Editor

Re: Australia’s 1996 gun law reforms: faster falls in firearms, deaths firearms suicides and a decade without mass shootings. Chapman et al. Injury Prevention: 12; 365-372. Dec 2006.

Chapman et al. use official Australian Government statistics to demonstrate a continuing fall in firearms murder and suicide following the implementation of the Australian National Firearms Agreement (NFA) of 1996. They also state that this was a continuation of a pre-existing trend in falling firearms deaths over several years. This confirms the previous reports of Reuter and Mouzos [1], Ozanne-Smith et al [2] and Baker and McPhedran [3]. In all four papers, the authors agree that there had been a steady decline in gun murder and gun suicide before the NFA [4] and that this decline continued post NFA. Reuter and Mouzos and Ozanne-Smith et al found no decrease in total suicide after 5 years. Reuter and Mouzos found a marginal fall in total murder, whereas Ozanne-Smith did not. Ten years post NFA, Baker and McPhedran and Chapman et al confirm continuing falls in both gun murder and gun suicide and also total murder and total suicide. Thus far, all authors are in agreement.

Controversy arises in that Baker and McPhedran report a slightly faster fall in total and gun suicide post NFA but no significant increase in the rate of decline in gun and total murder. They attribute the continuing decline to general social factors, not the NFA. In contrast, Chapman et al maintain that there are marginally faster rates of decline in gun and total murders and suicides which are significant and due to the NFA. While it makes sense that fewer guns would be associated with fewer gun deaths, it is intuitively difficult to see how mass gun confiscations would reduce suicides by hanging and car exhausts and reduce murders by stabbing and beating.

Harrison and Steenkamp reported a marked increase in suicide by hanging and car exhaust in the first 2 years after the NFA [5], suggesting initial method substitution. The subsequent fall in total suicide developed after Australia mounted a strong campaign to raise awareness of depression as a severe and treatable illness and to remove any shame or stigma attached to depression and other mental illness. Well known public figures, including politicians, actors and sporting personalities have described in the media their personal struggles with depressive illness [6]. This may account for the observed fall in total suicides, including the continuing decline in the subset of gun suicides.

Despite the welcome post NFA fall in murder, the current rate is still higher than in 1950-1980, when there were virtually no long gun controls at all [7]. Curiously, Weatherburn maintains, that for the most populous state of New South Wales, the fall in gun crime is due to good policing, reduced availability of heroin and the arrest of hard core violent criminals [8]. This has apparently occurred despite a 25% increase in legal gun ownership over 2002-5.

International comparisons are even more confusing. Despite increasingly strict gun laws, the United Kingdom murder rate doubled since 1966 [9] and is now higher than the Australian rate. (See Povey - Table 1.01 p15). In particular, since the total handgun confiscations of 1996, the total murder numbers have risen 62%. This includes gun murder numbers up 20%. ( Povey - Table 1.03 p17) and handgun crime numbers up 66%. (Povey - Table 2.03 p 51.) IE Mass gun confiscations in UK have produced exactly the opposite effect claimed for Australia.

The USA murder rate doubled during 1960-1975, from about 5/100,000 to 10/100,000per annum, remained at this level for 10 years, and has now fallen to almost 1960 levels.[10] This drop occurred despite a 36% increase in the number of legal US guns over 1975-1985 [11]. Paradoxically, the landmark paper of Lott and Mustard [12] reported a marked decrease in mass gun murders in public places in those US states which changed their laws to allow citizens to carry concealed handguns. Curiously, new Zealand, which participated in the Australian deliberations, but chose not to implement the NFA, experienced a significant decline in gun murder, but no change in total murder. [13] Strangely, Chapman et al do not mention any of the international figures.

Chapman et al claim correctly that there have been no mass gun murders in Australia since the implementation of the NFA in 1996 and that the NFA is therefore a “success”. Unfortunately, there was never any generally agreed definition of “success” at the time the NFA was implemented .However there have been a few mass murders, not involving firearms, particularly the arson attack at Childers, Queensland, in which 15 people died. The others were domestic tragedies in which parents killed their children and then suicided. Oddly, Chapman et al appear to define a mass murder as an incident with 5 or more deaths [14]. They state specifically that “this is to exclude most of the more common firearm related spousal and family violence killings” (footnote to Table 1 p367). In contrast, the Australian Institute of Criminology uses a definition of 4 or more deaths in a single incident [15]. Chapman’s choice of definition would result in fewer “mass murders”. (Note: The murders in Snowtown, South Australia, 12 deaths, were serial killings). It is puzzling that Chapman et al quote Reuter and Mouzos [16] that mass murders are an “appropriate evaluation outcome”, but ignore their contention in the same article that “the frequency of those events is so low that not much can be inferred”[17] and that mass murder shows a “statistically insignificant lower rate than pre-1996”[18]. Fortunately, Reuter and Mouzos put the matter in perspective, pointing out that mass murders account for only 3% of all homicides in Australia [19].

In an earlier work, Chapman points out that the Port Arthur murderer was receiving a pension for intellectual handicap and sociopathic personality disorder, and had a mental age of 11[20]. The murderer had never had a gun licence and also drove a car without a licence [21]. If we wish to prevent further mass gun murders in public places, it seems a good idea to find out how such a person managed to obtain a military assault rifle illegally. This was never even investigated. It did not emerge at the trial as the accused pleaded guilty.( Note: For the benefit of readers outside Australia, I point out that all the Port Arthur victims were unarmed, as local laws prohibited weapon carrying for self defence. I state this as a matter of fact, without comment).

Chapman et al quite correctly point out that there was great public and media support for the NFA in 1996. Most of the credit for this must go to Chapman himself. Over several years before the Port Arthur killings, Chapman himself co-ordinated “the planned ,strategic use of media”, and “a sustained period of public advocacy for gun law reform” [22]. He describes “preceding years of advocacy”[23] and recommends that “violent gun incidents should be anticipated and planned for so “advocates exploit to advantage the huge public and political interest these disasters generate when they occur” [24]. The distinction between media advocacy and propaganda is never explained.

These matters are not mere academic quibbles. The Australian federal government has spent at least half a billion dollars of public funds on mass confiscations of legally owned guns over 1996-2003. “Buy-back” was a euphemism for confiscation under threat of fines and imprisonment, although monetary compensation was paid. Further tens of millions of dollars are spent annually on registering each individual legal firearm, despite the lack of any clear benefit. The state of Victoria has actually gone so far as to require registration of all antique black powder muzzle loaders and blank-firing sports starting pistols! As 90% of Australian gun crime is committed by unlicensed persons with unregistered guns [25] and legal guns are involved in about 2% of Australian murders [26], even total destruction of all legal guns in Australia would have only minimal benefit.

Could greater cost effectiveness have been achieved by using the resources for improving mental health services or drug rehabilitation, preventing domestic violence, anti-smoking campaigns? No-one has examined this, a surprising omission for a Professor of Public Health.

References

1"Australia: a Massive Buyback of Low-Risk Guns".Chapter 4. In: "Evaluating Gun Policy- Effects on crime and violence". Eds. Ludwig J, Cook P J. Brookings Institute Press, 2003.

2. Ozanne-Smith J et al. Firearms related deaths: the impact of regulatory reform. Injury prevention 2004;10:280-286.

3. Baker J, McPhedran S. Gun laws and Sudden Death: Did the Australian Firearms Legislation of 1996 Make a Difference? British Journal of Criminology 2006- Advance Access published 18 Oct 2006.

4.Firearms Deaths-Australia 1980—1995.Australian Bureau of Statistics 1997. cat no. 4397.0.

5. Harrison JE, Steenkamp M. Australian Injury prevention bulletin Issue 23, 2000. http://www.nisu.flinders.edu.au/pubs/bulletin23/bulletin23.html Accessed 22 12 2006.

6. See for example http://www.beyondblue.org.au/

7. Mouzos J. Homicidal Encounters. A study of homicide in Australia 1989-1999. Australian Institute of Criminology. 2000. p9.

8. Weatherburn D. “ Gun laws fall short in war on crime.” Quoted in Sydney Morning Herald 29 10 2005.

9. Povey D. (ed).Crime in England and Wales 2002/2003: Supplementary Volume 1: Homicide and Gun Crime 01/04 Editor: David Povey January 2004. Home Office Research, Development and Statistics Directorate (RDS). www.homeoffice.gov.uk/rds/pdfs2/hosb0104.pdf Accessed 23-12 2006.

10. Fox JA, Zawitz MW. “Homicide Trends in the US. Long term trends and patterns.” United States Dept. of Justice. Office of Justice Programs. Bureau of Justice Statistics. http://www.ojp.usdoj.gov.bjs/homicide/hmrt.htm Accessed 23-12-2006.

11. Kleck G. “Targeting guns”. Aldine de Gruyter 1997. pp96-97.

12. Lott JR, Mustard DB. “Crime, Deterrence and Right-to-Carry Concealed Handguns.” Journal of Legal Studies 26(1). Jan 1997.

13. Reuter P, Mouzos J. op cit. p135.

14. Chapman S, Alpers P, Agho K,Jones M. “ustralia’s 1996 gun law reforms: faster falls in firearms, deaths firearms suicides and a decade without mass shootings” Injury Prevention: 12; 365-372. Dec 2006. p366.

15. Mouzos J. “Homicidal Encounters. A study of homicide in Australia 1989-1999”. Australian Institute of Criminology 2000.

16. Reuter P, Mouzos J. op cit. p131.

17. ibid. p122

18. ibid p141.

19. ibid p127.

20. Chapman S. Over Our dead Bodies. Port Arthur and the Fight for Gun control. Pluto Press 1997. pp136-7.

21. ibid p73.

22. ibid. preface, 1st page

23. ibid p5.

24. ibid pp6-7.

25. Mouzos J. “The Licensing and Registration Status of Firearms used in Homicide”. Australian Institute of Criminology May2000.Trends and Issues Paper 151. http://www.aic.gov.au/publications/tandi/tandi151.html Accessed 28- 12 2006

26. Mouzos J, Segrave M. Homicide in Australia. 2002-2003 National Homicide Monitoring Program Annual Report. Australian Institute of Criminology. 2004 p15. http://www.aic.gov.au/publications/rpp/66/ accessed 28-12 2006.

Dr.J.B.Lawson. MB BS., B Med Sc., FRANZCR. 3 Lucas St. Brighton Vic 3186. Australia. Mob 0417 08 1113 lawbb@melbpc.org.au

2 Jan 2007.

Dear Editor

Dr James Lawson [1] seeks to summarise similarities in our findings [2] with those of three other reports, particularly that of Baker and McPhedran [3]. He notes that we agree that there was a “continuation” of the pre-existing trend in falling firearm deaths following the implementation of the Australian National Firearms Agreement (NFA) of 1996. The word we used purposefully was that there was a statistically significant “acceleration” of the downward trend. He says we attribute this to the NFA. In fact, we took care to emphasise (p370) that the accelerated overall decline was only associated with the passage of the NFA. We highlighted the difficulty of inferring that the downturn – being so dominated by firearm suicides – could have been readily attributable to the removal of semi-automatic firearms from the community.

We readily agree that the large scale effort to try and reduce suicide in the community is relevant to any consideration of why total suicides have fallen [4]. Browsing gun lobby websites shows that poor policing and mental health services, violence in the media, failure of the media to censor reports of mass killings, and failure to report people who “act strangely” are all putative causes of gun violence which have their enthusiasts, as do simplistic notions that people posing danger to the community are readily identifiable in advance. But suggesting that easy access to guns designed to kill many people quickly may be relevant is a profanity in such circles.

Where we differ from those who 10 years on, remain angered about their inability to own military-style weaponry such as that used to kill 35 at Port Arthur, is that we are open to the possibility that removing such firearms from the community might have reduced the ability of people to carry out such killings.

We described the most palpable and plausible effect of the NFA as the cessation of mass shootings, an omission of “rhinoceros in the living room” proportions from the Baker and McPhedran paper. A cornerstone of the NFA was the unanimous decision of all Australia’s federal, state and territory governments to outlaw private ownership of semi-automatic rifles and pump-action shot guns. These are weapons of choice for those intent on killing many people quickly. The Australian Prime Minister said at the time: “There is no legitimate interest served in my view by the free availability in this country of weapons of this kind… Every effort should be made to ensure such an incident [Port Arthur] does not occur again.” [5]

Dr Lawson and others in the gun lobby regularly seek to trivialise mass public shootings as rare events, implying that their infrequency somehow makes them an improper outcome of interest. Here, we would simply point to the overwhelming degree of public support for the NFA which occurred against a background of unparalleled public discussion and media attention where the gun lobby had every opportunity to put alternative views, including arguments that the buyback money could have been more effectively spent on other strategies. The small and transitory levy on income tax which paid for the gun buyback attracted minimal criticism.

People intent on mass murder have other options than using guns, as the Childers backpacker arsonist/murderer showed. Our analysis however, showed that there was no apparent net substitution effect for either homicide nor suicide. Other than the Childers incident, we know of no other mass killing by any method in Australia since the passage of the NFA.

Dr Lawson wonders how the Port Arthur gunman was able to acquire his highly effective mass killing weapons. The answer would seem rather obvious. There were hundreds of thousands of semi-automatic rifles and pump action shot guns in the community. Being largely unregistered, and so difficult to trace in their movement among gun owners, they were readily available to anyone willing to sell such a gun to any buyer with money. If even one in 1000 of Australia’s some 800,000 licensed shooters were prepared to sell just one such gun to criminals or unstable individuals, in an unregistered environment 800 such untraceable guns would fall into the hands of high risk individuals. The government saw this as unacceptable and the community agreed.

Lawson thinks it “strange” that our paper did not mention international comparisons in firearm deaths. Our paper concerned the Australian situation, but we are pleased to respond to his comments about the USA and the UK. We believe there are few lessons for nations like Australia in the USA’s track record with firearm deaths. Currently, the United States has 14.5 times Australia’s population, 102 times its total firearm deaths [2,6], and 173 times its number of firearm homicides [2,7]. Relating different periods of firearm deaths in the USA with the implication that Australia should emulate US gun policy is like arguing that Baghdad is safer than Bogota.

Similarly, Lawson notes that in the UK, total homicides have risen 62% and firearm homicides by 20% since the introduction of the post- Dunblane laws [8]. He fails to note though that the UK has, by US standards, an almost homeopathic rate of gun homicide (in 2002/03, just 80 in a population of about 60 million) [8]. On the assumption that he is arguing that US-style gun laws rather than UK and Australian laws make communities safer, it would appear that he has a little explaining to do. Also, of 24,070 crimes committed with “firearms” in the UK in 2002/03, 13,822 (57%) involved airguns and 1,815, toy or imitation guns [8].

Dr Lawson’s nostalgia for a return to the days when firearms were unregistered and his carefully qualified hints about the desirability of a heavily armed society where armed “good guys” could dispatch violent armed “bad guys” in public settings is not a view shared by the great majority of Australian citizens who have now lived over 10 years free of the regular gun mayhem that characterises news about guns coming from the United States. Similarly, his opinion of Lott and Mustard’s paper as a “landmark” contribution to evidence about armed deterrence is not one shared by a wide range of critical reviews, including the US National Academy of Sciences which found no evidence showing right-to-carry laws have an impact, either way, on rates of violent crime [9].

Finally, Dr Lawson gives SC far too much credit for “coordinating” gun control advocacy in Australia. SC was involved for a relatively short period (1993-1996), typically putting no more than several hours a week into advocacy for stronger gun control. The vast majority of Australian citizens strongly supported the NFA. They needed little persuading that Australia did not want to go down the US road so memorably examined by Mike Moore in Bowling for Columbine.

References

1. Lawson JS. eLetter. Injury Prevention 2006 4 Jan. http://ip.bmj.com/cgi/eletters/12/6/365

2. 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. Injury Prevention 2006; 12; 365-372.

3. Baker J, McPhedran S. Gun laws and sudden death. Did the Australian firearms legislation of 1996 make a difference? British Journal of Criminology 2006; Advance access Oct 18 doi:10.1093/bjc/921084

4. Morrell S, Page AN, Taylor RJ. The decline in Australian young male suicide. Soc Sci Med. 2007;64(3):747-54.

5. Howard J. ‘Never, Ever Again.’ Prime Ministerial Op-ed. Herald Sun. Melbourne, 10 May 1996.

6. US Centers for Disease Control. National Center for Injury Prevention and Control. WISQARS Injury Mortality Reports 2004. http://webapp.cdc.gov/sasweb/ncipc/mortrate10_sy.html

7. US Department of Justice. Federal Bureau of Investigation. Murder. Table 2.9 http://www.fbi.gov/ucr/cius_04/offenses_reported/violent_crime/murder.html

8. Povey D. (ed).Crime in England and Wales 2002/2003: Supplementary Volume 1: Homicide and Gun Crime 01/04 January 2004. Home Office Research, Development and Statistics Directorate (RDS). www.homeoffice.gov.uk/rds/pdfs2/hosb0104.pdf

9. National Academy of Sciences. Committee on Law and Justice. Firearm violence: a critical review. Washington, 2004.

Dear editor,

We read with great interest the cost analysis of fatal and non-fatal falls among older adults aged >or=65 years. The authors point out that fall related injuries among older adults are associated with substantial economic costs with fractures accounting for 35% of non-fatal injuries but 61% for total costs. The authors concluded that effective intervention strategies are mandatory to implement in order to decrease morbidity, mortality and healthcare cost.

Currently, especially among sporting athletes, the implementation of a balance board training has been convincingly shown to decrease injuries such as the rupture of the anterior cruciate ligament, ankle sprains or muscle injuries [1,2,6]. With advancing age motor control and coordination is tremendously decreased which impairs the daily activities substantially. Raty tested 105 former elite athletes (aged 45-68) and 966 community control subjects regarding the balance capabilities finding that former athletes were on average comparable to those of 24-30years younger community control subjects [4].

As early as in 1995 Province and coworkers studied the effects of exercise on falls in elderly patients in two nursery homes and five community-dwelling sites [3]. They stated that treatments including exercise for elderly adults reduce the risk of falls. Steadman involved in 2003 199 patients older than 60 years with a mean age of 83±6years a six-week balance training with increasing difficulty, while the control group performed conventional physiotherapy [5]. Both groups could increase the results in the 10-m-walk test significantly following six weeks of training. Both groups showed improvements in Ten-meter timed walk test (intervention: 22.5-16.5 seconds, P =.001; control: 20.5-15.8 seconds, P =.054), Frenchay Activities Index (18-21, P =.02 in both groups), Falls Handicap inventory score (intervention: 31-17, P =.0001; control: 33-17, P =.0001) and European Quality of life score (intervention: 58-65, P =.04; control: 60-65, P =.07). More patients reported increased confidence in walking indoors (36% vs 28%; P =.04) and outdoors (27% vs 18%; P =.02) in the enhanced balance-training group.

Therefore in both, young and older people a balance training as protective balancing® may be a reasonable option for injury prevention and should be advocated to enhance coordination and therefore decrease the risk of falls.

References

(1) Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A. Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumtol Arthrosc 1996;4:19-21.

(2) Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garret W Jr. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 2005;33(7):1003-10.

(3) Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Fraility and Injuries: cooperative studies of intervention techniques. JAMA 1995;273(17):1341-7.

(4) Raty JP, Impivaara O, Karppi SL. Dynamic balance in former elite male athletes and community control subjects. Scand J Med Sci Sports 2002;12(2):111-6.

(5) Steadman J, Donaldson N, Kalra L. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. J Am Geriatr Soc 2003;51(6):847-52.

(6) Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med 2004;32(6):1385-93.

Dear Editor

In his letter "Timely reporting of research is necessary", Mr Wardlaw suggests that lack of enforcement of bicycle helmet legislation in Ontario is an underreported aspect of bicycle helmet research.

Although the issue of enforcement of legislation has been raised as a potentially important aspect of bicycle helmet laws, to our knowledge, no one has studied the nature of enforcement of helmet legislation in Ontario (or elsewhere). A single police force in Ontario (Toronto Police Services) has no record of charging a child for not wearing a helmet, there are many ways that the police can enforce legislation that do not include the police issuing citations. For example, the police can warn children verbally that there is a helmet law. Further, Toronto Police Services routinely work with schools to promote safe bicycling in the form of Bike Rodeos. All children must ride helmeted at these events.

Many other ways of ‘enforcing’ laws exist, particularly for laws aimed at children. Laws give parents, teachers, and other adults the authority to promote certain behaviours in children. Many parents are grateful for the helmet law, because the requirement to wear a helmet is not based on their decision, but on a societal choice. They can therefore enforce the law within their own family. Further, school principals often require that children wear helmets bicycling to school because "it is the law". These are just two examples of ways that helmet laws have been enforced in Ontario, but their measurement is beyond the scope of the published study. The unit of analysis in our study was observed children, not their parents or teachers, and we did not measure their knowledge of the law.

Mr. Wardlaw comments on the decline in hospitalizations for head injuries in Ontario <1>. Administrative data are helpful in assessing trends in hospitalizations, but they do not measure factors such as helmet use. The report cited by Mr. Wardlaw measured hospitalizations which have been declining for many reasons, including changes in practice patterns for admission of head injuries. There is no concurrent comparison group with which to compare these trends. Although evidence from systematic reviews suggests that helmets are effective in reducing head injuries <2,3>, we do not know whether children admitted to hospital for bicycle-related injuries in Ontario were helmeted or not. The distribution of helmet use among admitted children is one key (unmeasured) factor that is necessary to understand the population impact of helmet laws.

In conclusion, we agree that timely reporting of results is necessary. We also believe that research results reported in the peer reviewed literature must be based on scientific evaluation of risk factors considered within the study design. Helmet laws have been shown to be effective in reducing head injuries in published studies from around the world <4,5,6,7,8>. Our study did not measure enforcement of the helmet law in Ontario.

References

1. "Bicycle-related injuries among Ontario children declining". Canadian Institute for Health Information. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_19mar2003_e

2. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists (Cochrane Review). In The Cochrane Library, Issue 3, 2000. Oxford: Update Software

3. Attewell RG, Glase K, McFadden M. Bicycle helmet efficacy: a meta -analysis. Accident Analysis & Prevention 2001;33:345-52.

4. Scuffham P, Alsop J, Cryer C, Langley JD. Head injuries to bicyclists and the New Zealand bicycle helmet law. Accident Analysis & Prevention 2000; 32:565-73.

5. Macpherson AK, To TM, Macarthur C, Chipman ML, Wright JG, Parkin PC. Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study. Pediatric 2000; 110:e60.

6. Cameron MH, Vulcan AP., Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia-- an evaluation. Accident Analysis & Prevention 1994; 26:325-37.

7. Leblanc JC, Beattie TL, Culligan C. Effect of legislation on the use of bicycle helmets. CMAJ Canadian Medical Association Journal 2002; 166:592-5.

8. Shafi S, Gilbert J, Loghmanee F, Allen JE, Caty MG, Glick PL, Carden S, Azizkhan RG. Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma centre. J Pediatr Surg 1998;33:317-321.