On Monday March 27th, Nashville was forever changed. Six people, including three nine-year old children, died in a mass shooting at The Covenant School. Since then, I have been asked repeatedly: what can we do to keep this from happening again? At the time, I didn’t have an answer. But since then, I’ve been studying, asking questions, and listening, and I’ve been working to find commonsense policy responses that we might all consider, recognizing that there is no single point solution and that each of us views the highly charged issue of gun safety from a different, frequently contrasting perspective. What we can do now, and as responsible citizens really should do, is at least consider what options might be on the table to bring us together around the absolute goal of the safety and security of our children and families.
I am a gun owner and a hunter. I have always and will continue to strongly support Second Amendment rights. I had a 12-year Senate career where I consistently backed responsible gun ownership. But times are different today – misuse of guns has grown much worse, substantially worse – with markedly more death and tragedy in our neighborhoods, than even a decade ago. This demands a fresh look, free of past biases and partisan tones which have ruled so much of our earlier discussions and debate. These honest revaluations should be carried out in local communities, in homes and at schools, civic gatherings, and places of faith, and likely will include changes in the larger policy framework in response to these new tragic realities.
Yes, over the last decade, deaths from firearms has grown into an official public health crisis. The facts are stark: Now, according to the latest CDC data, firearms are the leading cause of death for children and teens in America. In 2020, gun deaths reached the highest number ever recorded in the United States, killing over 45,000 Americans (a 25% increase from five years earlier and a 43% increase from 10 years prior). And in 2021, we surpassed the 2020 record with nearly 49,000 gun deaths nationwide.
My personal bias in viewing gun safety as the major public health threat it has now become is colored by my life both as a practicing physician and as a federal public health policy maker. I honestly believe we have an opportunity to depoliticize and more civilly and rationally respond to this fundamental, growing disease tearing at our social fabric. Our path forward will not be easy: it will require a substantive shift in our culture and will challenge our priorities. And, ultimately, there is no single law or policy that will eliminate gun violence in America. However, there are many small steps that, when taken together, can make a major difference.
Two weeks ago I joined with Vanderbilt orthopaedic trauma surgeon Dr. Alex Jahangir and Woodmont Christian Church senior minister Rev. Dr. Clay Stauffer in outlining four bipartisan policies Tennessee lawmakers could unite behind to reduce gun-related deaths in our state. This piece builds on those suggestions, and shares information on seven additional policies that warrant consideration, presented as an illustration of some of the tools that states and governments nationwide are adopting in response to this public health crisis of firearm violence and deaths:
1. Enact extreme risk protection order (ERPO) laws. Nineteen states have enacted them, with early evidence indicating that ERPOs reduce suicide deaths. These types of laws allow family members, physicians, or law enforcement to petition a court to issue a temporary confiscation of firearms and a temporary bar from purchasing firearms when individuals are posing a threat to themselves or others. Currently, Tennessee has no such law in place.
Just released today, a Vanderbilt University survey conducted by the Center for the Study of Democratic Institutions reveals that 75% of sampled registered voters in Tennessee strongly support or somewhat support such “red flag” laws that temporarily restrict access to guns for individuals who are at high risk of harming themselves or others, as a way to prevent school shootings. And the Vanderbilt researchers noted that even 67% of those who identified themselves as National Rifle Association (NRA) supporters were somewhat or strongly in favor of such laws as a school shooting preventive tool.
2. Implement child-access prevention and safe storage laws. Promoting safe and responsible storage of firearms is both prudent and effective. Child-access prevention laws impose penalties on adults that allow children unsupervised, unsecured access to firearms, while safe storage laws generally require unattended firearms to be stored unloaded, in locked containers, or disabled with trigger locks, or both.
A recent study conducted by RAND analyzed state gun laws and their relationship with gun fatalities over a period of 36 years (1980-2016), and found that the implementation of stringent laws pertaining to child access, such as mandating safe storage requirements for guns and ammunition, was associated with a 6% reduction in gun-related fatalities.
A closer look at Nashville is revealing. Axios reports that more guns were stolen from cars in Nashville in 2022 than in any previous year. Stolen guns have been used in high profile crimes in Nashville. Metro government data show in 2022 that 1,952 guns were stolen, over 70% of which were stolen from vehicles. Safe storage considerations could make a difference.
Today’s statewide Vanderbilt study shows broad support in Tennessee, with 67% of registered voters strongly or somewhat supporting laws that would require gun owners to securely store their firearms or face penalties for failing to do so.
3. Expand background checks to all firearm purchases. This might seem like common sense, but only fourteen states currently require background checks on all firearm purchases. Tennessee does not. In states without universal background checks, data indicate that those legally prohibited from purchasing weapons circumvent the system by obtaining firearms through private sales. States that have universal background checks in place, however, typically require a private gun sale to occur at a licensed dealer or designated law enforcement agency where a background check can be conducted.
These universal background checks are a quick process – nine out of ten background checks are completed in a matter of minutes, and 99% of Americans live within ten miles of a federally licensed firearms dealer.
Requiring background checks for all firearm transfers can reduce avenues for criminals to obtain guns and help bring to justice private sellers who knowingly and illegally supply individuals prohibited from owning guns.
4. Require firearms safety courses for ownership. Many of us grew up hunting with our parents and grandparents, with our first successful hunt a cultural rite of passage. And we know every hunter in Tennessee must complete a hunter education course before that first hunt. Indeed, as explained by the Tennessee Wildlife Resources Agency: “Tennessee’s Hunter Education program works. Since 1975, when a formal hunter education program was introduced, the number of hunting and firearm-related accidents in Tennessee has declined dramatically.”
Given that this form of education has been shown to decrease the incidence of firearms injuries and accidental deaths, it seems logical to require education and training for firearms ownership. Such a requirement would enhance safety and could also provide an opportunity to identify individuals who have malicious intentions or who may be mentally unstable.
5. Expand who is restricted from purchasing or owning firearms. Under federal law, you are ineligible to purchase firearms in the U.S. if you: have a felony conviction; a conviction of a misdemeanor crime of domestic violence against a spouse or partner, parent, or child; have been involuntarily committed or found to be mentally incompetent by a court of law; are using controlled substances; are in the U.S. illegally; are a fugitive from justice; or have been dishonorably discharged from the military.
Some states have gone further, restricting gun possession by people convicted of elder abuse or misdemeanor charges of assault and battery, or are known to abuse alcohol. There are also some surprising categories of individuals who are not barred from buying guns, including those on the terrorist watch (Terrorist Screening Database) list. These are categories policymakers should consider.
6. Enhance school safety, including placing a school resource officer (SRO) at every school. This is an area Tennessee Governor Bill Lee has already demonstrated significant commitment toward, having increased funding for school safety since the start of his first term in 2019.
On April 3rd, Governor Lee unveiled new school safety legislation in response to the Covenant School attack, with more funding, more officer training, more school security upgrades, and additional behavioral health liaisons. The plan includes funds for an armed security guard at every Tennessee public school.
A statewide poll of over 1,000 Tennessee parents conducted in the fall of 2022 by the Vanderbilt Center for Child Health Policy found over 83% agreed schools are safer with one or more SRO present.
7. Ban high-capacity magazines and/or assault-style weapons. A previous federal, 10-year assault weapons ban established under President Clinton expired in 2004 while I was in the Senate. Two government-led studies of the ban published in 1999 and 2004 found mixed results of its impact — largely due to the findings that these types of weapons were relatively rarely used in gun violence nationally in those times. The studies also stated that it was also hard to discern impact because assault weapons and large capacity magazines produced prior to the federal ban were grandfathered, so a large number were still in circulation. While the horrific Columbine shooting occurred in 1999 during the ban, we did not see a continued trend of school shootings. Today, that has clearly changed.
The past 20 years have been a period of mass, targeted marketing by gun manufacturers that has accelerated the growth and popularity of semi-automatic weapons. At least two-thirds of the AR-15s in circulation in the U.S. have been manufactured in the last decade. And it is estimated that one in 20 adults own an AR-15 today, a semi-automatic rifle that is a civilian version of the military M16 rifle which fires one round for each pull of the trigger, automatically reloading for the next shot, capable of firing 45 to 60 rounds a minute. This is an astounding figure, but underscores the cultural acceptance of those firearms today.
Largely in response to the increase in violence using these firearms, nine states have implemented assault weapon bans of their own, and fourteen have banned high-capacity magazines.
The most recent statewide survey reveals that in Tennessee right at 50% of registered voters support a ban on assault-style weapons to prevent school shootings (37% strongly support and 13% somewhat support).
I recognize this is a highly politicized issue, but there are steps we can take to protect the Second Amendment and also protect our children’s lives. Constitutional issues and public health issues are not mutually exclusive.
We know from shootings where high-capacity magazines are used, the death toll is much higher. The period when a mass shooter must pause to reload is a vital moment when he or she can be overpowered, and victims have the opportunity to escape. A recent study analyzing mass shootings between 1990 and 2017 found that attacks where high-capacity magazines were used resulted in a 62% higher death toll, and that these types of high-fatality shootings were twice as common in states that hadn’t outlawed these magazines. Banning large capacity magazines, generally those with more than 10 rounds of ammunition, can potentially take a tool away from would-be mass shooters.
It’s clear from today’s data – especially the growing incidence of mass shooting events involving high-capacity magazines and assault weapons – that it’s time to consider a policy changes.
8. Fund research to better understand the drivers of gun violence. Here is where we can act immediately. We need more and better research and science-grounded information and studies to inform what we do. This can determine what works and what does not. In the past, our federal government has purposely (and wrongfully in my opinion) not funded gun safety and gun violence research. For over 20 years, a 1996 budget amendment pushed by the NRA prohibited it. Thankfully, this has begun to shift and in 2020 federal research funds, though minimal, began to flow again. The unfortunate, government-caused gap in fundamental safety knowledge has held back an informed response in policy, but now this can be rectified if we demonstrate broad public support for federal research.
Beyond federal research to inform policy, we need better local understanding by each of us as individuals. This will require investing in understanding the health and firearm-related attitudes, culture, and behaviors within our own local communities, something we began to do in Nashville with a 2019 comprehensive health and wellness population survey – the first of its kind in nearly 20 years. Through discussions with over 1,800 respondents, we at NashvilleHealth discovered information about disease prevalence, health behaviors, mental health challenges, and gun ownership. The self-reported survey indicated 27% of Nashvillians kept firearms in their homes. Among the owners, 42% reported the guns loaded, with more than half describing their loaded firearms as unlocked and accessible. We learned that most respondents regarded their gun ownership and accessibility as a safety issue for themselves: 63% reported that they felt safer when they have firearms in their home or vehicles. These data alone don’t dictate specific policies by themselves, but they can serve as provocative, constructive starting points for personal and community conversations about firearm safety in our neighborhoods. I encourage all communities to conduct similar surveys to better understand their own more immediate environments.
And statewide surveys such as that released by Vanderbilt today are also useful to encourage informed conversation. Tennessee Governor Bill Lee, who enjoys an approval rate over 80% among GOP registered voters and 53% among all voters (the highest of all elected officials polled), received support from 82% of registered voters for his recently signed executive order strengthening background checks. This broad support is something state legislators should consider when evaluating his call for an order of protection law, to be considered in a special session this summer.
9. Raise the legal purchasing age. In Tennessee the legal age for purchasing all types of firearms is age 18. About a third of states have raised the purchasing age for handguns to 21, and some have also raised the purchasing age for semi-automatic weapons and assault rifles as well. Hawaii, for example, which boasts the lowest rate of gun ownership and gun death of all 50 states, limits legal gun sales to those 21 and older.
Interestingly, there is substantial scientific evidence demonstrating that the frontal lobe of the brain, responsible for judgment and impulse control, is still developing at the adolescent stage into the mid-20s. That is one of the reasons the minimum rental age for cars is often set at 25 years old.
A 2012 study by the Johns Hopkins Center for Gun Policy and Research found that in the U.S., 18- to 20-year olds were the age group most likely to commit homicides. Our nation has also seen a notable uptick in teenage suicide, an increase of 29% among adolescents ages 15 to 19 over the previous decade, and the latest data has found that guns were the most common method of suicide for Tennessee adolescents and teens, accounting for 65% of suicide deaths.
10. Make gunmakers liable for harm caused by their products and improve product safety. Right now, the firearms industry bears no liability for shootings, and thus has no financial incentive to make their products safer. Ironically, mass shootings actually increase firearms sales. What can be done to incentivize change?
There are both high-tech and low-tech solutions gun manufacturers can add to their products to make them safer, including: chambered round indicators, magazine release safeties heavier trigger pulls, grip safeties, firing pin blocks, and now, the technology for “smart guns” is here. This includes guns that require biometric data like a fingerprint, a PIN, or phone app to unlock the weapon – making it inaccessible to minors and rendering it useless if stolen.
The government can play a role in requiring the production of safer firearms, in the same way we have made cars safer with airbags, backup cameras, blind spot detection, and driving assistance.
11. Fund mental health. I list this one last not because it’s least important, but rather because it’s arguably the most complicated and hardest to solve for. Across the board, mental health is massively underfunded and undertreated in the U.S. Research has shown that only about 4% of community violence is attributable to severe mental disorders – meaning its impact is frequently misassumed and often simplistically overstated, and does not apply to the perpetrators of most gun crimes.
We often hear that those who are mentally ill shouldn’t be able to purchase firearms, and indeed, those committing mass shootings are certainly mentally unwell. Unfortunately, there isn’t an easy way to check a person’s mental wellbeing during a background check. Only individuals who have been involuntarily committed to a mental hospital or declared mentally incompetent by a court or government body are required to be flagged to the National Instant Criminal Background Check System (NICS). So, while many individuals who have committed mass shootings in recent years have histories of mental health problems – including it seems, Audrey Hale of Nashville – few if any have been involuntarily institutionalized and would show up on the NICS database. We know, for example, that both Hale and the Uvalde school shooter legally purchased their firearms through federally licensed firearms dealers, successfully passing background checks.
Earlier mental health intervention is unquestionably important – not just to prevent mass shootings, but also to reduce the climbing rate of youth suicide, and to improve overall wellbeing. Unfortunately, as we know, our mental health system is broken and inadequately supported. It is imperative we follow through with sustained resources so that access and affordability are no longer barriers.
I may favor reform of guns laws, but I am someone who also values gun ownership. I recognize that some of these suggestions will not appeal to many Tennesseans and many Americans. But I share them with a hope that they can be starting points for civil, informed conversations at a time when we know we must reverse the current trends of worsening gun violence. Lawmakers might be surprised how broadly supported so many of these ideas are – a new Fox News Poll found 87% of voters support universal background checks, 81% support raising the firearms purchasing age to 21, 80% support requiring a mental health check on gun buyers, and 80% supported allowing police to take guns from those considered a danger to themselves or others.
All nations have criminals and the mentally ill, but only we have an epidemic of mass shootings, and we are failing our children. Now is the time to address the massive new public health threat to kids.