Gun violence in the United States is a public health crisis that demands urgent action, Surgeon General Dr. Vivek Murthy declared in a major new advisory that pushes for more research and stronger laws designed to reduce harm.
It’s the first time a publication from the country’s leading voice for public health has focused on firearm violence and its “profound consequences” on survivors, communities, and mental health.
Guns have become a deeply polarizing issue, Murthy said, but the advisory is meant to “take it out of the realm of politics and put it into the realm of public health, which is where it belongs.” The advisory lays out key preventive steps and regulatory measures that Murthy says can turn the tide on gun violence — just as they did for tobacco-related disease and motor vehicle crashes.
“Many people I’ve talked to around the country worry that this may be an intractable problem, that there’s no way to solve it,” he said. “That’s not true.”
Record-breaking level of gun deaths
Tuesday’s advisory spells out how devastating gun violence has been in the United States and details how public health strategies can help.
“We’ve experienced so many mass shootings, so many incidents of gun violence in our neighborhoods and communities, that it has really pervaded the psyche of our country. It has induced fear in people about regular day-to-day activities, like going to the grocery store, going to school, going to work,” Murthy said.
In 2022 alone, more than 48,000 people in the US died from firearm-related injuries, according to provisional data. That number included homicides, suicides and unintentional deaths.
The rate of firearm-related deaths in the US has been rising, according to the advisory, reaching a three-decade high in 2021. Since then, data has shown a decrease in gun-related homicides, while the number of gun-related suicides have stayed about the same, the advisory says.
While mass shootings are still rare, making up just about 1% of gun deaths, the number of mass shooting incidents has been rising, according to the advisory.
A KFF poll in April last year also showed that gun violence is all too common in the lives of Americans. More than half of adults that live in the US report that they or their loved ones have experienced a firearm-related incident. One in five adults say they have personally been threatened with a gun, and nearly the same number said that a family member was killed by a gun. That last number included those who used a gun in a suicide.
People of color are disproportionately impacted by gun violence, the surgeon general’s advisory says. In 2022, Black people saw the highest rates of firearm-related homicides across all ages.
That same year, Black children and adolescents made up half of all firearm deaths, despite being only 14% of this demographic, the advisory says. The violence isn’t just a direct physical threat: It can threaten an entire communities’ sense of well-being and can lead to elevated levels of stress and mental health problems.
Children ages 1 to 19 die from guns more than anything else in the US, studies show.
Children, in general, faced the highest gun violence mortality rate among peer countries by far. In the US, there were 36.4 deaths per million people ages 1 to 19; in Canada, its 6.2 per million, in Australia, it’s 1.6 per million and in the UK, it’s 0.5 per million.
An analysis of unintentional firearm deaths among children and adolescents found that 56% of these incidents happened in the child’s own home. Part of the problem is the way firearms are kept: Among the incidents where the details were known, 74% of the firearms were stored loaded and 76% were stored unlocked. Most commonly, guns were found in sleeping areas, such as in nightstands, under a pillow or mattress or on a bed.
In addition to the physical problems such violence can cause, firearm violence can also take a toll on mental health, the advisory says. Fears about gun violence are particularly common among children, the advisory says, and many worry that they will experience such violence at school.
Public health leaders will have to address the country’s high suicide rate, according to the advisory. More than half of gun deaths in 2022, 56%, were from suicide.
Unlike with homicides, the highest rate of gun suicides for adults 45 years and older involved White people. For younger people, those who identified as American Indian or Alaska Native had the highest rate of gun suicides.
In 2021, the suicide rate for men who are veterans was 62.4% higher than for men who are not veterans. It was 281.1% higher for women who are veterans compared with women who are not.
A public health approach to gun violence
The advisory says more money needs to be dedicated to firearms research to understand how to reduce and prevent firearm violence in the US, and investments must target better data collection and prevention strategies. The advisory urges communities and health-care systems to step up to help populations that are particularly vulnerable to this kind of violence.
The advisory also calls for more gun laws, including requirements for safe and secure firearm storage, a ban on assault weapons, universal background checks and effective firearm removal policies. It also says firearms should be treated like any other regulated consumer products, such as cars or pesticides.
“There are no federal standards or regulations regarding the safety of firearms produced in the US,” the advisory says. “Firearms manufactured and sold in the US may not undergo safety testing or include safety features like warning labels related to associated risk or authorized-use technology (“smart” firearm technology) for firearm access. Treating firearms as a consumer product could result in changes which may enhance safety.”
Gun advocates pushed back against the report. In a tweet, the NRA said “This is an extension of the Biden Administration’s war on law-abiding gun owners. America has a crime problem caused by criminals.”
Gun violence prevention advocates welcomed the attention this advisory would bring to the issue.
“This advisory not only sounds the alarm for all Americans, but it signals there must be greater investments in research and violence prevention solutions,” said Dr. Joseph V. Sakran, Brady board chair and chief medical officer in an email. Sakran, a survivor of gun violence and trauma surgeon who leads the group that has been advocating for more of a public health response to gun violence for years, labeled the advisory “groundbreaking.” “Historically, we have seen how the release of Surgeon General reports on public health issues such as the dangers of smoking ignited a wave of policy, legal, and public health initiatives that saved countless American lives and in this case led to deprogramming our nation from the tobacco industry’s lies. We hope this report will have the same resounding impact on the gun violence epidemic.”
The American Psychological Association also applauded the effort to put gun violence “front and center” on American minds.
“The picture is appalling,” Arthur C. Evans Jr, the CEO of the American Psychological Association said in a news release. “The impact of gun violence reverberates across communities, leading to collective trauma, stress, and anxiety.”
This is not the first advisory Murthy has issued. A 2021 advisory detailed the spate of mental health problems people faced, and a separate advisory explained how Americans could confront a rash of health misinformation. Last year, Murthy issued another advisory on the effects of social media on youth mental health.
“It is up to us to take on this generational challenge with the urgency and clarity the moment demands,” the advisory says. “The safety and well-being of our children and future generations are at stake.”