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The Epidemiology Of Gun Violence: Race, Region And Policy


This is TALK OF THE NATION. I'm Neal Conan in Washington. Data from the Centers for Disease Control and Prevention come to some remarkable conclusions about gun deaths, race, sex and region. Briefly put, white people who die by gunfire are much more likely to be male, rural and suicides; black people much more likely to be urban, victims of homicide and again, male.

We'll explore the analysis, which was featured in the Washington Post. We'd also like to hear about your experiences. How has gun violence affected you, your family and your neighborhood? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, the Coast Guard and the Northwest Passage. But first gun deaths in America. Dan Keating is data editor and reporter with The Washington Post and joins us now from studios at that newspaper. Good to have you on TALK OF THE NATION today.

DAN KEATING: Good afternoon.

CONAN: And I understand of course, you're a reporter, you went through reams of statistics. But this is also your story.

KEATING: Yes, I mean, it's something that when you look at it, white people tend to have a much greater chance of having experience in their life where they've come up with suicide of someone they know or, you know, a relative, whereas African-Americans are much more likely to be able to cite an example of someone they know, a relative, someone they went to school with, who suffered homicide.

So it's not unusual in that regard. And in fact as I was reporting on the story, I really hadn't thought about this before. I kind of started to jot down a list of the people I knew who had committed suicide, especially specifically with guns, and there was a colleague and a relative and some friends' dads, things like that.

CONAN: And this you suggest, at least in terms of people who have experience of other people in their lives with gun violence, is not unusual.

KEATING: Yes and especially the disparity is just so striking that suicide is really a white thing, as you said especially white males, and that homicide is, to such a large degree, a black thing.

CONAN: And give us some idea of the disparity.

KEATING: Well, I mean, it's an interesting - it's an exact mirror in terms of ratio. So a white person is five times as likely to die by a suicide by gun, than by a homicide. And African-Americans are five times as likely to die by homicide from a gun, than by suicide. So quite simply, you know, for every white person shot in a homicide, five shoot themselves; and for every black person who shoots himself, five are killed by homicide.

CONAN: And availability of guns, well, affects both statistics.

KEATING: Well, it's kind of interesting, because then what really drove my story was not just the disparity in the rates, but how that applies to guns and access to guns. So the people that suffer homicide among relatives, family, friends, tend to have a very anti-gun attitude. And so that's prevalent in the city across all races and in the African-American in both cities and African-American community of predominately homicide for gun deaths, and there's a strong urge for gun control both in the urban environment and in the African-American community.

But then as you move out of the city, suburbs and then rural, where the gun deaths shift to suicide, you also shift to a much lower desire for gun control, much more support for gun rights. And so what really is interesting to me about that is that when people die in a gun homicide, the gun is vilified. The gun is blamed, and people want to stop the guns.

But in gun suicide, the gun is not blamed. The gun is actually considered, you know, not the problem, and it's that, you know, they tend to more put a stigma on the person, oh there was something wrong with him. So in the reporting on this, it was - you know, and in talking to the experts, when you go to the academic experts and those kind of people, they have a very strong conviction, and they look at the data about access to guns and suicide, and how much more suicide there is in places where there are a lot of guns.

And they make a very big deal about the guns, whereas when you move actually to those places that have the high suicide rates, you hear much more that the gun is not the issue, that it's about mental health, and, you know, they really do not have a push against the guns that you get.

So it's kind of an interesting disparity between the academic experts on suicide and the people that are actually in the high suicide areas. I was kind of surprised at how big a difference there was in that point of view.

CONAN: Just to flip that on the other side, yes a state like Wyoming, which has a very high access to guns and a very high suicide rate, compared to a state like Massachusetts, where it's more difficult to get a gun, and suicide rates are lower.

KEATING: About one-seventh as high in Massachusetts, as compared to Wyoming. I mean that's a pretty amazing discrepancy because as one of the experts said, there's no reason that people with - that gun owners have a higher rate of mental disorder, of mental health issues. So there really should not be a reason for there to be a higher rate of suicides.

But what you get with the suicide, and this is what the experts talk about, it's not a permanent feature. It is an impulse. And if you can act on that impulse, then of course it becomes permanent. But if you can be intercepted, intervened, and, you know, with my story we ran tips about suicide prevention, then, you know, I'm sorry, I don't have the exact statistic off the top of my head, I think it was 90 percent of people who have attempted suicide and failed then did not go on to kill themselves. So that once you stop it, but especially say for instance with teenagers, we have a lot of places where we have special laws to prevent teenagers from their own impulsiveness when it comes to driving, drinking, other issues with regard to teenagers.

But when it comes to guns, teenagers with access to guns and the suicide rate there is very high and especially teenagers who commit suicide almost always do it with their family's gun.

CONAN: We're talking with Dan Keating of the Washington Post about the epidemiology of drug - of gun deaths. We want to hear about the experience in your life. How has the gun violence affected your life, your family, your friends and your neighborhood? 800-989-8255. Email talk@npr.org. We'll start with Jan(ph), and Jan's on with us from Buffalo, Wyoming.

JAN: Thank you, Steve(ph), for taking my call.

CONAN: It's Neal, but go ahead.

JAN: I'm sorry. I wanted to echo what Mr. Keating is saying. We live in a rural community in Wyoming, and for the last - in the last 12 months we have had six suicides in our small community of about 5,000 people, all genders - both genders, all ages, all incomes, and the discussion about guns and access to guns it totally verboten here.

Everyone talks about access to mental health, rather than the access to guns being a contributing factor to these deaths.

CONAN: When we hear about gun violence in the city and how it tears neighborhoods and families apart, what's been the effect of so many suicides in a small place like Buffalo, Wyoming?

JAN: It's very sobering. Everybody knows someone who has died of a suicide. And it is something that affects our school children, it is something that affects our community. We had a prominent community member commit suicide earlier this year. And it just - it just - it makes it very quiet around town.

CONAN: I can understand that. Jan, thanks very much.

JAN: Thank you.

CONAN: Joining us now is Mark Rosenberg, the president and CEO of The Task Force for Global Health, a former director of the CDC's National Center for Injury Prevention and Control. He joins us by phone from his office in Atlanta. Good to have you with us today.

MARK ROSENBERG: Thanks, Neal, good to be here.

CONAN: And the data shows that huge difference in how African-Americans and white experience gun death. How long has this been going on?

ROSENBERG: Oh, I think this has been going on for a long time. It's not been a secret. But I think these trends have probably been here I would say for at least 40 years.

CONAN: And is there any reason that you've come up with to explain that?

ROSENBERG: I think there are lots of reason for the discrepancy. And let me talk about the suicide first and for the high rates and that because I think there's a very, very fundamental problem in the way we think about this. And one of the guests, the call-in people, said that people think that it's either the guns or mental health that is the issue.

And what's really important to understand is it's not either or. It's both. And if you want to make the world safe for your child, for your child who might commit suicide, then you do everything you can. It's not that you have to choose either take away access to guns from young people or get them the mental health care they want, it's both.

Both are part of the causal chain. And the way you interrupt the causal chain is in as many places as you possibly can, if you want to save those children's lives. There's a story that I was told. I went to work at a school when they had a suicide, because they were afraid there might be a suicide cluster that followed the one death.

And they told me that in a year previously, a young student from this school was hell-bent on suicide and killing himself. And he took his car, he drove it into a big concrete bridge at 60 miles per hour, and he walked away because he had an air bag.

Now it wasn't necessary to treat his depression or to stop him from being impulsive, but the air bag saved his life. If you want to save the lives of our young people who are committing suicide, reducing their access to the fatal means is just as important as giving them mental health.

And as a parent or a concerned citizen, you want to make sure that they get every possible treatment that could prevent their suicide. I think people do not understand the importance of having access to the means of suicide. So many studies have demonstrated if you take the means away, you reduce the suicide.

CONAN: In a lot of places, though, a gun is a tool. It's like any other tool on a ranch. You've got to have it.

ROSENBERG: And you don't let your toddlers play with chainsaws.

CONAN: All right, stay with us. We want to hear your stories, as well, those of you listening, about your experiences with gun violence, whether you live in the city or in rural part of the country. How does it change your life, your family, your town? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Our guests are Dan Keating, editor and reporter for The Washington Post; and Mark Rosenberg, who is an epidemiologist and president and CEO of The Task Force for Global Health at the CDC in Atlanta. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.


CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Today, we're talking about gun deaths, specifically an analysis of CDC data by Washington Post that found a clear delineation: Black people who die from gunfire much more likely to be shot by others; white people, far more likely to shoot themselves.

In addition to analysis from our guests, Dan Keating of The Washington Post and Mark Rosenberg of The Task Force for Global Health, we want to hear your stories. How has gun violence affected you, your family, your neighborhood? 800-989-8255. Email talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Here's an email that we have from Bill in Carrboro, North Carolina: I was a teacher at a school affected by gun violence. The mother of a student was murdered outside of our school by the estranged father of the child. He used a handgun. I saw it; several of my students saw it. Since this time I've noticed that I've become a teacher stereotype.

I'm obsessed with safety. I do not tolerate noise in the classroom. I expect students to do what I say when I say it and not to question it. This is not who I am in general. As an educator, I want students to converse appropriately and to question things, yet if I'd been a strict disciplinarian at the time of the shooting, I would have saved several students from seeing this awful thing.

And Mark Rosenberg, we can't forget the ripple effect. It's not just the person who pulls the trigger and the person who receives the bullet.

ROSENBERG: There's a huge impact on people who grow up either in families where a suicide by gun has occurred or in a community where someone in their family has been shot, and the effects in terms of post-traumatic stress disorder, just living in high anxiety and the subsequent illness it causes, these costs are tremendous, and we're just starting to realize and appreciate those.

There are also something called the cycle of violence. So a child who grows up exposed to violence becomes more likely, him or herself, to employ violence in the future. So the impact is very extensive.

CONAN: Email question from Amy(ph): I'm curious to hear whether the data for women is significant. Please, Dan Keating, can you help us out?

KEATING: Well, the rates for women are just much lower for both homicide death and suicide death, and the discrepancies are not as great but it is still white women are much more likely to commit suicide than black women. That pattern of suicide by whites is one of the longstanding and interesting pattern, and I have never heard really a good explanation for it.

So but in any event, the death rates by gun for women are considerably lower, and unfortunately the data that we used for this, the CDC data, does not have full event data. So for instance you cannot see when you see that a woman died of a homicide, whether, say, it was a homicide-suicide event, where someone killed her and killed themself.

So that makes it a little bit incomplete because in fact I would be very curious if even as few or as low as the rates of whites dying from homicide is, if you were able to factor out the kind of suicide-homicide, murder-suicide cases, that the white homicide rate would be even lower.

CONAN: Let's see if we can go next to Christine(ph), Christine on the line with us from Boulder.

CHRISTINE: Hi, thanks for taking my call. I wanted to just follow up on the most recent comments about the gender differences and an earlier comment about impulse control. I'm a psychotherapist, and I do crisis counseling here, and Boulder, Larimer and Routt counties have some of the highest teen suicide rates in the world.

And what we've seen is that boys attempt less; however, they use guns and are more successful. Girls will attempt quite a bit more, but they don't use guns as often, and are more likely to survive. And the second part is that there is still such a stigma associated with the cause of death when it's suicide, that even though the kids in the community will know how someone died, there's not always a discussion in the community at large about it; although I have to say in Boulder we're working pretty hard and have a state suicide task force, as well.

CONAN: So blame the victim?

CHRISTINE: It's not so much blame the victim, it's more about protect the family because it can seem as if there was a failure somewhere within the family system that a child would want to kill themselves, or the implication that a parent isn't good enough.

CONAN: And so then those kind of recriminations can echo back and forth.

CHRISTINE: They can, and there's also - we had a couple of years ago, it was probably in the late '90s where we had a lot of copycat suicides, but not with guns. That was with hanging.

ROSENBERG: Could I speak to the question of impulsivity?

CONAN: Go ahead please, Mark Rosenberg.

ROSENBERG: I think it's really an important issue. There was a study done of young people who had very serious suicide attempts. These are people who shot themselves, who jumped from very high heights, who but for the grace of God would have died. And they asked these people how long they had considered committing suicide.

There was a very small group who had been seriously, chronically depressed and had thought about this for a very long time. But the largest percentage of young people had thought about suicide for a very short period, for many of them less than five minutes.

CHRISTINE: That's exactly what I see in my practice. I hospitalize a lot of kids that are suicidal, and the correlation also between poor impulse control and drug and alcohol use plays a huge factor.

ROSENBERG: Very big, and so the suggestion is that if you can prevent them from having access to the fatal means when they have the impulse - separate the impulse from the action - you can save their lives. And this is very, very important because if you have a waiting period, if people can't buy a gun right away but have to wait a week, that reduces the number of suicides.

There are things that work based on understanding the impulsive nature of suicide, especially in young people.

CONAN: Here's a tweet to that point from Riggs Mack: Guns in the rural Midwest never seemed like an issue until my 16-year-old cousin made a snap decision while angry and drunk and took his own life.

ROSENBERG: Many of these come from anger, from intoxication and a sudden event that triggers a feeling in them that quickly will pass if only we can keep them separated from the fatal means while they have that impulse.

CONAN: Christine, thanks very much for the phone call.

CHRISTINE: Thanks for taking it.

CONAN: And I wanted to turn back to you, Dan Keating. You drew a correlation earlier that in African-American communities, largely in urban areas, where there's a lot of homicides, there is also an attitude that it favors gun control. Vice versa in rural areas, where there are lots of suicides among white people. Can you draw that line that because these are homicides, therefore people are in favor of gun control or because they are suicides they are opposed to it?

KEATING: Well, I think - I think you can draw that line, and I think that the key connector in between is not blaming the gun; is that - and I think it's exactly what people have just been talking about in terms of how the reaction in the community is suicide, the reaction is so muted. It does ripple, it does tear holes in a community, but it does so quietly because people don't want to talk about it.

And I think there's an amazing irony here that the media is often accused of making a big deal about white crime victims and ignoring black crime victims. But the truth of the matter is when it comes to gun crime, black crime is very much in the news, and politicians campaign on crime and safety and all these kind of issues.

But the white people that are - you know, a lot more white people die from suicide than black people die from homicide with guns, but there's - nobody campaigns on suicide. Nobody's making a huge outcry about it, and the vast majority of these suicide deaths receive no publicity and no public discussion.

So the fact of the matter is these deaths don't generate - I think people are vastly unaware of how many white people kill themselves. And there's all this discussion about what's going on in the black community with all these homicides, but you don't hear anybody saying what's going on in the white community with all these people shooting themselves.

What - you know, there's no good reason that we can't intervene and lower this suicide rate, but nobody's talking about it. And so nobody's making the connection between a ridiculously high rate that shouldn't be there and access to guns and issues about mental health. People aren't even making - we're talking about, you know, is it one or the other or is it both? But people aren't discussing any of it. So I think it's because people keep it as a family thing.

CONAN: Mark Rosenberg...

ROSENBERG: I would compliment Dan for this story because it shows that by understanding the problem, we can really figure out a way forward. And I think what Dan showed beautifully in this article is that the victims are not just children in classrooms who are massacred occasionally, but the victims of - largest part of the victims are young black men in their communities and young white men in their homes. These are big parts of the gun violence problem. And I think that there's a stigma not only to people who commit suicide, but I think there's also a stigma to people who are homicide victims.

KEATING: And I think we stigmatize young black men who get shot. And we don't give them fair justice and fair treatment. We say, oh, these are just young black gang members and we don't think about the people who didn't belong to a gang, who were shot unintentionally, the wrong victim was picked or they were an innocent bystander or, yes, they were involved in something, but didn't deserve to die. The stigma applies to both.

CONAN: Here is an email that questions some of our assumptions here. This is from William. Japan and South Korea have near total gun control. I believe they are also two of the highest in suicide rates. According to data from the World Health Organization, South Korea is number three in suicide, Japan, number 11, U.S., 34th.

KEATING: That is a very - it's interesting, because when you go between countries, another example of it gets cited a lot of times that you could find prominently on the NRA website, for instance, is that Russia has very tight gun control, very few guns, but a very high suicide rate and a very high homicide rate. Whereas Israel, which has very high gun possession, has a very low suicide rate.

CONAN: (Unintelligible) the same way, yeah.

KEATING: Yeah. So when you get into the international - and India has a very high suicide rate and interestingly there it's women, which is different than in the U.S., and there are certainly very important cultural reasons having to do with suicide with women in India. But the thing is, when you get into the international, you start to see very big cultural differences which I do not have good explanations for.

But within the United States, when you look at things like gun possession by state, the pattern becomes very clear. So I think it's interesting that some people focus on the international where it's definitely - I definitely, having looked at the data, could say you can't make a very good correlation between access to guns and homicide rate or, actually, even suicide rate. In the U.S. the pattern is much clearer.

ROSENBERG: In most places around the world, firearms are not the leading cause of suicide. The most common cause of suicide worldwide is pesticides. And what happens in a country like China, frequently, young women are upset or living in an abusive situations, and they run out against - often, impulsively, and swallow pesticides that are frequently fatal. That is the most common cause of suicide in China and around the world.

And it's been shown that if you can decrease access to the pesticides or if you can substitute non-lethal pesticides for what are ordinarily used, the suicide rate comes way down. The principle is the same: if you decrease access to the lethal means, you decrease the suicides.

And we have this horribly fatalistic sense about suicide. There is nothing you can do about it. That's our biggest threat. That's what's going to get us is the sense that we can't do anything. Suicide is eminently preventable. You can treat people who are depressed. You can help young people who are impulsive. It's preventable and (unintelligible)...

CONAN: Mark Rosenberg is an epidemiologist and president and CEO of The Task Force on Global Health. Dan Keating is an editor and reporter for The Washington Post. You're listening to TALK OF THE NATION from NPR News. And let's go to Jenny(ph). Jenny with us from Reno.

JENNY: Hi. Thank you so much for this program. In 1983, my brother who had been sick for 10 years with severe pancreatitis shot himself in my parents' backyard, and they found him. He had purchased the gun two nights before, and I firmly believe if his medical and psychological record could've somehow been kept, he maybe would've been given a second chance. I just feel the mental health care is failing us greatly here in this country. And he was working with the VA hospital and only got minimal, minimal mental health care.

CONAN: I'm so sorry to hear this story, Jenny. And it is a question that I guess we also have to turn to Dan Keating for, is there any correlation in the statistics with people who had or believed they had terminal illness?

KEATING: Well, the data that CDC has does not make that available. It is, you know, there are kind of age bursts up in suicide and older - there is kind of an age bursts up for the rate among young people, but then again, among older people where, you know, a lot of people have said depression is insufficiently diagnosed and treated.

And certainly there are cases of people who have more longstanding issues as well as, you know, and people that have a more sudden thing. But, you know, in many of the examples, as Jenny said, if he could've gotten more therapy and treatment, that would've been a very different situation.

CONAN: Jenny...

ROSENBERG: Or if the doctor had asked about whether he has a firearm or if he has a gun, the doctor might have been able to intervene and, with the family's help, prevent his suicide. There are multiple things that doctors can do, and they really need to try all of them at the same time. But asking about access to firearms by young people who are depressed or older people who are depressed is a very, very important part of practicing good medicine.

CONAN: Here's an...

KEATING: Another thing that people said that I found really interesting is that that it is a good idea to ask people if they are feeling like they might hurt themself, that they could even possibly kill themself, and a lot of people would not want to ask that for fear of kind of putting an idea in their head or suggesting it. But what the expert said is if someone's not considering suicide and you ask them that question, they'll just very quickly say no, I'm not thinking that. And if they are internally struggling with it, it'll be a huge relief to be able to let that out. So they said that it is a good thing to gently ask someone that you're close to if you see that kind of turmoil that makes you fearful for them to ask them if they're considering hurting themself because that is actually a good way to begin to intervene.

CONAN: We've put a link to Dan Keating's piece in The Washington Post at our website. Go to npr.org, click on TALK OF THE NATION. Dan Keating, thanks very much for your time today.

KEATING: Thank you.

CONAN: And Mark Rosenberg, thank you for joining us from the Centers for Disease Control there in Atlanta.

ROSENBERG: Neal. I worked at the Centers for the Disease Control for 20 years but I don't work there now.

CONAN: I apologize.

ROSENBERG: I have tremendous respect for them but I do want to not say that I'm speaking for them.

CONAN: OK. President and CEO of The Task Force on Global Health. Is that right?

ROSENBERG: That is exactly right, Neal.

CONAN: All right. I apologize, but thanks very much for your time.

ROSENBERG: Thank you.

CONAN: When we come back, we're going to be talking about the change in global patterns of climate which is opening the Arctic Ocean, which means it needs to be patrolled by some U.S. force, maybe the Coast Guard. It's the TALK OF THE NATION from NPR News. Stay with us. Transcript provided by NPR, Copyright NPR.