US healthcare:

The recent tobacco settlement will generate significant sums of money for the US states that took part in it. It was the outcome of a lawsuit to recover state and federal funds spent through the Medicaid programme on behalf of those who had smoking-related health problems.

New York State, for example, will receive $1bn a year for the next 25 years from the settlement. What to do with the money has become a major issue in many states.

Proposals range from spending the money on anti-smoking activities to providing health insurance for the uninsured, to using the money for property tax relief or new highway construction.

The current furore over the shootings at a high school in Denver has brought new calls for gun control. Before that tragedy there were already efforts by some cities to bring a tobacco-like suit against gun manufacturers. It is likely that these efforts will now draw renewed attention.

Last November the mayor of New Orleans announced a lawsuit the city was filing against 15 gun manufacturers, three firearm trade associations and several local pawnshops.

Although the reports did not specify an amount that the city wished to collect, they did say that the case was to recover funds spent on police protection, emergency services, police pensions, medical care and lost tax revenue related to handgun violence.

The logic of the lawsuit is similar to that of the tobacco cases - that the gun interests knew about the unreasonable dangers of their guns but failed to provide safety devices, warnings and other measures which could lessen or prevent those dangers. New Orleans has received the support of many of the lawyers who took part in the tobacco lawsuits.

Shortly after New Orleans announced what it was planning to do, Chicago joined the fray. The mayor announced a $433m lawsuit against the firearms industry to recover costs spent as a result of handgun violence.

These lawsuits have become effective public health strategies. Yet it seems clear that there is little reduction in cigarette use among the highly targeted youth market.

If anything, the fact that adults and authority figures want children not to smoke provides even greater incentive to do so.

Handgun control is a very different issue because it is far more difficult to trace the blame back to the manufacturer of the product.

Gun control is also seen as violating a core 'right' of Americans guaranteed in the Constitution. There is also the fear that if cigarettes and guns are 'controlled' the new puritans will move on to other areas such as fast food, alcohol or the content of the Internet in their efforts to regulate human behaviour. The target really doesn't matter - the lawsuits are a means for cities and states to raise new revenues without having to raise taxes. Moreover, they do not provide a single shot of new revenue, but rather produce a stream of revenue that continues for many years. If lawyers get 20 per cent of the tobacco settlement, that is more than $40bn to split among themselves.

The American Medical Association has received criticism for its proposal that when a physician concludes in a medical history that a patient has a gun in their home, the doctor should counsel the patient on gun safety.

Since doctors already talk to their patients (at least in theory) about diet, smoking, sexual activity, drugs, family violence and other personal topics, there would seem to be little reason for objection to this new query.

Yet the criticism stems from the fact that few people see the relationship between gun ownership and health problems and feel that physicians should be spending their increasingly limited time with patients on topics of greater relevance to the patients' needs.

While a lawsuit against a handgun manufacturer for the costs of violence that the gun may have produced would have been unthinkable only a few years ago, so too were the prospects of lawsuits that blamed cigarette manufacturers for the health problems that came from smoking.

In the aftermath of several shootings at US schools which have caused profound reflection on the nature of modern society and the limits that should be placed on both children and adults, it is quite possible that people will show their outrage by blaming gun manufacturers.

Howard Berliner is associate professor and chair of health services management and policy, New School of Social Research, New York.