NYT’s Nicholas Kristof: Smarter Way to Reduce Gun Deaths

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Speaker 1: Welcome to Conversations on Health Care. This week, you welcome Pulitzer
Prizewinning New York Times columnist Nicholas Kristof, who's written a
compelling piece on how to curtail gun deaths in America. Now, here are your
hosts, Mark Masselli and Margaret Flinter.

Mark Masselli: We've had 82 mass shootings in our country so far this year, and the number
keeps growing. We've never had so many occur in such a short timeframe, and
yet only 53% [00:00:30] of Americans say gun laws should be stricte r than they
are right now.

Margaret Flinte...: Are there solutions to this crisis? Pulitzer Prizewinning columnist Nicholas
Kristof writes in the New York Times about smarter ways to decrease gun
deaths, and you're about to hear him explain them.

Mark Mass elli: Well, Nick, welcome back to Conversations on Health Care.

Nicholas Kristo...: Great to be with you.

Mark Masselli: Yeah, and really, thank you for joining us from your home in Oregon. It's great.
Hopefully the weather's good out there. And you write that in order [00:01:00]
to break the gun violence paralysis, we need to focus less on guns and more on
those firing them, and you believe that means keeping guns away from risky
people. I'm wondering if you could elaborate more on that.

Nicholas Kristo... : Sure. Well, I mean, one statistic that always strikes me, so women over 50 in the
US commit fewer than a hundred gun homicides a year. In contrast, men 49
[00:01:30] and under commit more than 500 murders with their hands and fists
alone. So essentially, a young man is far more dangerous with his fists than a
woman over 50 is in the US. You could pretty much hand out mortars and anti -
aircraft guns to women over 50 with no criminal record, and if they didn't share
them with the men in their lives, we'd pro bably be okay. In contrast, pellet guns
can [00:02:00] be dangerous with young men.

And so what I think we can do a better job of is limiting access to people. And
that's what we do when other harm reduction models. We know that cigarettes
are lethal, tha t alcohol is lethal, and we limit those by age.

I think that there's also ... I mean, age is the obvious way to limit people, and
[00:02:30] I think that there is also some possibility of moving politically on that
in a country that is very divided. Here in Oregon, you can buy a handgun at 18.
This is a very blue state, and yet the age is 18. In Wyoming, one of the most pro -
gun states in the country, you have to be 21. And if Wyoming can ... I have this
conversation with Second Amendment supporting friends all the time and I say,
"Look, if Wyoming can make the minimum age 21, [00:03:00] then surely we
can in Oregon as well." And as long as they're over 21, they tend to agree.

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Margaret Flinte...: Well, certainly public health initiatives have been front and center in all of our
minds throughout the COVID pandemic, so it's an interesting one to follow out
how we might take those initiatives and apply them to guns. And the public
health initiatives are part about things like age and access, but tell us more,
wh at would your recommendation be for a public health approach to reducing
[00:03:30] death from guns?

Nicholas Kristo...: I should say that these aren't my ideas, but ideas I've stolen from other people,
including David Hemenway at the Harvard School of Pub lic Health wrote a, what
for me was a very influential book, oh, 15 years ago, about addressing gun
violence as a public health matter.

And so if you look at other elements of daily life that are dangerous, then we
learn to live with them, [00:04:00] but we try to reduce how many people they
kill. And so cars are a great example, and cars historically killed more Americans
than firearms did. But since over the decades we have built cars to make them
safer, so we had padded dashboards, we had seat belts, we had airbags. We
submit [00:04:30] cars to all kinds of crash testing to see survivability in a crash.
We readjusted highways so we have better lighting. We have those corrugated
edges on the highway so you wake up if you're leaving the road. We've done a
million ... We've limited access so that young drivers now you get graduated
licenses, so you can't have somebody else in them, you maybe can't drive at
night.

So we've really taken a evidence - [00:05:00] based approach, a public health
approach, to reduc ing the lethality of vehicles. And in contrast, we haven't done
that with firearms. Since 1921, we've reduced the fatality rate of guns per
hundred million miles driven by 95%. That's an incredible success. And in the US,
in recent years, that has stagnate d. European countries have gone well
[00:05:30] ahead of us in reducing the fatality rate from motor vehicles. But still,
over time, we've done an impressive job, and we haven't taken that public
health approach toward guns, and so guns now kill more Ameri cans each year
than cars do.

Mark Masselli: Why do you think that? I'm just sort of wondering the ... Obviously the gun
advocates go to this, "It's in the constitution, cars aren't in the Constitution," so
they're really, they draw their source [00:06:00] of energy from the
Constitution, though there's life, liberty, and pursuit of happiness. One could
make the argument I guess that it includes cars, but it's a little different, isn't it?

Nicholas Kristo...: Well, so people ... Look, I'm speaking to you fro m rural Oregon on the family
farm. I grew up with guns on the farm. I have a firearm. [00:06:30] Everybody
around here does and many are very, very strong believers in the Second
Amendment.

But what I say is, look, everybody understands that, notwithstand ing the Second
Amendment, even if you believe, as the Supreme Court now does, that it

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confers an individual right to firearms, still, we accept that there are limits, that
an individual should not be able to have a cannon, should not be able to have an
ant i - aircraft weapon. And [00:07:00] so the question then becomes where we
draw those lines and what access we provide.

So, in terms of the kinds of weapons, so the United States passed the National
Firearms Act, which essentially limits people's access, lim its people's ability to
buy machine guns. And in general, I think most people, however much they
believe in the Second Amendment, are good with that. [00:07:30] And now, in
addition, we all recognize that you shouldn't be able to bring your handgun on a
pu blic tour of the White House. There are limits in time, place, and manner of
how we carry firearms.

So the question, you can believe in the Second Amendment's individual rights
and yet still accept that there are going to be limits on what kinds of weapon s
and where they can be and who gets access and where they can be used.
[00:08:00] I actually -

Mark Masselli: And you've praised Governor Newsom for his efforts, and I think that was a
ballot initiative to implement background checks on the purchase of
amm unition. I'm wondering if you could talk a little bit about that. That's a state
where it made that decision to go forward. Is that how I understand that, how
that ammunition ban came forward? And I'm wondering maybe if you could
share with us what are som e of the early results showing?

Nicholas Kristo...: Yeah. [00:08:30] So California has really been a leader, and Gavin Newsom was
one of the architects of that ballot initiative that voters passed easily. And so
the idea is that we have universal backgroun d checks to ... or in some states, we
have universal background checks. In other states, it's a little less universal. But
in general, we have background checks to buy a firearm, but you can't really use
a firearm unless [00:09:00] you have ammunition. And while the gun may last a
hundred years, ammunition, it becomes less reliable after about 20 years and
that we may be able to require the same kind of background check to buy
ammunition.

So, that's what California did, and what they found is that an awful lot of people
try to buy ammunition who can't pass that background check, and in theory,
shouldn't have access to a firearm. [00:09:30] So that suggests that it does have
some effect.

Of course, people can ask a girlfriend or a boyfriend or a parent or s ome other
friend to buy that ammunition. They can go out of state and carry the
ammunition in. There are all kinds of things they can do. But does it help? Yeah,
I think it does. And California has also been quite good about gathering data and
about trying to get firearms away from people [00:10:00] who are a threat to
others or to themselves.

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And so if somebody has a domestic violence protection order against them,
seems dangerous to their ex, then no place does it perfectly, but in California,
it's more likely that there will be an effort to remove guns from that household,
from that person, than happens in other states. And all this is imperfect, and
one of the ... I mean, we had mass shootings in California, but [00:10:30] if I
remember right, the gun h omicide rate in California is 28% below the national
average, which suggests that there are some lives being saved.

And I guess, in general, I would take that as approximately the margin of lives
that can be saved if we use politically plausible measures, that we're not going
to eliminate gun violence in America. We have about 400 million guns in this
country. There are [00:11:00] going to be a lot of people killed and injured in
this country. But I do think that if we take a public health approach, an
evi dence - based approach, that it's plausible we could reduce that rate by about
a third and save maybe 13,000 lives a year. That would be really something.

Mark Masselli: Absolutely.

Margaret Flinte...: Well, I would add to plausible and public health just pr agmatic, the ammunition
bill that was passed, so thank you for [00:11:30] sharing that with us. And I
know, Nick, you're in a position of having to defend your points a lot on this
subject. David French wrote a critique in National Review sometime ago abou t
your arguments and says gun advocates like himself have proven they can
decrease crime while protecting the Second Amendment, and some people
point to the few Research Center reports that the rate of gun deaths today is
below levels of the past, which of course completely flies [00:12:00] in the face
of what we all are thinking these days as just in the last several days one
shooting involving three or four or five fatalities after a row, but what's your
response to people who say, actually, they've alrea dy shown that they can
decrease crime while protecting the Second Amendment?

Nicholas Kristo...: It's true. And I do think that my side, the world of liberals, that we sometimes
become too glib about the [00:12:30] perils of guns, and there is a correlatio n
between the number of guns in a society and the number of gun homicides, but
it's not a direct correlation. There's a lot of movement there, and it also
depends on the age of the society, all kinds of other factors, and any individual
car is more likely [00:13:00] to kill somebody than any individual gun.

So it's complicated, but we have regulated cars in ways that do make them, say
... And I guess one other thing that I think that conservatives kind of have a
point on is that it's not just about regulat ing purchase of guns or of ammunition,
but policing is also a factor, [00:13:30] and it's one that I think is harder for us
liberals to talk about, but there is, in this country, we have a long history of
racist policing, but we also have a pretty good evi dence base that policing can
reduce gun violence, and there have been various studies suggesting that, I
think it's roughly every 15 extra police officers can [00:14:00] reduce homicides
on average by one.

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I think we have to look at both the gun side and the law enforcement side, and
also, some things that frankly aren't controversial so we don't talk about. There
is good evidence that better lighting in urban areas reduces gun violence, that
greening vacant lots reduces gun violence. This is sort of the c lassic public health
approach where you just try a bunch of things, you study [00:14:30] them
carefully, you get feedback, you experiment, you do a randomized control trial,
and you learn what works and then you invest in the most cost - effective
methods, a nd I don't think we've done enough of that.

Mark Masselli: No, absolutely. Plan, do, study, and act, as we say in the healthcare world, is
very important. President Biden has really signed a number of historic executive
actions. I think over 20. Enacted th e first significant gun safety law in nearly 30
years. [00:15:00] I believe that was signed in June of last year. I'm wondering if
you think the administration's approach is working, and certainly, while he did
get that piece of legislation through last ye ar, looks less likely with the
Republican - controlled House for any future legislation, but what are your
thoughts about the work the President has done, and speaking about somebody
who understands the value of police, he's certainly one, not to talk about
defunding the police, but rather enhancing [00:15:30] their role in the
communities.

Nicholas Kristo...: I think that President Biden has done a credible job on both the firearm side and
the policing side. I think he has credibility as somebody who has use d guns.

I wish that he were, frankly, or the administration were more aggressive on
issues like ghost guns. I think that ... Ghost guns are sort of untraceable
[00:16:00] guns that are typically made from kits, and if you order the parts of a
semi - automat ic rifle, I mean, an AR kind of gun, if you order them in parts, you
can assemble it yourself and then you have this untraceable gun without a
background check. So I think that we could do a better job on that.

But fundamentally, I don't think that the le adership [00:16:30] on gun policy is
going to happen at the federal level. I think it's going to happen at this state
level. And I think that is going to be much more likely to be true of blue states.
Red states may go in the other direction, but I think t he real movement is going
to be at the state level, and I think the federal government can do more to
support the states in trying to figure out how to craft [00:17:00] limits on ghost
guns or on 3D printers, for example, that produce guns that perhaps can pass a
metal detector.

Mark Masselli: Is there anybody doing, just finding the seam of opportunity between the right
and the left on the conversation around guns, is there anything out there that
you'd sort of say, "Hey, this portends for something that m ight be very helpful in
this larger conversation at the state level, local level, where people [00:17:30]
are trying to have a conversation about what are the right things to do"?

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Nicholas Kristo...: Boy, I wish there were more of that. I mean, I think tha t that has been really
hard and guns is one of these toxic issues that has been really hard to have
those bridges, and people also tend to live in kind of segregated worlds that
either they and their friends don't have a gun in the household or they and th eir
friends all do, [00:18:00] and the conversations are really difficult.

I must say that I've kind of gone out of my way to have those discussions, and I
have found that it is possible, but social psychologists talk about complexifying
an issue to try t o bridge these to make these discussions. So I don't sit down
with somebody who's very passionate about gun [00:18:30] rights and an NRA
member, and I don't ask about the Second Amendment. I don't ask about
ending access to handguns, for example. But I tal k about these very specific
issues. I complexify it.

So, for example, as I said, the Wyoming has a minimum age of 21 to buy a
handgun. In Oregon, should we maybe raise the age too? And people are willing
to have that discussion. [00:19:00] I say, "Look, w e all recognize that when
somebody has a domestic violence protection order against them, they're at a
great danger to themselves and to their ex. Should we limit their ability to buy a
firearm or ammunition? Should we try to make sure that they don't have access
to guns in that period? What about somebody who talks about self - harm?
Should we try to remove guns from that household?"

And again, people are willing to have that [00:19:30] conversation. Safe storage
is something that people are more nervous ab out. I mean, a lot of people think
that they're going to protect their home if they have a home bristling with guns,
and I find that when I present the data on that, that actually a gun in the home
is more likely to lead to a death in that home than its ab sence, but people are
will ... For example, I mean, one of the things that President Biden once said
that got him in trouble with both left and right was [00:20:00] he said, he
advised people to get a shotgun, and if there's a potential home invasion, you
just shoot out the window a couple of times, and everybody hated him for that
remark. But if more people had a shotgun at home than had a 9mm handgun,
we'd be in so much better shape.

And I always tell my friends that when I ... I'm a backpacker, when I b ackpack
through Grizzly Country, I take bear spray because you're better off statistically
[00:20:30] with bear spray than with a firearm to repel a grizzly bear, and my
bet is that bear spray might be more effective against a intruder, against a home
inva sion, than a firearm would be, and I'd be less likely to end up dead. Some
states limit access to bear spray. We don't think of bear spray as a public health
intervention, but we just need to kind of think in creative [00:21:00] ways,
again, along the line s of harm reduction.

Margaret Flinte...: Well, I couldn't agree with you more about the need to simplify some of this, so
I have to say that the simplest message perhaps that I would put on the table
for people is the report from the Johns Hopkins Center f or Gun Violence

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Solutions that showed the burden on young people. And this is hard to even say,
that gun violence is now the leading cause of death for young children and
teenagers in the United States. Gun [00:21:30] violence is the leading cause of
death . I think we've got to get people's attention around that and in a way that
nobody wants to see young people die from gun violence.

And then you talk about the strategies, and you mentioned one of them,
requiring people to lock up their weapons, right? Ho lding them responsible
maybe if they do not, and we certainly have read the tragic stories of kids
getting their hands on them or accidental [00:22:00] discharge. I'm also
remembering certain states, I believe, that really went strongly against the
America n Academy of Pediatrics recommendation that we include in our well -
child visits in primary care a simple thing from your trusted, hopefully, physician
or nurse practitioner in a well - child visit saying, "Do you have guns in the home?
And if so, are they se cured and locked up?" And legislation was passed to make
that something you couldn't do.

What's your answer to people who can't [00:22:30] even get behind what would
seem like very pragmatic, simple ways to keep young people from dying by gun
violence?

Ni cholas Kristo...: Well, and your comment about physicians I think is absolutely right, that where
clinical health and public health come together, that's when a trusted doctor
asks people about whether they're drinking too much alcohol, whether there is
a drug issue, [00:23:00] various other risky behaviors, including having a gun in
the home that maybe loaded and kept on the shelf, and so I am such a believer
in that kind of a conversation. It's a difficult conversation, partly because this
country is so p olarized and so toxic.

I do think that one of the things that my world of liberals can [00:23:30] do to
make those conversations more possible is to lower the temperature a little bit
and talk less about banning guns, and I never talk about gun control, I talk about
gun safety and acknowledging that, look, we're going to have a lot of guns in
this country, but there may be some steps we can take that will leave the
country safer.

[00:24:00] And also if we're willing to touch the law enforcement side of th at, I
think that builds some space to, again, lower the toxicity here to some degree.
We're never going to win over every person, but it does help that the NRA
seems to be collapsing. I do think that there are an awful lot of Americans,
including those on the center and right, who [00:24:30] recognize that we have
a horrific firearm violence problem.

Unfortunately, the solution that they've grabbed onto is to go buy a firearm
themselves for self - defense, and women in particular are now more likely to buy
w eapons. To me, that's exactly the wrong conclusion, but it does mean that I
think there are plenty of people who are less ideological and more willing to talk

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about, okay, maybe they've bought [00:25:00] a weapon, but maybe we can
convince them to keep it in a gun safe in the house, or at least to put a trigger
lock on it with a code, whatever it may be.

We don't' really know, but we think there are about 300,000 firearms stolen
each year in the US. 300,000. And those are guns who were going to the hands
o f various bad actors and often used in dangerous ways, and [00:25:30] that's
because we don't have more guns stored in gun safes, for example.

Mark Masselli: Nick, let me shift gears a little. We know you as a prolific journalist and opinion
leader. Some o f us would've liked to see you as a governor in Oregon, but that
didn't happen. But you weigh in on issues from US domestic issues to
international conflicts. I'm wondering if you might share some of your thoughts
about, we're coming up to the one - year ann iversary of the war in Ukraine,
[00:26:00] and then also I know you have some reflections maybe on President
Carter as he's taking hospice at home at this point.

Nicholas Kristo...: Sure. So I guess on Ukraine, I would make the point that this is where I t hink
values and interests align, that what Russia is doing in Ukraine [00:26:30] is
engaging in war crimes, crimes against humanity. I talked to people who had
been tortured and raped and civilian buildings attacked. Hundreds of medical
facilities have bee n attacked. And I think President Biden should provide more
weaponry, and more advanced weaponry in particular, [00:27:00] long range
precision weaponry so that the Ukrainians could hit Crimea, and both the land
bridge that gives Russians access to Crimea and the Sea Bridge, the Kerch
Bridge, that enables them to resupply their bases there.

I think that if the Ukrainians could put more pressure on Crimean Russian bases
there, that will make Putin realize he's not going to win this war and will make it
easi er to have realistic peace negotiations. So [00:27:30] I'd like to see F - 16s
provided to Ukraine, ATACMS, long range missiles, Gray Eagle, drones, and
continue the intelligence sharing, and so on.

On Jimmy Carter, I mean, what a hero of public health. I t end to think that his
presidency was actually better than a lot of people think. I think he did a lot of
really hard, difficult [00:28:00] things like the Panama Canal Treaty, like, well,
the Camp David -

Mark Masselli: Camp David. Absolutely. Yeah. Yeah.

N icholas Kristo...: ... Middle East Peace Awards, and he was one of the first to talk about green
energy in an important way. He elevated human rights in a way they never had
been elevated in this country. So I would be a defender of his presidency.

But if you also look at what he is done after that, river blindness, I've traveled a
lot in West [00:28:30] Africa. There were vast, vast swaths of countries like
Burkina Faso where nobody could live or farm because of river blindness. And

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it's not being eradica ted, but it's declined by, I don't know, 95% or something.
Guinea worm disease used to affect three million people a year, and now we're
... I think that last year there were about 15 cases or something, maybe 13 cases
in humans [00:29:00] all over the wor ld, mostly in South Sudan, and that's
because of Jimmy Carter.

I mean, the way he has improved the lives of so many people in so much of the
world is I think just extraordinary. And I've met a lot of ... One of the great
things about the columnist gig is I've met a lot of extraordinary people,
presidents and kings and Nobel Peace Prize winners, [00:29:30] but it's hard to
think of anybody who is as fundamentally good and has impacted more lives for
a longer period than this one term president who was, afte rward, pretty much
abandoned by his own party.

Margaret Flinte...: Well, we talked about some tough topics this morning, so thank you for that
note about somebody who really brought so much good to the world, and I
think out of recognition for his commitme nt to [00:30:00] children and to
families, I want to give you an opportunity to talk about a topic that I know
you've got some strong thoughts on, you and your wife, Sheryl WuDunn, who
we had on the show with you I think the last time you visited us, wrote a terrific
book a couple of years ago called A Path Appears: Transforming Lives, Creating
Opportunity, and it told the story of a program we're quite well aware of that's
been around for a couple of decades, the nonprofit Nurse - Family Partnership,
which h as [00:30:30] been clearly shown to make a difference in the lives of
babies and new parents. It's one of several programs that do this, but it has a
long track record and Congress has just renewed funding for these home visiting
programs. Share your persp ective. Why are these so important? What do they
contribute to a good and healthful society?

Nicholas Kristo...: One of the revolutions in trying to deal with social problems is that we used to
have arguments and now we have [00:31:00] evidence. And one of the areas of
evidence that has emerged most strongly is the importance of early childhood,
really beginning in pregnancy through three or five. And it's not that later years
don't matter, they do. But those early years when the brain is developing really
matter. And beginning in pregnancy, if a mom [00:31:30] is abusing alcohol or
drugs, that will have effects long after that for that child. Smoking also has
deleterious effects.

And in general, our interventions are mostly after a kid is five or six and e nters
the public school system, and so Nurse - Family Partnership works with a mom
beginning in pregnancy [00:32:00] through age two. And at first, it was hard for
me to see how it could have all these effects years later, less contact for that
child with th e criminal justice system, more likely to graduate from high school,
less likely to be pregnant as a teenager, years later earning more income, and
now I think we see that pathway more clearly, that if [00:32:30] you can reduce
ACEs, adverse childhood expe riences, if you can reduce trauma in early
childhood, then there's less cortisol flooding in the child's brain in ways that

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seem to affect brain architecture and put that child on a kind of a hair trigger
fight or flight response.

And whether that's ... T hat's probably part of the path pathway, there may be
others as well, but we now understand that these home visiting programs,
[00:33:00] the question isn't whether we can afford to invest in them. It's
whether we can afford not to invest in them. And so o ften, we as a country, we
just fail to put our money in programs that have such a great evidence
background and can do so much good.

Mark Masselli: Oh, great. Nick, thank you for returning our program, and we always appreciate
your insight and critical thi nking on such a wide range of topics. And [00:33:30]
thanks to our audience, there's more online about Conversations on Health
Care, including a way to sign up for our email updates at our website,
chcradio.com. Thank you, again. We appreciate it.

Nicholas Kristo...: Great to be with you.

Mark Masselli: Alrighty, great. Ciao.

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