Not Even One

The Carter Center

February 1994

A Report on the Crisis of Children and Firearms

Contents

The Report of The Carter Center Consultation

On the Crisis of Children and Firearms

Feb. 23-25, 1994

1. The Preview: Who Is Tormenting Our Children?

   We have barely begun to engage the task of changing guns from symbols of sexy power to symbols of stupid impotence.

2. The Consultation:

   Not Even One

   Until we expand the discussion beyond reactive criminal justice, we will not be able to create a strategy capable of preventing firearm injuries.

   A Framework for a National Strategy

   To be successful, our strategy must integrate approaches that focus on firearms and on behaviors.

3. The Conclusion: A Voice for Our Children

   Once we recognize that not even one death is acceptable, a different urgency, a different tenacious creativity begins to engage.

4. Additional Thoughts and Suggestions

   The Background of Violence

   Supplementary notes on the extent of the problem of children and firearms

   Suggestions for Action

   A list of recommended strategies provided in advance by consultation participants

   Participants in the Consultation

Who Is Tormenting Our Children?

Not even one child's death from firearms is acceptable or inevitable. What will we do about it?

We gathered at The Carter Center, 26 people from various fields and disciplines, all concerned with protecting and lengthening the lives of children, to seek a path forward amid the carnage of our children caused by firearms. What could be done to stem the hemorrhage in the streets?

Could we do enough to make a difference? Could we do anything at all?

Author Norman Cousins has said that the greatest t the United States has given the world is to demonstrate that it is possible to plan a rational future. It is easy to lose hope when faced with a situation as horrible as thousands of children dying from firearms. Yet even here, we affirm that it is possible to plan a rational future.

Our gathering was framed around a modest focus on:

1. Children, not all people;
2. Firearms, not all violence;
3. Initiatives that could make an urgent and significant impact in the next five to 10 years;
4. Things we could work on immediately.

We found so many places to begin. Once one starts to look at the lives of children with eyes open wide to the tragic and hopeful, a vast, multilayered agenda opens up. When we look at things through the eyes of children, we get the question right and usually the answer follows.

Historian Will Durant writes that Imhotep was the first person to be recorded in history who was not the leader of a group. In ancient Egyptian writings, he is identified as an artist and a scientist, still a combination to be sought. If science is, as Aldus Huxley says, "common sense at its best," the crisis of guns and children calls us to combine the creativity of artists with the common sense of science: creative common sense at its best. Our moral outrage calls for more - creative and compassionate common sense at its best.

A beginning point is to reclaim the practical tenacity evident in the old "maternal mortality committees." These committees were formed as people began to realize that relatively few deaths of pregnant women were unpreventable. Every such death demanded close examination to determine what went wrong and what could be done to prevent the next death. The idea was not punitive; rather it was driven by the knowledge that maternal deaths could be prevented. As a result, deaths of pregnant women, numbering in the thousands only a few decades earlier, now are rare. Although the United States lags behind other industrialized countries in many health indicators, we are among the best in maternal mortality.

Could we do the same for children who die of gunshot wounds?

A child's death by a firearm would automatically call for, not just a criminal investigation, but a public health investigation that would determine all of the things that went wrong and produce recommendations for corrective actions to be taken by every responsible individual, group, agency, and public organization to be sure it didn't happen again.

Such a sentinel system would inevitably become the basis for a research agenda so that the tragic deaths would at least bear a fruit of understanding. The sentinel events could put faces on statistics and channel emotions toward prevention, not just after-the-fact punishment. Firmly grounded research also has the power gradually to force public policy to implement the creative, compassionate common sense programs that are needed.

Firearm Facts

A gun in the home is 43 times more likely to kill a family member or friend than it is to be used in self-defense.

Firearm Facts

If all Americans were shot and killed at the same rate as young African-American males, 260,000 Americans would be murdered with guns each year.

Humorist Sam Levinson once said that it isn't hard to have a brilliant idea. All you have to do is find the most foolish idea around and take the exact opposite position. Losing thousands of our children to gunfire is certainly the worst idea on the planet. Perhaps we can find the opposite by carefully understanding the pathological patterns today.

The central driving conclusion of our gathering was the conviction that not one gun death of a child can be acceptable. Not even one. Yet as Marian Wright Edelman, president and founder of the Children's Defense Fund, points out, we are losing the equivalent of a classroom of children every day. Is our goal of no deaths hopelessly unrealistic?

History suggests otherwise. In 1762, half of all children died before their eighth birthday. Noting that, the great French visionary Jean Jacques Rousseau cautioned, "This is nature's law. Do not try to contradict it." Today, even the most desperately underdeveloped countries on the planet do far better for their children. We are astonished at Rousseau's fatalism, even as we echo it regarding firearm deaths. Isn't it time to push beyond short-sighted fatalism? We can protect our children, if we want to.

I have long been fascinated by grizzly bears. In the spring, these solitary and powerful creatures gather at mountain streams to feed on fish. Accustomed to miles of separation, they fish and eat quietly only a few feet apart - by avoiding eye contact. As long as they don't look into each other's eyes, they can act as if they aren't within fighting distance. We do the same with great problems that ordinarily call for our full energies. We must make eye contact with the dying children and with each other so that we can no longer pretend that we are not living only feet away from tragedy.

Moral clarity comes from understanding that not even one death of a child is acceptable. This in turn opens our eyes to the multiple strategies available.

As we at The Carter Center consultation began to make eye contact with our dying children, we found ourselves framing both an agenda and a movement. Generally, our strategy flows into three basic categories, detailed in the following section of this report:

• legislation that should be passed,
• research that must be done (and funded),
• a movement that has to be built.

Legislation

The legislative agenda is both fluid and complex. We made no attempt to draft legal language. However, we were attracted to the work of Cease Fire, by Josh Sugarmann and Kristen Rand of the Violence Policy Center, which attempts to detail the rational steps that would treat firearms like any other potentially dangerous consumer item.

We were attracted to the concept of a flat tax on handguns high enough to make the purchase decision less casual and to provide a flow of revenue for research, trauma centers, and community initiatives.

We considered it important to maintain the right of communities to create their own pro-child gun strategies. And we are concerned by state pre-emption laws that nullify local ordinances. Too often, state laws have been pushed by cynical pro-gun interests afraid of creative municipal and county initiatives.

Research

For all the expertise and good ideas, we are still mystified by how much we don't know, by the yawning gaps in our knowledge. Even the initiatives that seem to make the most sense (the flat tax on handguns, for instance), have not been verified as effective by scientific study. Many community mobilization strategies, such as gun buy-backs, seem promising, but are unevaluated. We do not need to wait to act, but we do need to evaluate our actions carefully so that we can steadily improve our effectiveness.

We strongly support the movement by some key foundations to provide support in this area. However, government resources are essential for the scope, scale, and longevity of the research needed. Serious legislative steps to protect children must include funds for research to evaluate and improve our efforts.

A Movement to Build

To make gains in legislation, research, and social climate, we will need not only a compelling agenda, but also a powerful movement. The forces with the potential to protect children from firearms are numerous and strong, but almost totally unorganized. At best we tend to cluster in sub-clans around traditional interest groupings: health professionals here, children's groups there, researchers here, religious groups there. Meanwhile, the National Rifle Association (NRA), its clones and spin-offs, and the gun merchants plan their multimillion-dollar defense of the deadly status quo.

The pro-child movement has all the power, both moral and political, to protect children, if it finds a common voice and works together on common strategies.

We must build a movement that is equal to the task of changing the social climate. Movement building is as urgent as legislative and criminal justice interventions. The social climate cannot be changed as quickly as legislation can be passed. We know, however, that within our urgent time scale of five-to-10 years, we have the tools and techniques to alter the role of guns in our society.

Guns may be a deeper, more powerful cultural icon than cigarettes. We have barely begun to engage the task of changing guns from symbols of sexy power to symbols of stupid impotence. The tools of public education, mass media, and community mobilization have only started to be employed.

Creative, compassionate common sense cries out for a movement of all responsible adults in our society to protect our children. The movement we envision does not need one leader, but will need leaders in various fields to work closely together, to find a common voice. The participants recommended that The Carter Center could play a convening role. We are searching for an appropriate time and place to call together leaders from various disciplines and sectors to find that common voice.

The movement will need more than big meetings and strong statements. It must have a supportive infrastructure for communication and consultation. This is not a movement that will succeed with one vote in Congress but a multiplicity of actions taken by many. We have a decade of urgent work before us and we must create the structure to support our combined labor. A large, inclusive movement needs tools that encourage diversity. The Advocacy Institute is one group that is consciously laying the groundwork for this, and we strongly support their efforts.

A Bulletproof Vest

As we began to find our way forward, we sought an appropriate symbol for our efforts to define solutions. We wanted to protect our children but knew that no one strategy, however clever or encompassing, could serve as the shield we want to give our children until we are able to create a safer, more secure world.

Why not, we decided, wrap them in a movement as strong and flexible as a bulletproof vest?

The vests our police wear are made of fabric so flexible that a human being can work and even laugh in them. Yet the vests are so tough they can absorb and resist a bullet in flight. What if we could weave our various organizations into such a vest, flexible enough to fit the humanity of our communities, yet tough enough to resist anything that would prevent us from protecting our children?

Not even one child's death is acceptable.

We know there are ways to protect our children from firearms.

The author/philosopher Primo Levi argues that when one could relieve torment and fails to act, one becomes the tormentor. Will we fail to act? Will we allow ourselves to become the tormentors of our own children?

Firearm Facts

In 1990, 4,941 children in the United States under the age of 19 years died from gunshot wounds; 538 of these children were shot accidentally.

Not Even One

Until we expand the discussion beyond reactive criminal justice, we will not be able to create a strategy capable of preventing firearm injuries and deaths.

Few would doubt that we are living with "an epidemic of violence." New anecdotal evidence of the crisis erupts daily both far away and close to home. For every mass shooting spree in places as diverse as New York commuter trains and small town post offices, many more die in less dramatic fashion in the streets and homes of our cities and rural towns. The youth of our country, especially, seem more deeply and more casually involved in acts of violence and suicide. Children are killing other children and themselves at alarming rates, using powerful weapons of violence: firearms.

Everyone agrees that violence is an epidemic but there is no unanimity on the nature, or even the existence of, the cure. However, traditional polarization between conservatives and liberals - either "law and order" or "gun control" - is increasingly seen as unnecessary. Both camps and all in-between are beginning to come together to take responsibility for this societal plague, and to work toward its resolution.

No Comprehensive Strategy

Calls for rational policy in the face of this crisis have, until recently, met with more resistance than success. The traditional "law and order" paradigm - manipulated with great skill by politicians of both parties - has generally held sway in the national public debate on the issue, focusing the discussion solely on issues of criminal justice policy while preventing the development of a coherent national policy to combat youth firearm violence.

The most damaging result of our inability to expand the limits of the discussion beyond the standard reactive responses of the criminal justice system has been the profound lack of a national strategy on the prevention of firearm injuries.

At present there are few prevention-oriented federal laws regulating firearms. Those that do exist are woefully underenforced. Moreover, there are little coordination of current efforts and an absence of an overarching rationale driving the few national policies that are being enforced at some level.

A well-coordinated strategy, combining rational public policy, well-executed scientific analysis and effective enforcement is needed to combat the crisis.

Tragically, this potent combination is precisely what our current policies seem to lack.

Our current regulatory scheme represents a political compromise made many years ago under quite different societal circumstances. U.S. federal laws regulating firearms are by far the most lenient in the developed world. Moreover, they have failed miserably to stem the flow of weapons to those most likely to misuse them. The existing patchwork of statutes and regulations is at best fuzzy and uncoordinated, and at worst self-defeating.

The Conceptual Background

Perhaps the most influential among the frameworks for advocacy considered at the consultation was the public health approach, the movement to "reframe" the problem in terms of the impact of firearms violence on the public's health. Advocated by Mark Rosenberg of National Injury Prevention at the Centers for Disease Control and Prevention and Arthur Kellerman of Emory University's Center for Injury Control, this approach has captured the imagination of many concerned about firearm violence. Though it has been only within the past decade or so that experts have begun to look at the staggering human costs associated with this epidemic as an issue of public health, this perspective already has demonstrated its usefulness.

Firearm Facts

From 1975 to 1991, the number of licensed firearms dealers increased 95,000 - the total had reached more than 255,000 by 1994. In 1992, nearly 92,000 Americans applied to get or renew a federal firearms license. Only 52 were denied.

Firearm Facts

In 1987, 1,300 males under age 19 were murdered with guns in the United States. In the same year, in Canada, Japan, France, West Germany, Australia, England, Wales, and Sweden combined, fewer than 80 males under 19 were murdered with guns.

Such an approach also brings to the debate what is now urgently needed for a national strategy: a clear, scientific methodology capable of cutting the rhetoric down to core flesh-and-blood effects of the epidemic. The problem of firearm violence is public because its roots are in our communities and societies. Its debilitating effects are not restricted to individuals and families but extend to the community at large. The crisis is one of health because it is the direct cause of so much personal death and disability, as well as an increasing drain on our hospitals, emergency rooms, and public health and welfare institutions.

The health paradigm can provide a major link between often polarized philosophical and political coalitions on the issue of violence. Our present crisis suggests that debate dominated by the language of "gun rights vs. gun control" should give way to analysis of "firearm injuries and deaths."

Politics aside, the fact remains that the actual physical injuries from gun violence are creating a crisis for many metropolitan health-care facilities. Emergency rooms and hospitals are being forced to divert attention and precious resources from preventive health and care of the sick to the critical care of bullet-ridden adults and children.

When we begin to focus on the real, concrete human costs of this crisis - the death and disabling of thousands of our young people each year - we encourage a "paradigm shift" in the ways our society approaches the problem of violence and injury. We begin to move away from an exclusively criminal justice approach of punishment of offenders to an integrated prevention focus.

Reframing the dilemmas in a new way may burst through the logjams of old ideas and tired assessments, clearing the way for new solutions.

The public health approach brings with it three critical advantages to current efforts to define a comprehensive strategy:

• First, it shifts the focus from punishment to prevention. The ultimate goal of any health project is to prevent the problem. The greatly successful mass immunization projects are models of this approach. A focus on prevention can unlock real and lasting solutions to the epidemic of youth firearm violence.
• Second, the health approach brings a science-based approach to an emotionally and politically charged issue. It would model a workable methodology applied to a critical human dilemma by persons who are deeply involved in and concerned about the crisis.
• Third, the health approach emphasizes integrative and multilayered solutions. The most successful health campaigns have offered a wide spectrum of solutions. Similarly, any successful approach to youth firearm violence must involve all concerned parties, across traditional and entrenched barriers.

Balancing Approaches

Others at the consultation pointed to the inadequacy of placing exclusive emphasis on the purely "consequentialist" concerns about the impact of guns and gun ownership on the "health" of the public. Philip Cook of Duke University's Terry Sanford Institute of Public Policy and others reminded participants of these issues. There are a series of wider political and philosophical frameworks within which discussions of violence and firearms must take place. Concerns over public health, though critical, must not replace public discussion of the relationship between citizens, the community and the society at large. As a practical matter, the political and philosophical should not be ignored, if only because the single most powerful player in the debate over firearms regulation, the National Rifle Association, will not let such concerns die easily.

Many Americans see firearms as having legitimate uses. Many argue that the U.S. Constitution guarantees that each person has the legal right to arm him/herself. Such deeply held myths will not be disposed without careful and sensitive national debate over the appropriate relationship of the individual, the police, the community, and the state.

Perhaps the most compelling reason most give for preserving public access to guns is the ability to defend oneself. This attitude is based on a pervasive fear of crime and the resilient belief that guns provide protection from criminals. Indeed, self-defense is the most common reason given by those of all ages (including teenage gang members) when asked why they carry a gun. Such surveys also reveal a widespread distinction between "legitimate" uses of firearms (self-defense and hunting) and illegitimate ones (crime, suicide).

Any approach that treats all uses of guns as equally objectionable is likely to meet stiff opposition. This concern led some at the consultation to recommend that legitimate gun ownership be clearly distinguished from firearm violence, suicides, and accidents. Moreover, the support of gun owners concerned about gun violence was held to be critical to the success of long-term anti-violence initiatives.

Since there are many competing conceptions of firearms and their use in our society, participants in the consultation concluded, the goal of anti-firearm violence policy must be a multilayered portfolio of policies that can address the array of firearm problems that have an impact on groups and communities.

A Regulatory Approach

Alongside the reshaping of the public perception of firearms violence as a crisis of public health, efforts must be made to initiate a comprehensive regulatory approach to firearms, according to another conceptual stream. This would mean treating guns not as quasi-sacred instruments of defense, but as the inherently dangerous consumer products that they have become. Seen in this light, restrictions that prevent federal regulatory agencies from supervising the firearms industry are at the root of our problem. Why not regulate firearms at least to the same extent as prescription drugs or household chemicals?

With this anomaly in mind, the Violence Policy Center, has created comprehensive legislation to serve as a model for national efforts to bring firearms in general, and handguns in particular, under the national regulatory agencies. Firearms would be subject to regulation to the extent the guns pose risks to users and the public. Once firearms are seen as inherently dangerous consumer products, it remains only to design an effective regulatory scheme that can then be applied across state and other jurisdictional lines.

At present no regulatory agency has the authority to oversee firearms. The Bureau of Alcohol, Tobacco, and Firearms (BATF), though possessing limited authority to regulate commercial aspects of the firearm trade, has no warrant to regulate firearm safety and is not empowered to protect the public from the dangers of firearm use. The Consumer Product Safety Commission (CPSC), the agency charged with overseeing the use and manufacture of most household products, is specifically prohibited from regulating firearms in any way.

Though the virtual lack of regulation might benefit most through the creation of a new, independent regulatory agency, a more realistic alternative would be to expand greatly the authority of the BATF (through legislation) to set and monitor safety standards for firearms. Most handguns, as well as all assault weapons, would likely fail to pass any such new criteria, and would thus be banned.

Coalition Building

Surrounding these conceptual approaches was, for conferees, the knowledge that any viable initiative designed to effect real change in our present crisis of firearms violence will arise only with the support of a broad-based movement, a coalition of interrelated organizations.

Firearm Facts

In 1993, the cost of direct medical spending, emergency services and claims processed for the victims of gun violence nationwide totaled approximately $3 billion. Average hospital charges for treating one child wounded by gunfire were more than $14,000.

Firearm Facts

In the United States in 1990, 2,861 children 19 years of age and under were murdered with guns, an increase of 114 percent since 1985.

One influential group supporting such movement building is the Advocacy Institute (AI), which published a paper outlining steps to this goal shortly before the consultation. Broad alliances among diverse groups must be forged, AI urged, and it was acknowledged that reframing the issue in terms of injuries and public health might provide the most effective framework from which to appeal to such diverse interests. Moreover, the movement created by these alliances must equip itself for long-term struggle by developing an infrastructure of organizations, data, and persons capable of sustaining itself for a decade or more.

A Framework for a National Strategy

A viable national strategy needs a clear concept of the problem and the range of possible solutions. But in today's public mind, there seem to be two distinct approaches toward the problem of firearm violence - one focusing on firearms, the other on behaviors of persons, groups, and communities. Though these two approaches have often been treated as polar opposites, the only successful national strategy will be one that integrates both approaches.

Focus on Firearms

Central in any array of possible strategies against youth violence must be a focus on the object that is used to inflict the undeniable bulk of violent injury today: the firearm. There are three broad and interrelated problems that form the core of the current firearm crisis:

• Guns too easily fall into the wrong hands.
• Firearms are frequently misused.
• Many firearms are inherently unsafe and excessively lethal.

This suggests appropriate responses:

• Control Who Has Access to Firearms

  As we have seen, the existing patchwork of laws leaves firearms and ammunition supplies largely unregulated, and the vast numbers of guns on the street ensure that they will be readily available to virtually anyone who wants them. The result is that these guns fall too easily into the wrong hands. As long as the supply of dangerous and deadly firearms remains essentially unrestricted, persons lacking the responsibility required for gun use will continue to get their hands on guns far too easily.

  Those who should be prohibited from firearm ownership include not only convicted felons but all who lack the training and judgment necessary for responsible gun ownership. In addition to those who have shown a propensity to violence, this prohibited category should include all under 18 and people with a history of impairment by alcohol or other drugs.

• Avoid Misuse of Firearms

  A national strategy must be designed not only to limit access to firearms but also to promote lawful and safe use of those firearms that are available. As with other substances that have been labeled by Congress (through the Controlled Substances Act) to have "a high potential for abuse," firearms and ammunition should be subject to significantly tighter restriction and supervision by federal and state governments, much as prescription drugs are now. As a recent Washington Post op-ed article put it, "Buying ammunition should be at least as difficult as getting a Ritalin [a drug to depress hyperactive conduct] refill."

  Others have suggested imposing punitive taxes on handguns and ammunition, both to reduce demand and to raise revenue for preventive programs.

  On the positive side, the safe use of firearms could be promoted through a threefold strategy:

  • Create tough penalties for gun related crimes.
  • Regulate where firearms are allowed and how they are carried and stored.
  • Promote gun safety through education and financial disincentives to particularly dangerous firearms and ammunition.
• Make Firearms Safer and Less Lethal

  Although current laws prohibit the importation of some foreign-made, excessively dangerous types of firearms, domestic manufactured guns carry no restrictions. Furthermore, a domestic manufacturer need not show or even suggest that a weapon has a legitimate sporting purpose under current law. In this light, it seems clear that requiring domestically manufactured firearms to incorporate safety features such as trigger locks and load indicators would be a reasonable first step toward a more sane policy of firearm safety. More complex technologies such as the "smart guns" that can be fired only by their owners can be emphasized as they become practical.

Focus on Behavioral Change

Many opponents of restricted gun ownership rightly point out that the problem of violent use of firearms among youth is not solely blamable to guns themselves, but to complex personal and social factors as well. Thus, changing the social environment in which Americans live is essential to any successful long-term national strategy. Such change can be thought of as strengthening the social infrastructure, the "social capital" of our neighborhoods, communities, and cities.

A national strategy would therefore need to include a focus on job creation and training as well as serious and sustained efforts at improving the quality of education, particularly in urban areas where the blight of violence is most keenly felt.

Possible responses include:

• Change the Social Environment

  Community and neighborhood norms and values that reinforce a violent solution to everyday conflicts must be addressed. Whole sections of our youth subculture are being influenced to incorporate firearms violence into the fabric of their identity. Gang and neighborhood rites of passage are manifestations of this phenomenon, but more subtle and perhaps more insidious messages about nihilism and hopelessness, rugged individualism, hedonism, sexual conquest and exploitation form an integral part of today's youth culture.

• Change the Wider Culture

  At the most fundamental level, addressing the influence of the wider culture on violence will be critical to a coherent national strategy. The media, the public education systems, and our religious institutions need to be mobilized in a wide-ranging effort to influence the violence myths at the root of much of our popular culture. Perhaps more than any other institution, the popular media has the capacity to reach deeply within subcultures inaccessible to traditional institutions such as churches, synagogues, mosques, and schools. Successful experience in changing attitudes toward tobacco and automobiles suggest that changes in views toward guns could also be achieved.

• Change the Physical Environment

  Given the likely protraction of some firearms violence despite all efforts, some thought must be given to the physical environments within which the vast bulk of today's relatively uninvolved youth live and move, and how their environments might be restructured to give better protection from exposure to the violence of their peers. Daily functioning, which for many is filled with legitimate fear of death or injury, must be made relatively safe, especially for those living in our urban areas.

Firearm Facts

None of the federal taxes on guns are designated for the medical care of victims of gun violence. In fact, all of the revenues from the firearm excise tax are required to go to hunting-related activities.

A Voice for Our Children

Once we recognize not even one death is acceptable, a different urgency, a different tenacious creativity begins to engage. into the fabric of their identity. Gang and nei

Data indicate that more and more young people are dying from firearm wounds, usually inflicted by someone they know or by themselves. We wondered what we could rationally hope for in the face of this grim reality. Perhaps we could cut the annual number of deaths of young people in half, to 5,051? But what rational person would call 5,051 deaths something hopeful?

Would 90 percent be rational?

Which of us could tell the 1,000 mothers that their child's death was within the acceptable boundaries of hope for our society?

How many firearm deaths is too many to accept?

One!

In a civilized society not one child's death by firearm is acceptable.

Not one.

Any group that can tolerate large numbers of dead youth is unlikely to summon the sustained commitment to face terror with eyes wide open, with engaged minds. If we can tolerate a handful of dead "marginal youth," we are likely to be tolerant of the next 5,000. We could probably retain our numbness as the numbers soar beyond rational comprehension to the tens of thousands. This is exactly what is happening.

The first step toward hope is to repeat that not even one firearm death of a child is acceptable until that tenet becomes a moral imperative for our society.

This moral imperative would make the problem of strategic direction easier than expected. The common assumption is that we don't have any, much less many, answers. Once we recognize not even one death is acceptable, a different urgency, a different tenacious creativity begins to engage.

When the participants at The Carter Center consultation said "not even one," we implicitly said "yes" to a much broader range of strategies and allies. We found there is not one simple agenda, but a multileveled agenda that calls for national, state, and local movement combining many disciplines and sectors of our society.

What kind of movement is possible?

The task is not to describe something that might emerge. Rather, the task is to describe a movement that is already emerging, that already has a number of strong voices. We see a mosaic of organizations like stones set side by side. From a distance the stones cast a formidable image since they make up a broad cross-section of the most influential sectors of our society. As the Advocacy Institute noted in a report prepared for the Joyce Foundation:

"Many and diverse individuals and organizations are poised to take up advocacy against gun violence, or to raise fighting the epidemic of gun violence to the top of their advocacy priorities - groups ranging from the Coalition for America's Children and the Children's Defense Fund to the NAACP and the American Bar Association; the AFL-CIO; large and small retailers; mayors and law enforcement officials and their organizations; the American Public Health Association; the American Academy of Pediatrics; and Physicians for Social Responsibility.

Firearm Facts

Taxpayers pay for gun violence. The average cost of medical treatment for one hospitalized gunshot wound patient (all age groups) is more than $33,000. Approximately 80 percent of patients who suffer from violence are uninsured and/or eligible for government medical care assistance.

Firearm Facts

The firearm homicide rate for 15-19-year-olds increased 61 percent from 1979 through 1989. The rate of homicide by all other methods remained stable or declined.

"Many other interest groups are potential recruits to a well-framed, well-structured movement which is prepared to nurture and sustain their involvement; churches, civic associations, parent and teacher organizations and youth leaders themselves; alcohol and other substance abuse control advocates; the entertainment industry; the marketers of security systems and devices; at-risk government agencies such as the post office; businesses at-risk both in the workplace and in vulnerable consumer outlets; and the travel, tourism, and insurance industries."

Every part of this mosaic already expresses a priority for protecting our children from gun violence. We must turn the mosaic into a tapestry; to weave our various and distinctive strands into a protective fabric. Different, interwoven strands become much stronger and more resilient without losing flexibility. A bulletproof vest worn to protect our police is made of just such a fabric. Our children deserve no less.

The variety of voices and perspectives that could be woven together is quite a challenge in itself. It is crucial that we focus as tightly as possible on those things around which we can find common commitments:

• No youth-killing by a firearm is acceptable.
• The access of children to firearms must be limited.
• An intensive five-to-10 year effort must begin to remove the threat of firearms from the lives of children.
• Actions by local, state, and national authorities must complement one another, and all must give attention to criminal justice, community development and public health perspectives of the crisis.

We will need to listen and communicate carefully across boundaries of discipline and vocabulary. Our leaders - state, local, organizational, political, religious - need to reach out to each other with a new level of urgency and commitment to protect the children. To this end, one of the persistent recommendations from participants at The Carter Center consultation was the establishment of a leadership council facilitated by The Carter Center.

Three Key Areas

We identified three key areas on which to concentrate:

• Legislation
• Research
• Movement Building.

Legislation

Among the many initiatives that require legislative action, we found the following particularly strategic:

• Flat Tax on Handguns

  A flat tax on handguns offers the possibility of making a handgun purchase a less casual decision while opening the possibility of new financial resources for institutions and communities especially affected by gun violence. The most effective amount of such a tax would need to be identified by research. The revenue-sharing formula itself can have both an educational and coalition-building effect by targeting funds to trauma centers, community-based prevention programs and law enforcement. This may make a clear financial link between joblessness and the despair that leads to gun violence. Many community-based organizations see guns as a legitimate concern but on the periphery of their priorities. A substantial flat tax that flows funds into the communities most affected could make the link more visible.

• National Funding for Research

  Unlike the anti-tobacco movement that has roots in a large body of scientific research, the gun safety movement has relatively little research data to work with, especially that grounded in a health-risk perspective. The federal government spends for prevention research on gun violence approximately $2.4 million, for instance, as opposed to literally billions for cancer and HIV research. This low funding for research results from and also perpetuates the spasmodic support in the legislative arena.

• Limit Gun Ownership

  It is particularly important to broaden the list of people who can not legally have guns. We see a particular opportunity in seeking legislative action to expand the legal definition of people who should be excluded from purchasing guns. This is not only a rational way to protect our children, but also makes smart legislative strategy. This approach has the advantage of highlighting the limited impact of current legislation while forcing pro-gun advocates into awkward defense of spouse-abusers, child-molesters, and other politically difficult groups.

• Guns as Safe Consumer Items

  The legislative strategy of regulating safe design of guns seems an attractive, positive way to produce safety, as results of the auto safety movement indicate. Treating guns as dangerous consumer products removes them from the cultural icon role and permits rational analysis of specific risks, especially to children. The Cease Fire document is particularly persuasive at this point and deserves to be high on the legislative strategy. The Wexler Group is one of the leaders in the lobbying effort. Rep. Major Owens has introduced in Congress a bill embodying many components of the Cease Fire model legislation.

• Support Community Rule

  The role of pre-emptive legislation is troubling. Especially because we do not fully understand the phenomenon of gun violence, it is important that different communities have the opportunity to put their best strategies into action. If national legislation is the only ground of experimentation, our learning curve will be much longer and less certain. Opposing pre-emptive legislation - i.e., state or national legislation that negates local laws - may also force pro-gun advocates into positions that show them as both anti-child and anti-democratic. (This course does run the risk of local ordinances that are counterproductive: witness the law passed by a Georgia county that all its citizens were required to own guns.)

• Make Adults Legally Responsible

  It is ironic that adults have more legal liability when their dog bites a child than when their guns fall into a child's hands, causing injury or fatality. Even gun advocates agree that no child should have unsupervised access to firearms. This common-sense view must find its way into legal language to discourage adults from being casual with storage of guns. New laws could establish civil as well as criminal costs to irresponsible adults. This would have a particularly important potential impact on suicide deaths that constitute half of all gun deaths. Focusing on the responsibilities of gun owners to protect children from casual access offers the opportunity to highlight the dangers of ownership through suicide and intra-family homicide while finding common ground with reasonable gun advocates.

  Some legislative initiatives can be accomplished at state and even local levels. For instance, state law could be enacted to establish civic penalties for allowing one's firearms to fall into the hands of children or youth and even higher penalties when used in connection with a homicide or suicide.

  As this report was being prepared, the U.S. Congress passed legislation to prohibit a number of categories of assault weapons. This is another encouraging sign indicating that breakthroughs are within reach. This clears the way for addressing the greatest firearm issue of concern to children: handguns. The logic that persuaded Congress to ban assault weapons must now be focused on handgun legislation.

Research

We recommend the following research agenda:

• National Surveillance

  For a problem as large and emotional as this one, it is remarkable that we have no nationally consistent surveillance system providing us with basic information. We have few statistics that reveal what guns are killing what children under what circumstances. We do not have consistent reports of the events immediately preceding the incidents or reliable analyses of longer- term patterns. It is crucial that a national surveillance and data collection system be put into place. Only then can we begin to accumulate the raw data necessary for the development of solid interventions based on clear thinking.

  Firearm Facts

  In 1991, the Bureau of Alcohol, Tobacco, and Firearms performed compliance inspections on fewer than 4 percent of all existing gun dealerships; 5,967 violations were found: only 17 dealers' licenses were revoked.

  Firearm Facts

  Firearms are used in more than 80 percent of teenage homicides and about 68 percent of homicides by all ages.

• Network of Firearm Research Centers

  We are attracted to the idea of supporting a network of firearm research centers that could serve as the skeleton of a scientific research infrastructure. Such centers could be patterned after and even added onto the existing centers on injury research. In the case of guns and children it is especially important that the centers be linked integrally to community-based organizations and that the research include a variety of analytical methods.

• Behavior Research

  Because of a dearth of data on the behavioral side of the guns-and-children tragedy, there is a need for behavioral research. It is important to understand how to intervene in the sociology of children kiling themselves and each other with guns.

• Diversity Among Researchers

  Recognizing the important role that culture plays in the sociology of children killing children, we need to consciously seek out and develop researchers who represent those cultures that are most impacted.

• Evaluation of Current Policies

  Almost none of the presently employed strategies have been carefully evaluated. For example, the buybacks around the country have received only cursory analysis beyond counting turned-in guns. Creative local legislation has only rarely been studied for impact. We must take the problem seriously enough to force careful, systematic evaluation of whether our strategies are actually resulting in fewer child deaths.

• Interdisciplinary Exploration

  This complex issue will necessarily find its answers in interdisciplinary research. Criminal justice researchers must learn from and work with their colleagues from public health, sociology, community development, and faith groups.

  Important insights into the phenomenon of child gun deaths may already exist in complementary inter-disciplinary discussions. For instance, alcohol and substance abuse are often associated with violent incidents among youth. There are likely to be strong carry-overs into the issue of gun fatalities, especially at the point of framing preventive educational strategies and interventions.

• Balanced Research

  We must understand not only what guns killed what child, but what "rite of passage" motivated the killer to carry and use a gun; we need to understand not only the gun's caliber, but its symbolic role. This kind of qualitative research is crucial to urgent action because we do not have the time to act with our eyes less than wide open. The priority should be on research capable of aiding practical decision-making by community leaders, as well as national policy leaders.

• Focus on Donors and Legislators

  The practical motivation for placing a high priority on research is to some degree focused on donors and legislators. Few organizations have the in-house staff to do systemic evaluation of gun safety initiatives or careful research. Even the Centers for Disease Control has been allocated limited funds in this area. Therefore, any legislation proposed for protecting children should include funds for increased research.

  Foundations may be able to act more quickly, and certainly more creatively, than government vehicles. Many donors not traditionally involved in violence or firearm issues are being drawn into the movement because of their connecting interests (in education, health, or community development, for instance). This programmatic diversity brings with it the potential for diversity in research perspectives.

  To be effective, the small group of researchers already in the field need more colleagues from more diverse backgrounds.

Building the Movement

We are describing the need for a movement, not just a meeting; a range of actions, not just a meeting; a range of actions, not just one more bill in Congress. Thinking in strategic terms about a movement for child gun safety demands attention to the infrastructure such a movement demands. For this task we have relied heavily on the creative input of the Advocacy Institute as well as the pooled insight of our gathered experts. A number of critical areas need attention:

• Mainstreaming

  A strategy is needed to encourage a wide diversity of organizations - civic entities, interest groups, professional associations, government, and religious groups - to move child gun safety to the top of their own agendas. As long as gun safety is a special issue, limited in scope, children will never be safe. The survival and safety of our children is a crucial issue to every mainstream group in the nation, even though this is only slowly being recognized.

• Coalition Building

  The first task is to establish the concern for child gun safety as a commonly held mainstream priority among as broad a group of interests as possible. This could happen at local, state, and national events of mainstream organizations through the resolutions and presentations that normally define priorities within the groups. Coalitions are only as strong as the component commitments. It is time well spent to build support for coalition activities by securing broad understanding within each interest group. It is important for the leaders of various sectors to meet together and find common voice. It is just as important for those leaders to connect their groups' traditional interests to the issue of gun safety for children.

• Common Space

  A movement is more than meetings and speeches. The anti-tobacco movement teaches us that it is about common communication channels, interpersonal relationships, and strategies built on trust. On a day-to-day basis, the gun safety movement will need common spaces in which to meet and plan. The tobacco movement used SCARC-net, a computer network, as an online committee room in which an enormous amount of hard planning and information-sharing was accomplished. The Advocacy Institute is laying the groundwork for what might be called "safety-net" to do the same thing for the child gun safety movement. This is potentially a powerful tool.

• Diversity

  The breadth of the movement guarantees that no one of us will be at all the important meetings. It is especially important that at least a diversity of us attend. The length of the "urgent" time frame - five-to-10 years - implies that we have to develop a large, diverse group of leaders who have personal relationships in a variety of sectors and organizations.

• A New Social Climate

  We humans have the capacity to alter our social climate. Even within the five-to-10-year span we consider urgent, we can change how guns are seen, understood and used in our society. Since well over 200 million firearms circulate in the United States - nearly one for every man, woman, and child - we must confront issues beyond forward-looking control of guns. Even if we achieved a total ban on the manufacture and sale of handguns (and, if we knew how to frame it so that it worked), our children would still find themselves in a violence-soaked climate that treats guns as symbols of virility, independence, and power. This fact, especially dangerous among young males (especially those whose self-image is damaged by poverty, racism, or insecurity), calls us to urgently confront the task of changing the social climate.

  Firearm Facts

  In 1990, 4.37 million guns were produced for the American market. That is 12,000 new guns every day. Although they would save lives, few guns have trigger locks or loading indicators, because no law requires them.

  Firearm Facts

  Suicide is the third leading cause of death for adolescents and young adults in the United States, after car crashes and homicides. In 1990, 3,165 youth ages 15-24 killed themselves with guns.

  Changing the social climate is often seen as an area that takes too much time for urgent problems. Indeed, it is the crucial task that must engage the creative energies of responsible adults and youth leaders.

• Public Education

  The public schools are an important place in which to engage the overall social climate as it relates to young people. Yet it is unrealistic to expect schools to counteract the obsessively violent stream of social messages from other venues and media. Part of the attraction of youth to guns is based on rational insecurity - they are afraid of physical danger from others with guns. Public education can provide a possible forum for alternatives to violence through special curriculum, even as it today offers the venue for much of the insecurity. We must seek ways to tangibly increase the security and safety of youth or they will continue to seek it in guns or other dangerous tools.

• Media

  The mass media has played a significant role in promoting guns and casual violence yet suffered no consequences of its actions. It is also a medium capable of omitting messages when it chooses (tobacco) and incorporating them when it chooses (seatbelts). A gun is such an omnipresent and easy image of power and domination that it is used thoughtlessly to hold together many television stories. Children should not be forced to choose between a dangerous culture or a bland one. Media should be held accountable to standards of communication skills that could provide healthy and safe imagery while still challenging youth and adult interests.

  Changing the media is not simply a matter of asking them to do better. Lawrence Wallack, professor of public health at the University of California, Berkeley, identifies media advocacy as a role for public health scientists and community leaders. "It is a hybrid tool, combining community advocacy approaches with the strategic and innovative use of media to better pressure decision makers to change policy." He continues, "Media advocacy is, in large part, about making sure that the story gets told from a public health point of view."

• Signs and Symbols

  The Carter Center consultation spent time thinking through the ways in which the firearm has become a central and oppressive cause of fear and danger in our society and how the symbol can be changed. Within 10 years we expect, and will work to see, the firearm changed from a symbol of power into one of weakness. A cigarette once subliminally communicated sex; it now means "addict" and brings forth pity instead of desire. We will work to make the same transfer happen with guns ("only the weak would want a gun"). This by itself does not rid society of dangerous weapons. But it has an enormous amount to do with whether the weapons are carried casually on the streets, in the schools, and in our homes.

Realistic Optimism

We are optimistic about the possibility of protecting our children from firearms. We think it is possible to enact wise and rational legislation that will finally regulate firearms. We expect that our combined avenues of research will support and challenge our urgent activities toward true effectiveness. We expect to see a broad, interwoven movement take shape within the next months that can make a child gun death a rare and shocking event within the next five to 10 years. We fully expect that the social climate in 10 years will be quite different regarding guns and that we will look back on the passive fatalism of 1994 with curiosity.

We know this can happen, indeed, it already is.

Who is the voice that can speak for the children? The answer, of course, depends on the audience. We have described our vision of a bulletproof vest woven of many threads. The component messages of gun safety demand many different voices finding common voice around the commitment that "not even one firearm death" is inevitable or acceptable.

The Background of Violence

Supplementary notes on the extent of the problem of children and firearms

The Firearm Factor in the Youth Epidemic

Statistics paint a grim picture of violence in American society today. According to the FBI, 22,540 people were murdered in the United States in 1992 - more than at any other time in this nation's history. Though comparisons to foreign countries are obviously subject to differing interpretations, the huge gap between the rate of violent injury in the United States and that of any other industrialized nation is cause for alarm by any measure.

One example: The rate of death by homicide for males age 15-24 in the United States was 37.2 per 100,000 from 1988-91. By contrast, in Italy (the country with the second highest homicide rate in this age group), just 4.3 males out of every 100,000 were murdered, while the No. 3 country, Israel, recorded a rate of 3.7 per 100,000.

Even more telling is a comparison with homicide rates for the other leading industrialized democracies. Only one other European country, Sweden, recorded a rate over 1.1 per 100,000, and the rates for Germany, France, the United Kingdom, Canada, and Japan were all less than one-thirteeth the U.S. rate. Police reports in the United States, moreover, indicate that more than half of those arrested for these murders in 1991 were under 25.

The rise of violence in America is not evenly distributed across all age groups, nor generalizable for all possible weapons of violence. A thorough review of the evidence makes clear that firearms - and handguns in particular - are profoundly implicated in the rise of violence, especially deadly injury, and that it is primarily our youth who are both using firearms and suffering from firearm injuries at unprecedented rates today.

The evidence for these claims continues to mount: While the rates of non-firearm homicides in this country have remained relatively steady for the past 60 years, it is the rapid growth in firearm homicides since the 1950s that has fueled the overall increase in murder rates. More than 60 percent of all homicides involve a firearm: in 1990, more than 16,000 murders were committed with a gun. Most often the firearm is a handgun (81 percent), though on occasion a shotgun (7 percent) or a rifle (5 percent) is used. Since rifles or shotguns constitute more than 60 percent of all firearms in circulation, handguns would appear to be far more likely to be used in homicides, by a ratio of almost three-to-one. In short, firearms are the weapon of choice for murder, and handguns seem to be the preferred firearm.

An Epidemic Attacking the Young

The statistics are even more grim when they focus on the impact of handguns on the young. Across the country, firearm homicide is the second leading cause of death among all youths between 10 and 34 years of age, trailing only motor vehicle injuries. In Texas and Louisiana, firearms recently surpassed automobile injuries, and are the leading cause of death for young people.

Firearm Facts

Half of all Americans own guns. More than one-third of all male homicides are by firearms. Nearly half of all female homicides are by firearms.

Firearm Facts

From 1953 to 1978, the rate of suicide among young people tripled; this rise paralleled an increase in the firearm-caused suicide rate.

For African-American males ages 15-24 from all states, firearms are the No. 1 cause of death. Nationwide, firearms kill more teenagers of all races than all "natural causes" combined. For those under 18, firearm homicides rose 143 percent between 1986 and 1992 - nearly five times the adult rate of increase during the same period. Overall since 1984, firearm mortality rates for 15-24-year-olds have increased such that by 1988, one in five deaths among adolescents and young adults were gun-related.

Firearm death rates reached their presently high rate (higher than at any time since the 1920s) during the early 1980s, and seem to have remained relatively steady since that time. However, the rate for several discrete groups - specifically, young adults, women, and male teenagers - are higher than ever before. Fifteen-to-20-year-olds have suffered the worst increase. Since 1984, their homicide rate has risen 41 percent, and practically all of this increase is directly due to growth in gun murders. During the past eight years, the risk of a teenager dying from a gunshot wound has increased 77 percent!

In 1991, more than 38,000 people died from firearm related injuries - one death from a gunshot wound every 14 minutes. Furthermore, the majority of firearm incidents do not end in a fatality, and thus are not accurately recorded. By a 1985 estimate, more than 65,000 people were hospitalized by firearm injuries that proved nonfatal, and more than 170,000 more were injured with a gun but not hospitalized.

Although these statistics are alarming, homicide represents less than half (46 percent) of the deaths caused by firearms each year in the United States. Suicide actually accounts for slightly more deaths than homicide: almost 50 percent of each year's gun deaths, with the remaining 4 percent attributed to accidents. Firearms, not surprisingly, are the weapon most commonly used in "successful" suicide attempts; indeed, nonfatal, self-inflicted gunshot wounds are relatively rare.

Economic Costs to Society

Quite apart from the untold human suffering and injury to which these statistics point, the question of economic costs must eventually be raised in any public analysis. One study estimates that firearm injuries are the third most costly type of injury. At an average of over $375,000 per injury, these are by far the costliest on a per injury basis. And the immediate cost of trauma care is only the first part of what is usually an extended, costly recovery.

When one includes treatment as well as loss of potential earnings, firearm-related injuries cost society an estimated $14.4 billion in 1985, and more recent estimates have placed the figure between $20 and $40 billion a year. Further supporting the "public" nature of this economic problem is the fact that over 80 percent of the direct treatment, hospitalization, and rehabilitation costs associated with firearm injuries are ultimately picked up by public sources.

Distribution of Firearms

One factor clearly associated with the growing violence and death is that guns are increasingly easy to obtain. Firearms are already nearly omnipresent in our central city areas, and surveys reveal that if a 16-year-old does not have a firearm on his/her person now, chances are good that he/she knows where to get one in a hurry.

Several studies, including one in which the presence of a gun in the home was treated as a "risk factor," appear to confirm what many might consider a common-sense conclusion: Having a firearm easily accessible often puts owners at greater risk of death or injury. But despite these studies, access to guns by youth seems to be growing increasingly simple. A 1991 Centers for Disease Control survey revealed that 5.5 percent, or one in every 18 students, reported carrying a firearm "for self-defense" during the 30 days preceding the survey. In a new Justice Department survey of urban high schools in four states, 20 percent of the boys indicated that they owned guns, and 12 percent said they carry them routinely. Responding to a 1993 Harris survey, 35 percent of the students polled claimed that it would take them "less than one hour" to obtain a firearm. Almost 60 percent responded that firearms are for them "easily obtainable."

Surveys indicate that about half of all U.S. families own some type of firearm, and that nearly a third own a handgun. Overall, the Bureau of Alcohol, Tobacco, and Firearms (BATF) estimates that some 216 million firearms have been produced for sale in the United States through 1992, including 5.6 million in that year alone. Of this number, about 73 million are handguns, 77 million rifles, and 66 million shotguns.

The number of firearms has been doubling roughly every 20 years, from 54 million in 1950, to 104 million in 1970, to our present number well over 200 million. Some of these guns are surely no longer in circulation, but the current BATF estimate of actual guns in service is still between 150-200 million. With a 1992 Census population estimate of 255 million, it can be said that there are now almost as many guns as people in the United States.

The Market in Firearms

The BATF's extremely liberal licensing policy for firearm sellers has compounded the problem of gun proliferation. The agency estimates that there are more than 287,000 federally licensed gun dealers, up from about 87,000 in 1968. There are now more people federally licensed to sell firearms than there are gas stations in this country. Indeed, firearms licensees now outnumber schools by more than 2 to 1; the number of gun dealers is just slightly under the total number of places of worship in the nation.

Secondary sales and theft account for the huge "black market" in firearms that makes guns accessible to virtually anyone on the street. Additionally, crime reports indicate that 207,000 guns were stolen in 1991 - the vast majority (141,846) handguns.

Though ease of access to guns has not been conclusively proven to contribute directly to their use by persons contemplating violent action, both common sense and the results of at least one study would indicate that in altercations and situations of high anxiety and rage, such persons tend to reach for the most readily available weapon. Since it is well known that both assaults and robberies attempted using firearms are significantly more likely to end in the death of the victim than are attacks involving knives or other weapons, it is reasonable to infer that the wide distribution of guns among youth today is closely related to the rapidly rising rates of firearms deaths.

Firearm Facts

From 1976 to 1987, more than twice as many American women were shot and killed by their husbands or boyfriends as by strangers using guns, knives, or any other means.

Suggestions for Action

A list of recommended strategies provided in advance by participants

Firearm Facts

Guns are used in 60 percent of all teenage suicides. The youth firearm suicide rate in an American city with minimal restrictions on gun ownership is more than three times higher than a Canadian city with strict gun control laws.

Community Outreach

1. Reach the child directly through community/school programs
   • Pair adults and children
   • Provide strong after-school programs
   • Promote children's hospital program on safety in home and community
2. Reduce the home arsenal of firearms by public education
   • Teach the Second Amendment in perspective
   • Teach firearm health risks
   • Suggest alternative approaches to personal protection
3. Reduce exposure of children and adolescents to firearms and firearm danger in home and community through
   • Safe havens, widening circles of gun-free areas
   • Safe corridors to and from school
   • Gun buy-backs and toys for gun exchanges
   • Community health fairs for families with young children
   • Prevention strategies
   • "Lock it up" and gun safety programs
4. Enhance/integrate educational/counseling programs:
   • Drug and alcohol rehabilitation
   • Family, parenting, marriage counseling
   • Diagnosis and treatment of depression in youth
   • Access of youth to job training and internships
   • New curricula emphasizing cooperative learning/conflict resolution
   • Gun awareness program in elementary schools
5. Empower and facilitate key group efforts with:
   • National Rifle Association (enlist in promoting lawful and safe use of firearms)
   • Health care professionals (train and provide materials to counsel gun risk prevention as they do smoking and other risks)
   • Mobilization of health care professionals (e.g., HELP Network) to stand as a front advocating preventive strategies
   • Churches [faith groups] to lead community action against kids carrying guns
6. Promote healing/prevent re-injury of victims
   • Develop and evaluate hospital postvention program
   • Establish community-based after-care and support

Legislative/Legal Actions

1. Reduce availability of firearms through
   • Punitive taxation on guns
   • Requirements/regulations for "safer" firearm
   • Strict regulations/limits on manufacture and sale of prescription drugs
   • Banning manufacture, sale, and possession of assault weapons
   • Tracking and cutting supply lines for guns to street
2. Reduce availability of handgun ammunition by
   • Taxation, manufacturer liability, and bans on some (e.g., Black Talon)
3. Expand AFT regulatory authority similar to other federal health and safety agencies to protect Americans against unreasonably dangerous products
4. Close major loopholes that make it easy to obtain guns
   • Increase fees, inspection, local control of Federal Firearm Licensing system
   • Require all gun transfers to be made through dealers
   • Mobilize police against gun theft
5. Regulate use of guns, similar to motor vehicle regulations through
   • Expanded class of persons restricted from using firearms
   • State and local restrictions on minors possessing guns
   • Demonstrated competency and penalties for misuse
   • Registration, annual renewal, and formal transfer procedures
   • Insurance requirements and civil liability for owners
6. Introduce stricter consequences for crimes committed with guns by
   • Penalties oriented to adult and community accountability
   • Legal liability for sellers and manufacturers
7. Unify existing patchwork of state restrictions and reverse pre-emptive state legislation barring local initiatives
8. Adopt changes in sentencing of juveniles for firearm crimes to maximize safety and rehabilitation
9. Strengthen state laws creating safe school/neighborhood zones
10. Support legislative strategies to implement proven effective laws and to repeal/oppose laws that exacerbate problem (concealed carrying)

Media/Communications

1. Establish/fund integrated public relations program to reframe guns as a threat to children's health and safety emphasizing
   • Children, not all people, as the focus
   • Guns, not criminals, as the concern
   • Guns as illusion of security
   • Guns as unregulated, uncostrained consumer product
2. Refocus popular television/media on guns as threat to public health and safety
   • Put very human face on fatalities and injuries
   • Encourage stigma of use
   • Promote alternative approaches to personal protection
3. Encourage/orchestrate graphic media blitz: Our children are dying (e.g., starvation in Somalia, attack on market in Sarajevo)
4. Seek creative involvement of entertainment industry and popular heroes
   • Oscar-type award ceremony for nonviolent portrayals
   • Expanded violence code
   • Funding for alternative projects to war toys, videos, etc.
   • Programs, integrated with community action, designed to foster and initiate changes in community/neighborhood norms and values reinforcing violence
5. Design/support political lobbying efforts around targeted agenda
   • American Bar Association march on Washington, D.C.
6. Reframe guns in terms of public health and safety to open doors for new and larger alliances and movement building

Research

1. Emphasize surveillance programs
   • Determine which kids are carrying firearms and why
   • Acquire more data on the expanding illegal firearms markets
   • Establish a national firearms fatality and injury reporting system
   • Study patterns of firearms acquisition, ownership, and use

     Firearm Facts

     Three times more people are murdered during arguments than during robberies. In 1992, about three out of four murder victims were killed by someone they knew.

     Firearm Facts

     From 1986 to 1990, at least 65 students were shot to death and 186 were wounded on school grounds. In a 1987 survey, one in 100 boys brought a gun to school nearly every day.

   • Determine the real cost of firearm injuries to society
2. Undertake analyses:
   • Risk factors
   • Economic costs to society studies
   • Nonfatal injuries as integral part of gun impact
3. Evaluate interventions to identify what really works
4. Develop and implement targeted interventions and alternative approaches to personal protection
5. Establish a nationwide network of Firearm Injury Prevention Research Centers with an electronically accessible database and with capacity to inform journalists, policy-makers, etc.

Technology

1. Develop and introduce technological modification:
   • Safety devices for firearms
   • Gun and ammunition detectors ("load indicators")
2. Modify and change ammunition
3. Develop incentives for gun manufacturers to design and sell firearms with safety devices
4. Evaluate impact of use of metal detectors in schools and design appropriate/flexible electronic concealed handgun detection devices
5. Design/improve/market low-cost (perhaps high-tech) alternatives to personal safety

Participants

The Carter Center Consultation on the Crisis of Children and Firearms

David Allen, M.D.

The Atlanta Project

The Carter Center

Atlanta, GA

Jean Athey, Ph.D.

Injury Prevention and EMSC Programs

Maternal and Child Health Bureau

Rockville, MD

Philip J. Cook, Ph.D.

Terry Sanford Institute of Public Policy

Duke University

Durham, NC

Joyce Essien, M.D. M.B.A.

Office of Public Health Practice

School of Public Health

Emory University

Atlanta, GA

William H. Foege, M.D. *

Fellow for Health Policy

The Carter Center

Atlanta, GA

The Rev. Gary R. Gunderson *

Interfaith Health Program

The Carter Center

Atlanta, GA

Gayle Harrison

The Wexler Group

Washington, DC

Michael Heisler, M.D., M.P.H. *

The Task Force for Child Survival and Development

The Carter Center

Atlanta, GA

Janet Heroux

Robert Wood Johnson Foundation

Princeton, NJ

Jeffrey Houpt, M.D.

Emory School of Medicine

Emory University

Atlanta, GA

Victor LaCerva, M.D.

New Mexico State Bureau of Maternal & Child Health

Sante Fe, NM

Arthur Kellerman, M.D., M.P.H.

Center for Injury Control

School of Public Health

Emory University

Atlanta, GA

Deborah Leff

The Joyce Foundation

Chicago, IL

James Mercy, Ph.D.

Centers for Disease Control and Prevention

Atlanta, GA

Averette Mhoon Parker, M.D.

The Community Prevention and Demonstration Branch

Center for Substance Abuse Prevention

Rockville, MD

Susan F. Newcomer, M.D.

National Institutes of Health

Bethesda, MD

Elena Nightingale, M.D.

Carnegie Corporation of New York

Washington, DC

Patrick O'Carroll, M.D. M.P.H.

Centers for Disease Control and Prevention

Atlanta, GA

Michael Pertschuk

Advocacy Institute

Washington DC

Julius Richmond, M.D.

Harvard Medical School

Boston, MA

Mark Rosenberg, M.D. M.P.H. *

Centers for Disease Control and Prevention

Atlanta, GA

The Rev. Fred D. Smith Jr. *

Interfaith Health Program

The Carter Center

Atlanta, GA

Daniel J. Socolow, Ph.D. *

Consultant

The Carter Center

Atlanta, GA

Dan Sweat

The Atlanta Project

The Carter Center

Atlanta, GA

Sandra L. Thurman

The Task for Child Survival and Development

The Carter Center

Atlanta, GA

The Rev. Leon West

National Anti-Drug/Violence Campaign

Congress of National Black Churches

Washington, DC

Note *:> indicates a member of Coordinating Committee.