Gun Safety: A Call to License Arms

By Ryan M. Kane, MD, MPH



Kane R. Gun safety: a call to license arms. Harvard Public Health Review. Fall 2018;19.


Gun Safety: A Call to License Arms

The culture of safety that has developed for automobiles has been no mistake. Decades of advocacy from a plurality of voices were required to implement the intrinsic (e.g. seatbelts and airbags) and regulatory (e.g. speed limits and blood alcohol concentration limits) safety measures that have reduced the rate of vehicular fatalities by 90% since 1925. 1 The gradual change occurred through grassroots organizing, political action and increased industry standardization. This public health achievement creates a helpful case for car safety that can be applied to the current debate on guns.

Americans have evolved with the individualist spirit that cars and guns typify. However, the nation has decided to regulate cars more stringently to ensure their safety on all levels. The simple answer for this differential regulation is that too many people were dying. The car is a complex piece of heavy machinery that extends the abilities of the driver yet creates immense risk for driver, passenger and bystanders alike. Grassroots organizations like Mothers Against Drunk Driving played an essential role in elevating their concerns within the community and with legislators, raising public awareness and codifying solutions to their issues as law. 2 Thus, the auto-industry was pushed by public and legislative force to reduce these deaths by improving and standardizing their safety regulations.1

Now think about the case for firearms. In a recent discussion with former Governor of Ohio Ted Strickland, he highlighted that even the National Rifle Association (NRA) used to hold gun safety and the responsible use of guns as a principal tenet. However, over the past few decades, they have become increasingly radicalized. They now espouse gun rights as the keystone of our freedom-forward, individualistic American ideals—with any hint of legislation too far down the slippery slope to losing this freedom (T. Strickland, personal communication, March 6, 2018). Thus, Governor Strickland distanced himself from the organization to pursue common-sense gun safety legislation for his Senate bid, which the NRA halted with $1.55 million in independent communication and coordination expenditures. 3 In contrast to this, concerted efforts from organizations like Everytown for Gun Safety are currently playing the analogous role to Mothers Against Drunk Driving by promoting common-sense gun safety reforms.

Fortunately, the people are speaking; the industry is changing; state governments are imposing reforms. 456

The Trump Administration brought gun safety legislation to the national stage in a February 2018 meeting with legislators in response to the mass shooting in Parkland, Florida that left 17 victims dead. 7,8 He called for “one bill” to unite the gun safety proposals of those in attendance, but what could that look like: “one bill,” and when will the federal government set aside their disagreements to act in unison?7

Guns and cars are both complex machines that have the potential to end the lives of both the user and countless innocent bystanders. In the United States, this occurs on a massive scale with guns, through all-too-common mass shootings and the often-forgotten in home accidents, street violence, and suicides. In totality, these scenarios end the lives of over 36,000 Americans every year. 9 Numerous solutions to the societal ill of gun violence have been proposed without a singular, cohesive strategy. This is where the car comes into play.

The driver’s license was a crucial step in instilling a culture of safety and respect for the safe use of automobiles; this same strategy could be applied to all firearms in a standardized way to appease both sides of the aisle. 10 This is a realistic approach, as Americans already must purchase licenses if they wish to hunt. 11 Internationally, other gun-loving countries have already implemented effective gun licensing to enhance the safety of gun ownership. 12,13 A scaled system of government licensing for gun ownership could begin at 21 years of age with provisional licensure for gun use without ownership for those under 21, limiting unsafe access to guns and encouraging a culture of gun safety for youth gun use. Similar to the Canadian system of licensure, different levels of licensed ownership and safety training could correlate with the firearm’s class (e.g. handgun, rifle, etc.).14 Licensure would review the principles of gun safety: safe storage, use, family safety, mental health reporting for community safety and more.[13] As gun rights advocates push for the allowance of gun carrying in schools, there could be a higher level of training required to attain this special, non-lethal weapon licensure for onsite school security officers. Though more guns are not likely the answer for enhancing gun safety, concessions will need to be made in order to bring the strict constructionist interpreters of the Second Amendment together with gun safety advocates to pass a meaningful bipartisan bill.[7],[13] If cars, essential to the daily fabric of American lives, can be effectively regulated through a system of scaled licensure, so too can guns.

Think of the 99 Americans that are killed every day by the unsafe use of firearms.9 The people, the industry and the states have spoken. It is time for the federal government to step up. If not now, then the people must mobilize behind this cause in upcoming elections. The nation’s children should no longer have to fear the threat of gun violence in the very schools in which they are sent to learn.8 Each individual has a part to play: talk to representatives as a concerned citizen; patients as a healthcare provider; and fellow Americans as a friend/family member. Students from Parkland, Florida, to Chicago, Illinois, are raising their voices for change.15 Pediatricians have fought for the right to counsel on firearm safety. 16 Attorneys General are working to enhance common sense gun safety—most recently by blocking the distribution of downloadable 3D-printed guns. 17 Together, lasting political changes can be made to protect all American freedoms and people.

“By our readiness to allow arms to be purchased at will and fired at whim…we have created an atmosphere in which violence and hatred have become popular pastimes.”


  1. National Center for Injury Prevention and Control. (2001) Achievements in Public Health, 1900-1999 Motor-Vehicle Safety: A 20th Century Public Health Achievement. MMWR. 48(18);369-374. 

  2. Mothers Against Drunk Driving. (2018) About MADD. Retrieved from 

  3. Center for Responsive Politics. (2017, December 07). National Rifle Assn / Independent Expenditures. Retrieved from 

  4. Jamison, P., Heim, J., Aratani, L., Lang, M.J. (2018, March 24). ‘Never again!’ Students demand action against gun violence in nation’s capital. The Washington Post. Retrieved from 

  5. Sanchez, L. (2018, February 24). Companies scramble to distance themselves from NRA. The Hill. Retrieved from 

  6. Martin, M. (2018, March 10). Florida Passes Gun-Control Laws. NPR: All Things Considered. Retrieved from 

  7. C-SPAN. (2018, February 28). White House Meeting on Community and School Safety. Retrieved from 

  8. Prusher, I., Demczuk, G., Raab, J. (2018). Parkland Mourns: Tragedy Strikes a Florida Community. Time. Retrieved from 

  9. National Center for Health Statistics. (2017, May 3). All Injuries. Center for Disease Control and Prevention. Retrieved from 

  10. Fu, J., Anderson, C.L., Dziura J.D., Crowley M.J., Vaca F.E. (2013). The Impact of State Level Graduated Driver Licensing Programs on Rates of Passenger Restraint Use and Unlicensed Driving in Fatal Crashes. Ann Adv Automot Med. 57:88-98. 

  11. U.S. Fish and Wildlife Service. (2018, February 22). Hunting. Retrieved from
  12. Palmer, E. (2013) Firearms-Control Legislation and Policy: Switzerland. The Law Library of Congress. Retrieved from 

  13. Cukier, W. (1998) Firearms Regulation: Canada in the International Context. Chronic Diseases in Canada. 19(1):25-34. 

  14. Royal Canadian Mounted Police. (2018). Canadian Firearms Program. Firearms Licensing. Retrieved from 

  15. Ihejirika, M. (2018, June 18). ‘More in common than we thought’ – Chicago, Parkland youth stand in solidarity. Chicago Sun-Times. Retrieved from 

  16. American Academy of Pediatrics. (2017, February 16). American Academy of Pediatrics Applauds Ruling to Uphold a Physician’s Right to Counsel om Firearm Safety. AAP News Room. Retrieved from’s-Right-to-Counsel-on-Firearm-Safety.aspx 

  17. Shapiro, J. (2018, July 31). BREAKING: Attorney General Shapiro, Eight Other AGs Win Nationwide Restraining Order Blocking Federal Government from Allowing Distribution of Downloadable 3D Guns. Pennsylvania Office of Attorney General. Retrieved from 

  18. King, M.L., Carson, C. (1998). The Autobiography of Martin Luther King, Jr. London: Abacus. 

About the Author

Ryan M. Kane, MD, MPH

Ryan M. Kane, MD, MPH works as an Internal Medicine Resident at Oregon Health & Science University in Portland, OR. He graduated from the Medical University of South Carolina with his Medical Degree, and from the Harvard T.H. Chan School of Public Health with his Masters of Public Health, in the Social and Behavioral Sciences. His interests include Internal Medicine, Health Equity, Public Health, Nutrition, Narrative Medicine, and the Microbiome.