The Global Gun Epidemic:
From Saturday Night Specials to AK-47s
JAMA/Journal of the American Medical Association Book review
The Global Gun Epidemic: From Saturday Night Specials to AK-47s by Wendy Cukier and Victor W. Sidel, 310 pp, with illus, $49.95, ISBN 0-275-98256-4, Westport, Conn, Praeger Security International, 2006.
On April 20, 1999, in Littleton, Colo, Eric Harris and Dylan Klebold, two Columbine High School seniors, shot and killed 15 persons including themselves in an attack at their school. An additional 28 persons were injured. The attackers used a variety of firearms, including sawed-off shotguns and a handgun. The case fatality ratio for the incident - the proportion of those injured who were killed - was 35%. On May 26, 2006, a knife-wielding German teenager stabbed 30 persons in an apparently alcohol-fueled "rampage" following an event marking the opening of Berlin's new railway station. Six persons were seriously hurt, and one required a life-saving operation. The case fatality ratio for the incident was 0%.
In The Global Gun Epidemic, authors Wendy Cukier and Victor W. Sidel explore why violence in the United States is so much more likely to be lethal than violence in most other developed nations. As their title suggests, they identify the far greater role of firearms in the United States as the primary culprit.
In their preface, the authors promise to apply a "public health lens to the problem of firearms on a global scale." They describe the public health approach as including the identification of risk factors, development of interventions, implementation of those interventions, and evaluation and replication of strategies that prove successful. In each subsequent chapter, they apply this model to explore some aspect of the global pandemic of gun violence, always comparing the United States with the rest of the world.
In chapters 1 ("Guns: A Global Perspective") and 2 ("The Firearm Epidemic"), for example, we learn that there are an estimated 200 000 firearm-related deaths worldwide each year, including homicides, suicides, and unintentional deaths. Of these, approximately 30 000 occur in the United States. These data exclude deaths associated with military conflicts. The contrast is even more stark when the United States is compared with its peer group of 52 high- and medium-income countries: a World Health Organization report identified 104 492 deaths in those countries in 1998, 30 419 (29%) of which occurred in the United States. International comparisons can sometimes be problematic, however, as the authors acknowledge, since many factors can also affect rates of gun violence.
The United States is also identified as a disproportionate manufacturer and possessor of firearms. Chapter 3 ("More Guns Equals More Deaths") notes that "the United States has a higher rate of gun ownership, particularly handguns, per capita than any other industrialized country in the world," with as many as 40% of US households owning at least one firearm. Chapter 4 ("The Global Gun Trade") reports worldwide small arms production at 7.5 million to 8 million weapons annually, with the United States responsible for more than 3 million of that total.
In their discussion of "Globalization and Gun Running" (chapter 5), the authors remind us of one of the truisms of gun policy in the United States and globally, that "virtually every illegal gun begins as a legal gun." This means that the illegal market is driven by guns diverted from the legal market, often from places with weaker laws (like those in much of the United States) to places with more restrictive policies (as in Canada and much of Western Europe). Those policies are described in chapters 7 ("The Regulation of Firearms") and 8 ("National Approaches to Regulation"). These chapters will be especially helpful for those seeking models on which to base new legislation and to researchers trying to evaluate the effects of different regulatory approaches. Unfortunately, as the authors explain, to date "the reality is that outside of the United States, there is relatively limited peer-reviewed literature even describing gun laws let alone evaluating their impact." This book can serve as a useful first step in that much-needed research. The book concludes with a discussion of the efforts to establish an "international movement" for gun violence prevention, including the formation of the International Action Network on Small Arms (IANSA).
Overall, The Global Gun Epidemic provides a valuable overview of an important topic. By bringing together information from around the world, this book allows the reader to see connections and gain insights that might otherwise be missed. Those of us who focus on preventing gun deaths and injuries within the United States sometimes forget just how much the lack of an effective national regulatory system for firearms can affect other countries.
Of course, any book that aims to provide a comprehensive examination of a complex subject will be broader than it is deep. Discussions of specific policy approaches, such as the many different ways that the sale of firearms can be regulated, are brief. Sections that review, country by country, firearm data and various policy approaches can make for dry reading and may be more valuable for reference or future research. To their credit, the authors do not ignore the works of those who argue that firearms are, on balance, protective or that regulation is ineffective, but I might have wished for more engagement with these critics to better enable the reader to understand and respond to their arguments. In addition, this is not the book for readers who want to know exactly how to achieve needed change - advocacy strategies are only briefly addressed.
Returning to the German incident, although it occurred too recently to be discussed in The Global Gun Epidemic, it is probably no accident that the youth used a knife rather than a gun. As Cukier and Sidel explain, the "fundamental principle" of Germany's restrictive gun control laws is a concern for public safety. Violence with a knife, while tragic and preventable, is on average less likely to be lethal than violence with a gun. This book's public health approach reminds us that the instrument of violence matters.
Jon S. Vernick, JD, MPH, Reviewer
Johns Hopkins Center for Gun Policy and Research Johns Hopkins Bloomberg School of Public Health Baltimore, Md
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