“Editor’s” introduction to this post.
I am delighted that Joe Knowles has decided to let me share with you his innovative idea that could save many lives from gun violence. He first shared the idea with me last November at one of our occasional meetings for lunch together. Joe is the CEO of IHM, the Institute for Health Metrics, a serial entrepreneur, and accomplished practitioner of public health innovations. I first met Joe when we served together on the board of CRICO, the malpractice captive of the Harvard affiliated healthcare organizations and hospitals. Joe is a long term “Interested Reader” and passionate advocate for the improvement of the health of the population. In the past I have highlighted some of Joe’s work in these notes.
When I first heard Joe’s idea that could potentially reduce gun deaths by reducing the number of guns in the home that are readily available for either impulsive behavior or as the cause of tragic accidents, I was impressed by its simplicity and the realistic possibility that it could be a strategy that saved lives even while politicians continue to avoid their responsibilities to protect the public. I am not going to get into the analysis of how gun deaths track gun availability, but I would refer you once again to an article written by Nicholas Kristof in the New York Times in November of 2017. He called gun violence a public health problem, and I agree.
Joe’s idea also brought forward a frightful memory from my past. In the fall of 1984 there was a tragic and untimely adolescent death in my family. My wife and I flew to North Carolina with our son who was not quite two years old for the funeral which was to be in far Western North Carolina. We traveled to the funeral with my father and mother. It was a relatively long car trip to the little mountain town where the burial would take place. My son, my wife, and I were riding in the back seat of my father’s car. We did not know that my father carried a loaded “Saturday Night Special” 22 caliber pistol in the pocket behind the driver’s seat just in front of my son’s car seat. It had been my grandfather’s gun. My grandfather had died about seven years earlier, and since then my father had kept the gun for sentimental purposes. Guns were not part of the family culture, but my grandfather had opened a small “store” in his garage when the owner of the adjacent land had turned his property into a trailer park. My grandfather enjoyed having children and others come into the little store to buy candy and the other convenience items he carried. He bought the gun for protection after her was robbed. My two year old son found the loaded gun and pointed it at us. Fortunately, my wife was able to take it from him before he pulled the trigger. It was a “near miss” that added to the trauma of the whole experience of the funeral. My father was a very frugal man. I can imagine that if not having the gun would have saved him money, he may not have had it in his car.
Joe’s idea also comes to mind when we think about two widely publicized recent shootings of family members where it is possible that the easy availability of firearms was a contributing factor in the evolution of the tragedies. In Atlanta a prominent business woman shot and killed her two children who were in their early twenties, and then turned the gun on herself within hours of boasting on social media about what a wonderful summer they had enjoyed. The circumstances suggest that the tragedy might have been an impulsive act made possible by the ready availability of a gun. The other event was the murder in Virginia of the wife, infant son, and mother-in-law of a minor league pitcher in the Tampa Bay Rays farm system. His eighteen year old brother-in-law shot his mother, sister, and nephew. Was it impulsive? Was it made possible by a gun in the home? Guns in the home are often easily available to mentally unstable individuals.
Joe’s idea makes a lot of sense. I hope that you will think so also. The question is how to get insurance companies to make it a reality. That’s right, insurance companies, not politicians. Politicians are failing us. Perhaps a market approach is what might help. I doubt that we will follow the lead of New Zealand or Australia and just make guns unavailable by law or executive action.
Joe’s plan probably won’t prevent mass shootings like El Paso, Dayton, or bizarre events like the one in Odessa, Texas over this last weekend, but the majority of gun deaths are not the outcome of mass shootings by criminals. They arise from impulsive suicides, explosive episodes of domestic violence, and tragic accidents that follow from a young child discovering a gun, like the episode with son. Joe’s idea is addressing those events and it could save thousands of lives even while our politicians continue to be faithful to their Second Amendment constituency. It would not require Congress or any state legislature to pass a law. His idea could become a reality as a combination of business and personal decisions. Maybe that’s become the American way.
Guns in Homes: Time for a Safe Home Credit
Joe Knowles, MPH, MBA
A gun in the home is not currently considered to be a risk factor for homeowners insurance. Perhaps it should be. The insurance industry is responding to gun violence by refusing to insure schools where teachers are armed. If availability of guns is a primary cause of gun violence, then this is a rational step. The fact that it comes from an industry that derives its products from statistical evidence may say something about guns and risk.
Guns in American homes are common. But what risk do guns pose to homeowners and their visitors? Are guns in the home more risky from an insurance standpoint than, say, a backyard swimming pool, aggressive pet dog, or trampoline? Should insurers consider a gun in the home to be a risk?
Since over 40% of Americans live in a home with a gun, these are serious questions. Because the data show that keeping a gun in the home increases the risk of injury and death significantly beyond what it would be without a gun in the home.
If schools with guns are uninsurable, why would homes be any different? After all, several potential risks have been used for years to calculate policy discounts for homeowners insurance, including certain breeds of dog considered dangerous, wood burning stoves, swimming pools, diving boards, trampolines, tree houses, and one or more residents who smoke.
I propose that the five home insurance companies based in Massachusetts consider anew the quantifiable risk created by having a gun in the home. I ask that they offer a “Safe Home Credit” for homeowners who choose not to take the risk of having a gun at home. This would reasonably match the real reduction in risk, with not having a swimming pool, or trampoline, or pit bull, or other potential liability, which today earns a reduction in home insurance rates.
Data exists to support this actuarial approach.
A 2017 survey conducted by the Pew Research Center found that 40% of gun owners – including 30% of those with children under 18 at home – say there is a gun that is both loaded and accessible to them at all times when they are at home, confirming earlier data from a 2005 national survey study that found 31% of gun-owning families with preschool aged children leave their guns unlocked and accessible.
Well-publicized studies have found that children, most notably boys, are likely to handle a gun they find in a drawer, and many will pull the trigger.
Given the large number of guns in homes, storage practices, and curious children, it is not surprising that data reveal that guns in the home are a risk. These risks are broadly categorized as: accidental death, injury, suicide, homicide, and property damage.
In 2015, some 489 people died from accidental discharge of gunshots. In comparison, drowning deaths in swimming pools accounted for 683 deaths per year between 2005-2009. In the 10-year period from 2000-2009, 22 people died from trampoline injuries, or an average of 2.2 people per year. Dog-attack fatalities occur at about a rate of 19 per year, based on data from 1979-2005.
In 2015, there were 17,311 non-fatal, accidental gunshot injuries in the United States. In addition, there were 62,896 non-fatal, intentional gunshot injuries (assaults) and 3,878 non-fatal, intentional, self-harm gunshot injuries (attempted suicides) in that same year. In total, there were 84,085 non-fatal gunshot injuries in the U.S. in 2015. In 2015, there were 107,123 non-fatal injuries related to trampolines, 192,458 non-fatal injuries related to swimming pools and 348,000 non-fatal dog bite injuries.
How many firearm-related deaths and injuries occur in the home? According to a large study from seven major teaching hospitals across the United States, 53% of all gunshot injuries seen in their Emergency Departments between 2010 and 2011 occurred at the victim’s home and another 20% of those gunshot injuries occurred within 5 miles of the victim’s home.. Therefore, the risk of death or injury in or near the home when there is a gun in the home is significant and similar to the risk of having a swimming pool, trampoline, or aggressive pet dog.
In 2015, 22,018 people shot themselves and died. Another study found that, regardless of the gun storage system, type of gun, or number of guns in the home, a gun in the home increased the risk of suicide by firearm for men by a factor of ten, and increased risk for women by two times.
Researchers studying suicide have categorized them into impulsive and non-impulsive attempts. Most suicide attempts appear to be impulsive. The time between the triggering thought and the attempt is short; about half (48%) of suicide attempt survivors reported having suicidal thoughts less than 10 minutes before the attempt. Most people who survive one suicide attempt never try again. One study found that only 2% of people who attempted suicide went on to die by suicide in the following year and only 7% had died by suicide after more than nine years.
What does this have to do with guns in the home? About 91% of suicide attempts by firearms result in death. Therefore, having a gun at hand in the home means that an impulsive attempt at suicide usually results in death.
In 2015, almost 13,000 Americans were shot to death in homicides. A New England Journal of Medicine study showed that keeping a gun in the home – increases the risk of homicide by nearly three times, Nearly all of the victims were shot by a family member or intimate acquaintance. The victims are often women, and the risk of being a homicide victim for women increases four times when a gun is in the home. Children and teens are an especially high-risk group, with 10-19 year olds committing homicides with a gun at a higher rate than any other age group.
In total, deaths, injuries, and property damage from gunshots in America cost an estimated $229 billion annually. In addition, approximately $46 billion is spent injuries for emergency and inpatient care, rehabilitation, readmissions, and lost work to related firearm injuries. The total financial burden for a single gunshot victim is estimated to be more than $160,000 per patient, not including the cost of long-term care.
It is time for the insurance industry to confirm what study after study shows: a gun in the home represents a risk similar to swimming pools, trampolines, or aggressive dogs. Insurers should offer discounts to homeowners who do not keep a gun in the home, much as policy discounts are given when similarly risky items are removed from the home. In doing so, they would offer a financial incentive for a safer home, as well as confirming evidence that guns are not safe.
As a public health professional, I welcome insurance companies to the discussion of what to do about guns in America. Given their reliance on statistical evidence, policies designed by insurance companies can better reflect reality than those designed by the political process.
