Unrestricted access should be viewed as a public health disaster

Physicians throughout the world bear witness to the terrible consequences of small arms. But do we truly understand the impact and the epidemiology of the small arms pandemic, and can we devise effective strategies for prevention as we have for other major public health issues? The capacity for collecting consistent, reliable, and relevant data is limited by various cultural, economic, infrastructural, and logistic factors even in developed countries not at war. Nevertheless, we have some solid data on the size of the problem and indicators suggestive of possible solutions.

The United States, for instance, has over 28 000 deaths a year from small arms—accidents, suicides, and homicides—the highest rate in the developed world.1 In that country firearms are the leading cause of death among 15-24 year olds, slightly ahead of vehicle crashes, and the third leading cause of death in those aged under 15.2 While the US murder rate without guns is roughly equivalent to that of Canada (1.3 times), its murder rate with handguns is 15 times the Canadian rate.3 Countries with similar cultural, economic, and ethnic make up but with different gun possession rates also have widely differing firearm death rates, roughly correlating with the percentage of households with guns.4 For example, …