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Reducing Firearm Injury and Death: A Public Health Sourcebook on Guns.
  1. Jon S Vernick
  1. Johns Hopkins School of Public Health, Center for Gun Policy and Research, Baltimore, USA e-mail: JVernick{at}

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Effective injury control requires accurate information. For injuries caused by firearms, that information includes not only an understanding of the research and policy literature, but also a basic knowledge of how firearms work. This is particularly true for interventions that focus on the product—the firearm—rather than on changing the behavior of victims or perpetrators of violence. But some injury control researchers and advocates did not grow up in a household where firearms were present, and have been forced to learn how guns work, if at all, in a piecemeal fashion from sources not designed for a public health audience. With Reducing Firearm Injury and Death: A Public Health Sourcebook on Guns, authors Trudy A Karlson and Stephen W Hargarten remedy this gap in the public health literature.

After a brief chapter summarizing the scope of the firearm injury problem, the book's strongest chapters follow. In clear language, without jargon, the authors explain the historical development of guns and ammunition, the different types of modern firearms, and how differences in design affect the likelihood or severity of injury. One secondary insight from these chapters is just how pervasive firearms are in the culture and language of the US. Ubiquitous phrases like “flash in the pan”, “half cocked”, and “hair trigger” all derive from the design or function of firearms.

Especially valuable are the book's frequent asides explaining the “Public health implication” of a particular aspect of firearm design or operation. These sections speak directly to public health practitioners, providing a clearer connection between the information being conveyed and opportunities for prevention. A remarkably prescient example is the authors' suggestion that, given some firearm's unfortunate propensity for firing when dropped, perhaps only those guns that can pass a “drop test” should be eligible to be carried concealed. Had the state of Indiana accepted this suggestion, perhaps two women attending the November 1997 Annual Meeting of the American Public Health Association in Indianapolis might have been spared needless injury. In other areas, where adequate data are not yet available, the authors effectively explain what questions about the contribution of gun design to death and injury we could answer with better surveillance systems.

Chapters that follow, describing “Where guns come from”, and “How guns are currently regulated”, are somewhat less effective. Although the overviews these chapters provide can be useful, this is vast territory not always well served by superficial treatment. The authors recognize this limitation, however, and also refer readers to other, more detailed sources. These chapters are also less valuable for non-US readers. While the basics of gun design and operation do not change from country to country, injury data, gun policy, and opportunities for prevention can be quite different.

The book concludes with a chapter explicitly devoted to strategies for prevention. Consistent with the authors' product modification focus, these strategies build on the information provided in the book's early discussion. The relative political feasibility of implementing these strategies, however, is not carefully considered. And those interested in reducing firearm injuries through behavioral strategies or improvements in treatment should look elsewhere.

Preventing firearm deaths and injuries is a tremendously contentious subject, at least in the US. While other countries, such as Great Britain and Australia, have recently sought to address their own firearm injury problem by banning certain firearms, this is not currently feasible in the US. Reducing Firearm Injury and Death persuasively demonstrates that interventions targeted at the gun itself, even without eliminating guns altogether, also merit our attention. Opponents of such efforts often argue that injury control practitioners do not even understand the product they seek to regulate. Readers of this book can not only “arm” themselves with the information to rebut this assertion, but will be better equipped to craft new approaches.