U.S. Surgeon General Vivek H. Murthy on Tuesday declared gun violence a public health crisis and urged the nation to tackle it with the same zeal as we do to reduce deaths and injuries from tobacco and car accidents.
The Surgeon General's recommendation marks the first time that the nation's leading voice on public health – the same agency that highlighted the deadly effects of smoking in the 1960s – has issued an emergency statement on firearm-related deaths. The 39-page recommendation highlights the severe physical and psychological toll that gun violence inflicts on communities across the country.
Overall, gun deaths hit a 30-year high in 2021 due to increases in homicides and suicides, according to the advisory. In 2022, more than half of gun deaths were suicides, and 40% of gun deaths were homicides.
Murthy, who has long sounded the alarm about the dangers of guns, said Tuesday's recommendation was prompted by the rise in gun violence, particularly mass shootings since 2020, which he said are taking a huge toll on the nation's well-being.
“I want people to fully understand the impact that gun violence has on our country and I want them to see this as a public health issue,” Mursi said in an interview. “I know it's polarizing and I know it's politicized, but if we can see this as a public health issue, then we can come together and implement public health solutions.”
As of 2020, firearm-related injuries are the leading cause of death among children and adolescents ages 1 to 19 in the United States. Firearm-related youth deaths exceed deaths from traffic accidents, cancer, and heart disease.
“This is not just about policing law and order. We need a more public health approach to reducing and preventing gun violence,” said Alexander McCourt, a gun control researcher at the Johns Hopkins University Center for Gun Violence Solutions.
Deaths from gun violence are a uniquely American phenomenon, and one that medical and public health advocacy groups have attempted to address, often with limited success. In 2015, the U.S. had a firearm-related death rate 11.4 times higher than 28 other high-income countries, according to data from the U.S. Centers for Disease Control and Prevention and the World Health Organization. The disparity is even greater among young people, with U.S. children up to age 14 accounting for 90% of firearm-related injuries in that age group across the 29 countries studied.
“We are definitely an exception, and not in a good way,” Murthy said. “We have parents who are not comfortable sending their kids to school because of school shootings.”
The report calls for measures to put distance between guns and people who are at risk of harming themselves or others, such as laws to prevent children from having access to guns, mandatory universal background checks for gun transactions (including gifts), and bans on assault weapons for civilians.
“There was research done a few years ago that showed that states that banned high-capacity magazines had fewer mass shootings,” said David Hemenway, director of the firearms researcher Harvard Injury Control Research Center and professor of health policy at the Harvard T.H. Chan School of Public Health, “and when mass shootings did occur, fewer people were killed.”
Despite the high number of gun deaths in the United States, legislation often prevents the implementation of stricter gun control laws, perpetuating lax laws that allow mass shootings to occur. Research also shows that states with weaker gun laws are more likely to have mass shootings, according to an analysis by the Harvard T.H. Chan School of Public Health.
“We see a lot of efforts at the state level, but they don't necessarily pay off because some states have strict laws and neighboring states have looser laws, so the laws get diluted and may not be effective,” McCourt said.
Despite growing public support for stricter gun control, gun groups such as the National Rifle Association (NRA) have long opposed stricter gun control. In 2021, the NRA launched a $2 million campaign against President Biden's gun control measures. The Surgeon General's recommendations were also criticized by the NRA.
“This is an extension of the Biden Administration's war on law-abiding gun owners. America has a crime problem caused by criminals,” Randy Kozuk, executive director of the National Rifle Association's Institute for Legislative Action, said in a statement. “It's largely due to President Biden and many of his allies' unwillingness to prosecute and punish criminals. That's a simple fact.”
The gun violence advisory comes a week after the Surgeon General issued a statement on another major issue: social media, in which Murthy called for social media to have warning labels like those on cigarette packs.
Jonathan M. Metzl, who has studied gun violence for 20 years, said he appreciates the recommendations on gun violence, but framing it purely as a public health issue doesn't address deeper power issues related to race and democracy.
“They said they're going to use the same approach as they did with cigarettes, seat belts and other public health interventions. … It's a mistake to think people are going to think the same about guns,” said Metzl, dean of Vanderbilt University's School of Medicine, Health and Society.
“The NRA has long exploited the history of gun ownership as a white privilege, but that has not been true for cigarettes or cars,” Metzl said. “White gun owners are often perceived as patriots, while black gun owners are perceived as a threat or criminals.”
Tuesday's gun violence report highlights the impact that mass shootings, which account for about 1% of all gun deaths, are increasing in frequency. The advisory said mass murders, defined as incidents with four or more victims in addition to the perpetrator, are more likely to involve women, whites and children than other homicides.
According to the Surgeon General's recommendation, high school students who experience a school shooting are 20 percent more likely to skip school due to safety concerns than their peers who do not experience a school shooting.
“I remember meeting with a group of high school students who said they were walking around their neighborhood and constantly heard gunfire and it made them feel unsafe walking around their neighborhood,” Murthy said.
Health insurance claims from 2007 to 2021 revealed that youth ages birth to 19 who were injured by firearms experienced a 117% increase in pain disorders and a 68% increase in psychiatric disorders compared to youth not injured by gun violence.
Gun violence does not strike equally: The report cites a 2019 national study by Northwestern University that found that gun homicides and poverty go hand in hand, with poor residents being 27% more likely to die from a gun.
Murthy said he's concerned the public doesn't understand the psychological trauma caused by the gun violence epidemic.
“There are people who witnessed these events, and there are families who are suffering the loss of loved ones,” Murthy said. “All of them experience negative mental health effects.”
In the United States, black people have the highest risk of death by firearm, at 27 per 100,000 people, compared with 6.2 for all other racial and ethnic groups combined. White people over the age of 45 have the highest firearm suicide rate at 14.8 per 100,000 people, while American Indians or Alaska Natives have the highest firearm suicide rate under the age of 45 at 12.3 per 100,000 people. Firearm suicide rates among veterans have also increased significantly.
The report calls for a public health approach to reducing gun violence. Recommendations include increasing funding for gun violence research to develop prevention strategies, including community violence interventions. According to the Surgeon General's recommendations, these interventions involve “trusted communicators and practitioners” who prevent violent confrontations by disseminating resources, such as health care and employment services, within communities.
“Given that health care is the touch point for many families … in the name of keeping people healthy and safe. [doctors] Doctors have a “huge responsibility” to prevent gun violence, said Chethan Satya, a pediatric trauma surgeon and director of the Center for Gun Violence Prevention at Northwell Health.
The recommendations similarly advocate for increasing access to mental health services to help people cope with the trauma caused by gun violence.
“We have been tackling complex and difficult public health challenges … and by taking a thoughtful, science-based public health approach, we have been able to make real progress,” Murthy said.
