September 27, 1993 MEMORANDUM FROM: PHB SUBJECT: CLINTON ON GUNS, HOMICIDE, AND HEALTH President Clinton is making a lot of imaginative statements regarding firearms and violence, some of which are misleading, others merely false. As the saying goes, there are lies, damned lies, and Bill Clinton. Homicide wasn't even in top ten causes of death in '46, and not in until 1989. The statement is misleading and false -- and irrelevant: After all, by 1989, the percentage of households with firearms had been stable for three decades, the percentage with handguns for 15 years; and the gun market was in the doldrums through most of the '80s. And, of course, we all agree there is a problem with too much homicide, and too many assaults -- although non-fatal constitute a greater contributor to the medical health cost problem than homicide. It is misleading in part because where homicide fits depends upon how one classifies other causes and subcauses. It is misleading in part because when homicide is in the top ten, it's right around tenth. Using standard definitions of "causes of death," homicide was in the top ten in 1970, 1975, and 1979 (to pick just three years in a given issue of the Statistical Abstract of the U.S.). In 1992, according to the HHS, ahead of homicide (in 10th place, less than 1,000 deaths ahead of liver disease) were: Heart disease, cancers, cerebrovascular diseases, bronchitis and other chronic obstructive pulmonary diseases, accidents, pneumonia/influenza, diabetes, AIDS, and suicide. Homicide has been right around 10th place (give or take two places) for about two decades. Now homicide is not just in the top ten, but is the second leading cause of death for Americans between the ages of 15 and 25. Rhetorically, he has shifted from top ten overall to second in a single age group, implying, without saying, the rise in ranking has been substantial. Just as the rise into the top ten meant a rise from about eleventh of twelfth, homicide has long been among the leading causes of death for teenagers and young adults -- persons who have passed beyond the natural-death killers of the young, and have not proceeded to the natural-death killers of the middle aged, have generally died from unnatural causes (and there are only three of them: homicides, suicides, and accidents). Homicide has been the second leading cause of death for American between 15 and 24 since 1967. (It bears noting that the real and dramatic change in killers -- one with a dramatic impact on medical expenditures -- is the rise of AIDS, which is one of the leading killers of adults aged 25-44. To put it mildly, the medical costs of treating AIDS victims is substantially greater than treating homicide victims, one occurring over a period of months or years while the other occurs over a matter of seconds or hours.) More teenager boys die from gunshots than from any other cause; it's the "leading cause of death among teenage boys." Basically, the statement is a lie. In 1988, the last year for which we have complete data, there were roughly 70% more motor vehicle accidental deaths among 10-19 and 15-19 year old males, with nearly twice as many motor-vehicle accidental deaths among 10-14 year olds as gun-related deaths. Grant some increase in gun-related homicides and a decrease in motor vehicle accidents, and the statement remains almost certainly a lie. The average age of people killing each other is under 16 in some of our cities. Even HCI wouldn't make such an absurd statement. The average age of killers is about 26, and it would take of lot of 10 year old murderers to make up for any 50 year old killers to lower the average. The policy wonk probably meant to say median, which would make his lie less substantial. The median age is probably about 22. (Both the average and the median are down due to lots of young killers, but there is no way his absurd statement will be true for any city with more than about three homicides.)