Mandatory background checks on firearm purchasers receive widespread support from the general public and firearm owners. Background checks appear to reduce the risk of violence substantially among prohibited persons whose purchases are denied. However, population-level studies, including studies of comprehensive background check policies, have often shown no clear evidence of benefit. There is one notable exception: Permit-to-purchase policies have consistently been associated with beneficial population-level effects. The findings of no benefit may in part be an artifact of history, as the completeness of the data on which background checks are run has improved substantially since the periods examined by those studies. Nonetheless, significant problems with implementation and design still limit the population-level effectiveness of background check policies. In this article I review nine of these problem areas and suggest actions that could substantially improve the effectiveness of background check policies in preventing firearm-related violence.
Keywords: Access to care; Background checks; Firearms; Guns; Health policy; Law enforcement; Legal and regulatory issues; Mental disorders; Mental health; Public health; Violence.