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Conclusion Good ideas are not automatically accepted. They must be driven into practice with courageous patience. —Admiral Hyman Rickover The United States has more guns in civilian hands than any other industrialized nation. We have far more handguns per capita, and a gun is easily obtainable by virtually anyone who wants one. Our crime and violence rates are comparable to other developed countries; what distinguishes the United States is our rate of lethal violence, most of which involves guns. During the 1990s, ninety people a day were killed with guns in the United States, and another three hundred were wounded. Guns were also used in the commission of about three thousand crimes per day. Firearms violence is a major public health problem in the United States. The public health approach, so successful in reducing the burden of infectious disease and the risks and dangers of many everyday products, can also be used to reduce gun violence. The public health approach is scientific, emphasizes prevention, focuses on the community as a whole, and encourages multidisciplinary and multifaceted research and action. While the gun lobby wants only to punish the “criminal,” the public health approach emphasizes that it is not cost-effective to direct policy exclusively at the individual product user. Good policy also needs to focus on the manufacture and distribution of the product and the environment of product use. It is unrealistic to expect every individual to behave appropriately and responsibly on every occasion. To prevent injuries, it is more effective to build a system that makes it easier for people to act properly, more difficult to make errors, and less likely for serious injury to occur when people behave improperly, inappropriately, or illegally. People should be held accountable for their actions. Such responsibility 224 Conclusion 225 pertains not only to the behavior of gun users but also to the conduct of gun owners, gun carriers, gun manufacturers, gun distributors, public officials, and other decision makers. However, the goal of public health is not to find fault but to prevent injury and death. The threat of punishment can deter criminals, and incarceration can help prevent them from harming members of society; criminal justice (like tort law) is part of the prevention package. But it is only one part. Instead of looking exclusively at the pathologies of the hundreds of thousands of perpetrators and victims of firearm violence and injuries each year, public health tries to understand why these events occur with regularity year after year and to determine how best to break the cycle of violence and injuries. To reduce the problem of gun violence, public health not only urges multiple strategies but also recognizes the importance of mobilizing many partners . Public health understands the need to involve the entire community and sees roles for many groups, such as educational institutions, religious organizations , medical associations, and the media. The public health approach also broadens the discussion of firearms policy from an exclusive criminal justice orientation to one concerned with all firearm injuries—including suicides and unintentional gun deaths. The entry of public health practitioners into the field of firearm injury control brings new data sources (e.g., hospital data), new types of statistical analyses (e.g., odds ratios), new research designs (e.g., case-control studies), and new organizations and interest groups (e.g., the American Academy of Pediatrics). It also brings an increased spirit of science, pragmatism, and optimism. The public health approach is not about banning guns. It is about creating policies that will prevent violence and injuries. In the late 1990s, Massachusetts Attorney General Scott Harshbarger unveiled the first consumer protection regulations in America designed to promote handgun safety. Harshbarger used his office’s consumer protection powers to require safety warnings, childproofing, and other safety features for handguns (Massachusetts Attorney General 1997). However, these requirements hold only for firearms sold in Massachusetts. Action is needed at the federal level. The crucial first step is to create an agency that has the power to regulate firearms as a consumer product. Like the National Highway Traffic Safety Administration, which requires cars to have seat belts, collapsible steering columns, and shatterproof windshields, the firearms agency could require that firearms are childproof, that pistols have magazine safeties, and that serial numbers be tamper resistant. The agency should probably ban certain products from regular civilian use, such as caseless ammunition and .50-caliber bullets. It should require recalls on defectively designed firearms. It is crucial for this federal agency to have the...