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Gun-Related Deaths: How Australia Stepped Off “The American Path”

2013; American College of Physicians; Volume: 158; Issue: 10 Linguagem: Inglês

10.7326/0003-4819-158-10-201305210-00624

1539-3704

Simon Chapman, Philip Alpers,

Suicide and Self-Harm Studies

Ideas and Opinions21 May 2013Gun-Related Deaths: How Australia Stepped Off “The American Path”FREESimon Chapman, PhD and Philip AlpersSimon Chapman, PhDFrom the University of Sydney, Sydney, Australia.Search for more papers by this author and Philip AlpersFrom the University of Sydney, Sydney, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-10-201305210-00624 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Australia and the United States share many characteristics. Both are English-speaking democracies of multicultural immigrants. The 2 nations have been allies for nearly a century. Australians and Americans consume similar diets of movies, video games, popular music, recreational drugs, and alcohol. Both have vast interiors, early histories of armed European settlers mistreating native populations, plenty of feral pests to shoot, and many firearm enthusiasts. Yet the 2 countries differ dramatically on the issue of gun violence. The U.S. population is 13.7 times larger than that of Australia, but it has 134 times the number of total firearm-related deaths (31 672 vs. 236 in 2010) and 27 times the rate of firearm homicide (11 078 [3.6 per 100 000] vs. 30 [0.13 per 100 000] in 2010) (1).The event that spurred this change in Australian gun control occurred on 28 April 1996 at the tourist site of Port Arthur, Tasmania, when a gunman killed 20 people in 90 seconds with his first 29 bullets. This “pathetic social misfit” (the judge's words) was empowered to achieve his final toll of 35 people dead and 18 seriously wounded by firing semiautomatic rifles originally advertised by the gun trade as “assault weapons.” Like most mass shooters in Australia and New Zealand, the killer had neither a criminal record nor a diagnosed mental illness.In the 12 days after this event, Australia's 6 states, 2 territories, federal government, and opposition parties agreed to enact a comprehensive suite of firearm law reforms (2). John Howard, the newly elected and conservative prime minister, quickly reformed gun control laws. Since then, there have been no mass shootings and an accelerated decline in total gun-related deaths (3). All sides of Australian politics view tighter gun laws as a triumph of Howard's administration.Key components of the reforms included a ban on civilian ownership of semiautomatic long guns and pump-action shotguns; a market-price gun buyback program financed by a small, one-off income tax levy on all workers; proof of genuine reason for firearm possession; the formal repudiation of self-defense as a legally acknowledged reason to own a gun; prohibition of mail or Internet gun sales; and required registration of all firearms (2). In a long series of state and federal gun amnesties and guns being voluntary surrendered for destruction, Australians have smelted more than 1 million firearms, or one third of the national civilian arsenal. An equal number in the United States would be 90 million guns (3).On the day of the massacre in Sandy Hook, Connecticut, one of us tweeted a link to our report on gun deaths in Australia during the decade after the Port Arthur massacre and ensuing reforms (4). In the 6 years since our paper was published, readers accessed it online 14 742 times. During December 2012, a total of 82 310 people accessed it (see http://injuryprevention.bmj.com/articleusage?rid=12/6/365). Demand led to the reprinting of a book detailing the events surrounding Australian gun control (5), which was also made available as a free download. The world, particularly Americans, seems thirsty for information about the Australian experience.The U.S. gun lobby argues that, because people (not guns) kill people, gun control will not reduce gun deaths. The Australian experience can inform this debate.Whereas firearm suicides and single-victim homicides, such as domestic murders and criminal-on-criminal shootings, dominate the landscape of firearm-related deaths in industrialized nations, it was a mass shooting that outraged Australians and oxygenated public demand for gun control. The firearms banned from civilian ownership in Australia are frighteningly efficient, mass-killing machines originally designed for military combat. These weapons contribute little to target shooting or hunting. At the time, and across all mainstream media, gun lobby pleas to allow open civilian access to weapons designed for the battlefield were labeled as “un-Australian” extremism (5). Prime Minister Howard stated that “This country, through its governments, has decided not to go down the American path in regard to guns.” But few predicted that a ban on semiautomatic weapons to prevent massacres would have had a significant impact on Australia's total gun deaths. Then, as now, unintentional shootings and suicides were responsible for 75% to 80% of gun deaths. Yet, the ban on semiautomatic weapons led not only to a 16-year absence of gun massacres but also an accelerating decrease in the total rates of gun deaths (3).The rate of firearm homicide, which was decreasing by 3% per year before the reforms, decreased 7.5% per year after the new laws. This change failed to reach statistical significance (P = 0.15) because of the relatively small numbers involved, but it remains notable (4). Firearm-related suicides in Australian men declined from 3.4 to 1.3 per 100 000 person-years (a 59.9% decline) between 1997 and 2005, while the rate of all other suicides declined from 19.9 to 15.0 per 100 000 person-years (a 24.5% decline), suggesting no substitution effect (6). The yearly change in firearm-related suicides in men was −8.7% per 100 000 person-years (95% CI, −10.2% to −7.0%), and the yearly change in other suicides was −4.1% (CI, −4.7% to −3.5%), less than half the rate of decrease in firearm suicide (6). Although gun lobby researchers in Australia have sought to repudiate these data (7) using methods that have been heavily criticized (8, 9), to date no peer-reviewed research has established a plausible alternative cause for these accelerated declines. Meanwhile, others have attributed even stronger public safety effects to Australia's firearm reforms (10).A nation's incidence of firearm deaths reflects many cultural, economic, and legislative factors. Those implacably opposed to Australia's reforms remain intent on attributing the declining incidence of gun death to anything but the new gun laws and the destruction of one third of the nation's firearms. But Australia's public health initiatives resemble the explanatory elephant in the room. No factor other than the dramatic reduction in access to the semiautomatic weapons needed by those planning massacres has been advanced to plausibly explain the cessation of mass shootings in Australia.Although pro-gun spokespersons remain obsessed with the injustice of “decent law-abiding shooters” being “treated like potential criminals,” this rhetoric finds little traction in Australia, where drivers are regularly treated as potential public menaces at random breath-testing checkpoints and travelers as possible terrorists when passing through airport security.Recently, a public health approach to gun control has taken root in the White House. Each of President Obama's recommendations has its basis in evidence-based public safety interventions patiently researched by our U.S. colleagues. Interventions similar in intent and design to those that successfully reduced the toll of guns on the lives of Australians may, perhaps, take hold in the United States.References1. Alpers P, Wilson M, Rossetti A. Guns in Australia: facts, figures and firearm law—Death and Injury, Total Gun Deaths and Gun Homicides compared to the United States. Sydney, Australia: Sydney School of Public Health, The University of Sydney; 2013. Accessed at www.gunpolicy.org/firearms/compare/10/total_number_of_gun_deaths/65,66,69,87,136,177,192,194 on 28 February 2013. Google Scholar2. Commonwealth of Australia. Resolutions from a special firearms meeting. Canberra, Australia: Australian Police Ministers Council; 10 May 1996. Google Scholar3. Alpers P. The big melt: how one democracy changed after scrapping a third of its firearms. In: Reducing Gun Violence in America: Informing Policy with Evidence and Analysis. Webster DW, Vernick JS, eds. Baltimore: Johns Hopkins Univ Pr; 2013:205-11. Accessed at http://jhupress.files.wordpress.com/2013/01/1421411113_updf.pdf on 11 February 2013. Google Scholar4. Chapman S, Alpers P, Agho K, Jones M. Australia's 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings. Inj Prev. 2006;12:365-72. [PMID: 17170183] CrossrefMedlineGoogle Scholar5. Chapman S. Over Our Dead Bodies: Port Arthur and Australia's Fight for Gun Control. Annandale, VA: Pluto Pr; 1998. Available for download http://ses.library.usyd.edu.au/handle/2123/8938. Google Scholar6. Chapman S, Hayen A. Declines in Australian suicide: a reanalysis of Mcphedran and Baker (2008) [Letter]. Health Policy. 2008;88:152-4. [PMID: 18571279] CrossrefMedlineGoogle Scholar7. Baker J, McPhedran S. Gun laws and sudden death: did the Australian firearms legislation of 1996 make a difference? Br J Criminology. 2007;47:455-69. CrossrefGoogle Scholar8. Neill C, Leigh A. Weak Tests and Strong Conclusion: A Reanalysis of Gun Deaths and the Australian Firearms Buyback. EPS Journal Discussion Paper 555. Canberra, Australia: The Australian National University, Centre for Economic Policy Research; 2007. Google Scholar9. Hemenway D. How to find nothing. J Public Health Policy. 2009;30:260-8. [PMID: 19806067] CrossrefMedlineGoogle Scholar10. Leigh A, Neill C. Do gun buybacks save lives? Evidence from panel data. American Law and Economics Review. 2010;12:462-508. CrossrefGoogle Scholar Comments0 CommentsSign In to Submit A Comment Samara McPhedran, PhD, Jeanine Baker, PhDInternational Coalition for Women in Shooting and Hunting (WiSH)19 March 2013 Gun Related Deaths: What has really happened in Australia? As the United States struggles to develop meaningful ways to reduce firearm related deaths, it is imperative that these efforts be guided by sound evidence and informed by robust debate. Although the United States and Australia differ substantially in terms of society, history, and culture, some have suggested that the United States can learn from the Australian experience with gun control. Given the importance of this topic, it is disappointing to see that Chapman and Alpers (1) provide only a superficial and highly selective account of evidence around Australia’s firearms legislative reforms. Citing their own work, they state that Australia’s legislative changes have had significant impacts, and imply that only one paper written by ‘gun lobby researchers’ (2) has disputed this view. This is incorrect. Indeed, on the basis of detailed review of many studies, it has recently been proposed that Australia’s gun laws do not represent a cost-effective intervention (3). Aside from Baker and McPhedran (2), there is a body of research into the impacts of Australia’s 1996 gun laws. Using a range of different statistical methods and time periods, none of these studies has found a significant impact of the legislative changes on the pre-existing downward trend in firearm homicide (4) (5) (6) (7). Nor does the decline in firearm homicides in Australia appear unique, with other Commonwealth countries experiencing similar or greater declines over time, despite less restrictive legislative approaches to firearms control (5). Findings for impacts of the legislative changes on pre-existing downwards trends in firearm suicide are inconsistent. Some studies find evidence of an impact (8) (2) (6) (7), while others find little or no evidence of an impact and/or document substitution to other methods (4) (9) (10) (11) (12). Chapman and Alpers (1) imply Australia’s gun laws have stopped mass shootings, and allow no possibility that any factor other than gun bans could produce this outcome. They fail to mention that Australia’s close neighbor New Zealand – a country that is genuinely similar to Australia in terms of history, culture, and economic trends – has experienced an almost identical time period with no mass shooting events despite the continued widespread availability of the types of firearms banned in Australia (13). The absence of mass shootings in New Zealand despite ongoing availability of semi-automatic firearms cannot be reasonably attributed to pre-existing differences between the two countries. Using standardised data to control for population size differences, it was found that the occurrence of mass shootings before 1996/1997 was comparable between countries (13). In the late 1980s and early 1990s, both Australia and New Zealand experienced high levels of unemployment, followed by a decade of relative economic stability and growth from the mid-1990s onward. The clustering of mass shootings around a period of economic downturn and high unemployment, followed by the absence of such events during a period of economic stability and relatively low unemployment, may reflect broader relationships between economic wellbeing and violence. Despite accepting that many external factors contribute to the incidence of firearm-related deaths, Chapman and Alpers (1) imply that discussion of these factors as contributors to declines in deaths is somehow unreasonable. However, a wide range of potential contributors to declines in Australian firearm-related deaths have been recognised by a number of sources. These include improved suicide prevention efforts and treatments for psychiatric illness, mental health literacy and stigma reduction, socioeconomic trends and an unprecedented period of economic prosperity, improved social programs, community-based policing and intelligence-led disruption of criminal activity (11) (12) (14) (15) (16). It is entirely appropriate to incorporate these factors into any explanatory model around firearm-related deaths, and to encourage otherwise represents an irresponsible and simplistic approach to policy-making. Finally, in an ‘appeal to authority,’ Chapman and Alpers (1) claim that Baker and McPhedran’s (2) paper has been ‘heavily criticised’ by Hemenway (17) and Neill and Leigh (18). Perplexingly, having deemed criticism by others a relevant point to make, Chapman and Alpers omit to mention that Leigh and Neill’s findings (6) have also been criticised (19). Neill and Leigh’s claims (18) about our paper (2) are demonstrably incorrect, and our response to these is publicly available (20). Regarding Hemenway’s (17) criticisms of our work, we previously sought to place a right of response on record, to correct a number of misleading claims (21). Unfortunately, despite publishing ethics dictating that authors whose work has been criticised should be allowed a right of response, the editors of that journal refused to publish our reply (22). Consequently, the record stands uncorrected, allowing authors such as Chapman and Alpers (1) to continue making misguided assertions about our work. We agree that the United States can learn valuable lessons from Australia. One of these is to avoid going down the Australian path of attempting to silence debate and censoring, or trying to discredit, scientific findings that do not fit a particular ideological view about firearms. We understand some may find evidence showing a lack of impact of Australia’s gun laws unpalatable, and seek to dismiss such findings. However, critical inquiry and the ability to engage in robust and honest debate remain the foundation of good science and effective injury prevention. References 1. Chapman S, Alpers P. Gun-Related Deaths: How Australia Stepped Off “The American Path”. Ann. Intern. Med.: online first, published 12 March 2013. 2. Baker J, McPhedran S. Gun laws and sudden death: did the Australian firearms legislation of 1996 make a difference? Br. J. Criminology. 2007; 47:455-69. 3. Vos T, Carter R, Barendregt J, et al. Assessing Cost-Effectiveness in Prevention (ACE-Prevention): Final Report. University of Queensland, Brisbane, and Deakin University, Melbourne. 2010. Available for download at http://www.sph.uq.edu.au/docs/BODCE/ACE-P/ACE-Prevention_final_report.pdf 4. Lee W-S, Suardi S. The Australian firearms buyback and its effect on gun deaths. Contemp. Econ. Policy. 2010; 28(1):65-79. 5. McPhedran S, Baker J, Singh P. Firearm homicide in Australia, Canada and New Zealand: What can we learn from long-term international comparisons? J. Interpers. Viol. 2011; 26(2): 348-59. 6. Leigh A, Neill C. Do gun buybacks save lives? Evidence from panel data. American Law and Economics Review. 2010;12:462-508. 7. Ozanne-Smith J, Ashby K, Newstead S, et al. Firearm related deaths: the impact of regulatory reform. Inj. Prev. 2004; 10: 280-86. 8. Chapman S, Alpers P, Agho K, Jones M. Australia’s 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings. Inj Prev. 2006;12:365-72. 9. De Leo D, Evans R, Neulinger K. Hanging, firearm, and non-domestic gas suicides among males: A comparative study. Aust. NZ J. Psychiatry. 2002; 36:183-89. 10. De Leo D, Dwyer J, Firman D, Neulinger K. Trends in hanging and firearm suicide rates in Australia: Substitution of method? Suicide and Life-Threatening Behav. 2003; 33(2): 151-64. 11. Klieve H, Barnes M, De Leo D. Controlling firearms use in Australia: Has the 1996 gun law reform produced the decrease in rates of suicide with this method? Soc. Psychiatry and Psychiatric Epidemiol. 2009; 44: 285-92. 12. McPhedran S, Baker J. Suicide prevention and method restriction: evaluating the impact of limiting access to lethal means among young Australians. Arch. Suicide. Res. 2012; 16(2): 135-46. 13. McPhedran S, Baker J. Mass shootings in Australia and New Zealand: a descriptive study of incidence. Justice Policy J.; 8(1). 14. Public Health Association of Australia. Firearms Injury Policy. Accessed at http://www.phaa.net.au/documents/130201_Firearms Injuries Policy FINAL.pdf on March 15 2013. 15. Standing Council on Police and Emergency Management. Communique – 29 June 2012. Accessed at http://www.attorneygeneral.gov.au/Media-releases/Pages/2012/Second Quarter/29-June-2012---Communique---Standing-Council-on-Police-and-Emergency-Management.aspx on 15 July 2012. 16. Williams S, Poynton S. Firearms and violent crime in New South Wales, 1995-2005. Contemporary Issues in Crime and Justice. 2006; 98: 1-8. 17. Hemenway D. How to find nothing. J. Public Health Policy. 2009;30:260-8. 18. Neill C, Leigh A. Weak Tests and Strong Conclusion: A Reanalysis of Gun Deaths and the Australian Firearms Buyback. EPS Journal Discussion Paper 555. Canberra, Australia: The Australian National University, Centre for Economic Policy Research; 2007. 19. Hemenway D, Vriniotis M. The Australian gun buyback. Harvard Injury Control Research Centre Bulletins: 2011; 4 (Spring):1-4. 20. WiSH. Gun laws and “negative deaths”: the facts. Accessed at http://www.ic-wish.org/WiSH Fact sheet Gun laws and negative deaths.pdf on 15 March 2013. 21. McPhedran S, Baker, J. Why ‘finding nothing’ matters for good science and policy. Working Paper. Accessed at http://www.ic-wish.org/Why finding nothing matters for good science and policy.pdf on March 15 2013. 22. McPhedran S, Baker J. Supplemental submission to the Senate Community Affairs References Committee Inquiry into Suicide in Australia. Accessed at http://www.ic-wish.org/Inquiry into Suicide in Australia_supplemental.pdf on March 15 2013. Author, Article, and Disclosure InformationAffiliations: From the University of Sydney, Sydney, Australia.Financial Support: Mr. Alpers runs GunPolicy.org, which has current or recent funding from the Joseph Rowntree Charitable Trust, York, United Kingdom; Netherlands Ministry of Foreign Affairs, The Hague, The Netherlands; Oxfam Australia, Melbourne, Australia; Small Arms Survey, Geneva, Switzerland; Swiss Federal Department of Foreign Affairs, Bern, Switzerland. Dr. Chapman was involved with the Coalition for Gun Control (Australia) for several years in the 1990s.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0369.Corresponding Author: Simon Chapman, PhD, University of Sydney, Sydney, Australia, A27, New South Wales 2006, Australia; e-mail, simon.[email protected]edu.au.Current Author Addresses: Dr. Chapman and Mr. Alpers: University of Sydney, Sydney, Australia, A27, New South Wales 2006, Australia.Author Contributions: Conception and design: P. Alpers.Analysis and interpretation of the data: P. Alpers.Drafting of the article: S. Chapman, P. Alpers.Critical revision of the article for important intellectual content: P. Alpers.Final approval of the article: S. Chapman, P. Alpers.Collection and assembly of data: P. Alpers.This article was published at www.annals.org on 12 March 2013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByFirearm-Related Injury and Death in the United StatesJames R. Webster, MD, MSReducing Firearm Injuries and Deaths in the United StatesJames Webster, MD, MSThe Health Care Professional's Pledge: Protecting Our Patients From Firearm InjuryChristine Laine, MD, MPH and Darren B. Taichman, MD, PhDExamining the Accuracy of Print Media Representations of Homicide in AustraliaMedia Agenda Setting Regarding Gun Violence before and after a Mass Shooting 21 May 2013Volume 158, Issue 10Page: 770-771KeywordsDrugsFire safetyFirearm injuriesGamesHomicideInternetPrevention, policy, and public healthSuicideTaxesViolent crime ePublished: 21 May 2013 Issue Published: 21 May 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...