us-news/we-just-have-heal-different-way-santa-fe-parkland-diverge-n876416?cid=eml_nbn_20180522. Accessed May 22, 2018.
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21.Wertz, J, Azael, D, Sorenson, S, Hemenway, D, Miller, M. Differences between new and long-standing gun owners: results from a national survey. 2018. AJPH
22.Downs, Anthony, Up and Down with Ecology-the Issue-Attention Cycle, Public Interest, 28 (1972: Summer) p.38
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24.The Buzz. NRA sues Florida over new gun law. Available at: http://www.tampabay.com/florida-politics/buzz/2018/03/09/nra-sues-florida-over-gun-bill/. Accessed May 27, 2018.
25.Governors Cuomo, Malloy, Murphy, and Raimondo announce “States for Gun Safety” coalition to combat the gun violence epidemic. Available at: https://www.governor.ny.gov/news/governors-cuomo-malloy-murphy-and-raimondo-announce-states-gun-safety-coalition-combat-gun. Accessed May 27, 2018.
26.Schuppe, J. Rural counties responses to state firearm laws: Gun sanctuaries. NBC News. Available at: https://www.nbcnews.com/news/us-news/rural-america-mad-about-proposed-gun-laws-so-they-re-n877481. Accessed May 27, 2018.