Surgeon general declares gun violence a public health crisis

Firearm violence is officially a public health crisis in the U.S. — Surgeon General Vivek Murthy says so. In a new advisory published on Tuesday, Murthy calls attention to the health toll of gun violence, describing the size of the crisis while laying out a roadmap of research and policy interventions to curb its effects.

“My hope is that framing just the profound impact and pervasive impact of gun violence in our country … can firmly take it out of the realm of politics and put it into the realm of public health, which is where it belongs,” Murthy told STAT.

Gun violence is hardly a new issue in the U.S., and in recent years organizations including the American Medical Association have highlighted that the burden of firearm injury and deaths in the country has risen to the level of a public health threat. But as he’s worked on the issue of gun violence for over a decade, said Murthy, the issue has reached a new level of urgency.

“Gun violence has now become the leading cause of death among kids and teens,” said Murthy. According to the report, more than 4,600 deaths under the age of 19 were caused by gun violence in 2022, and 54% of all American adults say they or a relative have experienced a firearm-related incident. About 60% of Americans are worried about losing someone they care about to gun violence.

The impact is sprawling. “There are those who are shot and survive and have to live with lifelong injuries, the people who witness the events, the people lost, the family members of those who are lost, and the people all around the country who are reading and hearing about that violence every day,” said Murthy. “The mental health reverberations are really quite profound.”

Although Americans are highly aware of the threat of gun violence, experts think the surgeon general’s authority has the potential to make a difference. “It’s not common for a surgeon general to issue reports of this nature. I think it’s a pretty big deal,” said Daniel Webster, a health professor at the Johns Hopkins Bloomberg School of Public Health and researcher at the Center for Gun Violence Solutions. “I strongly suspect that this will be a type of report that gets cited often, and that people will pay attention to.”

Though Webster acknowledges that reactions to the report may shake out along partisan lines, he also thinks it’s hard to dismiss an evidence-based report from the surgeon general. “Many studies are cited in this report, and it does provide some guidance for effective ways to reduce the problem of gun violence, recognizing that there are many forms of gun violence and certain strategies are more tailored to some forms than others,” he said.

Specifically, the advisory notes how firearm deaths don’t impact everyone in the same way. Boys and men are five times more likely to die from firearm injury than their female counterparts, though half of the homicides in cases of intimate partner violence are committed with guns. Black people had the highest firearm-related homicide rate, while white people over 45 had the highest rate of suicide through firearm.

In 2022, more than half of all firearm-related deaths were due to suicide.

The surgeon general’s plan to tackle firearm violence starts with a call for investment in research and data. This is essential to strengthening the body of evidence to advocate for policy changes, said Andrew Morral, a senior behavioral scientist who co-leads gun violence work at the RAND Corporation, a nonprofit think tank.

“Think about how much research was done on the dangers of smoking before smoking rates started plummeting in the U.S. and before people started acknowledging that smoking causes cancer,” said Morral. Similar levels of overwhelming evidence are necessary to support public health interventions and move the needle, he said. The limited research available has already made a difference: Evidence on child access prevention, for instance, ended up informing safe gun storage laws.

Beyond partisan criticism, public health experts may debate over the advisory’s stance, said Morral. “There’s some disagreement in our society about whether you should focus on firearms themselves and firearms violence, or violence. Whether you should focus on firearm suicide or suicide,” he said. “Some people are going to have that question about this report: Why are we focusing on the tool rather than the problem?”

Morral says there is strong evidence to address this criticism — specifically, research demonstrating that the ease of killing with a firearm brings up the death toll, and that many homicides and suicides simply would not happen without a gun — that could be incorporated into the advisory.

Beyond research, the report discusses proven intervention strategies, including education on safe storage, violence prevention programs, and addressing the social determinants that increase the risk of gun violence. It also issues recommendations for policymakers, including implementing background checks and firearm removal policies. Finally, it highlights the importance of mental health care, including for substance use disorders, both as a way to prevent gun violence and to provide support for those affected by firearm deaths and injuries.

The report steps around the topic of law enforcement, which both contributes to the toll — policing kills about 1,100 people in the U.S. every year — and is a potential avenue to reduce violence, said Webster. “I certainly recognize that there are circumstances where people are injured or killed due to firearm violence by the police; these are complete tragedies,” said Murthy, “and we also recognize the distress that this creates in public safety institutions.” His hope, he said, is that the strategies laid out in the advisory start a conversation that expands into other areas, including the role of law enforcement in reducing firearm fatalities.

In 2023, Webster noted, more recent data reported by the Gun Violence Archive and the University of Chicago’s Live Crime Tracker have suggested that gun violence is declining. “I would have hoped and expected that there’d be some mention of very encouraging data points,” he said. “We should take heart in that, and recognize that this is not an inevitable phenomenon. It is a phenomenon that changes and responds to public actions.”

Some of the country’s leading medical organizations — including the American Academy of Pediatrics, the American College of Emergency Physicians, and the American Medical Association — have issued statements in support of the advisory, saying that it raises awareness of the public health impact of gun violence while providing concrete solutions.

“The most important thing that I want people to understand is not the scope and scale of this crisis, but that there is a solution,” said Murthy. “There are things we can do to actually start addressing gun violence in America.”

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.