Book Review

Gun Violence: The Real Costs

N Engl J Med 2001; 344:1484-1485May 10, 2001

Article

Gun Violence: The Real Costs
By Philip J. Cook and Jens Ludwig. 242 pp. New York, Oxford University Press, 2000. $25. ISBN: 0-19-513793-0

In 1997, guns claimed the lives of more than 32,000 Americans, and another 81,000 suffered serious nonfatal injuries. Yet these figures fail to reveal the full toll of firearm violence. Not included, for example, are the costs of personal efforts to manage risk, expenditures for prevention by public agencies, and a general reduction in our quality of life. In Gun Violence, Philip J. Cook and Jens Ludwig attempt to quantify the total annual expense of firearm misuse. They settle at an estimate of $100 billion. While developing their accounting scheme, they concisely but thoroughly discuss the major issues in gun-policy research. The scope of the book is therefore broader than its title suggests, and it should appeal to a wide audience.

Monetary estimates of the value of human lives or the costs of fear and worry will always contain a subjective element. The methods used by the authors also require many assumptions, and the available data are often spotty. Some readers are certain to object to the conclusions. Still, Cook and Ludwig's approach is ambitious and pathbreaking. Theirs is the first attempt to document the many ways in which gun violence affects the United States, and they consider outcomes that are overlooked in most discussions. Their estimate — however imprecise — permits comparisons with other social problems, and it provides a basis for further refinements. Their analysis also guides preventive measures toward strategies with the largest net payoffs. This important book will be a model for other research, and it should influence discussions of public policy.

Cook and Ludwig conclude that the costs of medical care and of lost productivity contribute only a small fraction to the costs of gun violence. They estimate an annual gross expenditure of about $2 billion for the treatment of firearm injuries. After allowing for worker replacement and injuries that victims would have suffered anyway, the net figure becomes smaller. Productivity losses are lower still: if gunshot victims consume as much as they produce, the net effect on the community is essentially zero.

Beyond its effects on medical care and productivity, firearm violence causes harm in other ways. Victimization is among these, and in an interesting chapter the effects on work patterns, choice of residence, and the criminal justice system are discussed. Worries about personal and collective welfare impose additional burdens on many Americans. According to the book, the costs of prevention and victimization are enormously higher than the costs of lost productivity or medical treatment.

Cook and Ludwig contend that the best way to measure these costs is to find the amount that the public would willingly spend to eliminate victimization and the need for prevention. Of several possible methods to estimate the costs, they prefer “contingent valuation” surveys. With this approach, people are simply asked how much they think a given level of risk reduction is worth. To estimate the cost of firearm assaults, Cook and Ludwig presented the following scenario to a national sample:

Suppose that you were asked to vote for or against a new program in your state to reduce gun thefts and illegal gun dealers. This program would make it more difficult for criminals and delinquents to obtain guns. It would reduce gun injuries by about 30% but taxes would have to be increased to pay for it.

The respondents were then asked whether they would vote for the program, with the specified size of the tax increase varied. Aggregating the results, Cook and Ludwig found that citizens would be willing to spend about $1 million dollars to avert a single gun assault. Given the volume of firearm crime in 1997, eliminating crime-related gunshot injuries would thus be worth $80 billion annually. Using other methods, the authors conclude that eliminating suicides and accidents would be worth an additional $20 billion.

A large literature in economics considers the validity of contingent-valuation studies, and this book presents a persuasive argument in favor of the approach. Still, skeptical readers might wonder whether a different question would yield different results. The lower bound on the tax increase was zero, for example, but a fervent opponent of firearm regulations might wish to specify a negative value. More generally, the question did not address inconveniences to legitimate gun owners. Even small barriers to access to guns might dramatically erode the support found by the survey.

In the final section of the book, Cook and Ludwig discuss possible interventions to reduce the frequency of firearm injuries. This short chapter can largely stand on its own, and it gives a reasoned assessment of many current policy proposals. Overall, this interesting and well-written book is not likely to produce a consensus about how much the misuse of firearms costs the nation. Given the care and detail of their work, however, Cook and Ludwig's analysis sets a very high standard for alternative estimates. Perhaps more important, the book offers a valuable framework for thinking about how gun violence affects American life. Anyone with even a casual interest in the topic will profit from reading it.

David McDowall, Ph.D.
State University of New York, Albany, NY 12222