Calling gun violence a public health crisis is a ‘first step’ to fight it 

For the first time in history, a United States surgeon general has formally declared gun violence a public health crisis. 

On June 25, U.S. Surgeon General Vivek Murthy issued a 40-page advisory calling out major health threats linked to guns, including mass shootings, the toll of gun violence on children, families and communities, and racial and gender disparities in firearm-related deaths. The advisory also outlines a kaleidoscope of ways to potentially prevent firearm violence.

Such advisory statements are “reserved for significant public health challenges that demand the American people’s immediate attention,” according to the U.S. Department of Health and Human Services.

One particular concern: the impact gun violence has had on U.S. children. The announcement comes two years after the mass shooting at Robb Elementary School in Uvalde, Texas, and a quarter century after the massacre at Columbine High School in Colorado (SN: 5/26/22). At the time in 1999, Columbine was the deadliest school shooting since 1966. It has since been surpassed by four others, at Virginia Tech in Blacksburg, Sandy Hook Elementary School in Newtown, Conn., Marjory Stoneman Douglas High School in Parkland, Fla., and Uvalde.

“Our children should not have to live in fear that they are going to get shot if they go to school,” Murthy said in a video accompanying the advisory announcement. 

His advisory also follows a spate of recent studies sketching a more complete picture of how gun violence affects Americans’ everyday lives — in ways that make headlines and in ways that may slip under the public’s radar. For instance, in 2020, firearms became the leading cause of death in U.S. children and adolescents ages 1 to 19, surpassing even motor vehicle crashes, statistician and injury prevention researcher Jason Goldstick of the University of Michigan Medical School in Ann Arbor and colleagues reported in the New England Journal of Medicine in 2022.

Many of these gun deaths are due to suicide. In people ages 10 to 19, suicide accounts for about 36 percent of firearm deaths, or 7,573 of the 21,173 firearm deaths from 2016 to 2021, scientists reported in JAMA Pediatrics in May. But that number varies wildly from state to state, says study coauthor Lois Lee, a pediatric emergency medicine physician at Boston Children’s Hospital. In Maine, Montana, Wyoming, Idaho, North Dakota and New Hampshire, more than 75 percent of firearm deaths in this age group are suicides. 

One reason for the deaths may be easy access to guns. According to a 2023 Pew Research Center survey, about 4 in 10 adults in this country say they live in a household with a gun. Despite local efforts to promote gun storage safety, some 25 percent to 41 percent of gun owners with children in the house keep loaded guns unsecured, the U.S. Centers for Disease Control and Prevention reported in June.

Beyond these statistical snapshots of death and injury is the mental health toll taken on family members, friends and communities. Science News spoke with Lee, Goldstick and David Hemenway, an injury and violence prevention researcher at Harvard T.H. Chan School of Public Health in Boston, about the surgeon general’s new advisory and what impact it could have on American gun violence. Our conversations have been edited for length and clarity.

SN: What did you think when you first heard about the gun violence advisory? Is it warranted? 

Hemenway: I thought, it’s certainly about time. I mean, this is an enormous public health problem in the United States. And it’s a uniquely American problem, at least relative to all the other high-income countries. The surgeon general should step up and say, “Oh my goodness, this is terrible. Here’s what can be done.” 

“Data from the Centers for Disease Control and Prevention and the World Health Organization (WHO) found that, in 2015, the overall firearm‑related death rate was 11.4 times higher in the U.S. compared to 28 other high‑income nations.“

U.S. surgeon general’s advisory on firearm violence

Goldstick: It’s encouraging to see the surgeon general cast this as a public health crisis, because it is. A lot of times, when people think about public health, they think of infectious diseases. But injury is also an element of public health.

SN: Why does having the surgeon general call out this issue matter?

Hemenway: The surgeon general has the bully pulpit to try and influence people to do the right thing; it really matters. 

Lee: It’s really important for awareness. And the advisory takes a public health approach to address the problem, which uses multiple strategies, including things like recommending legislation and increasing funding for research.

Goldstick: It signals that this is a societal priority, not just an individual or community level thing — I think that’s important. And using a public health approach is critical to injury prevention, and something that’s been successful in the past, as with motor vehicle crashes. 

“According to the National Safety Council, the mileage death rate in 1923 (21.65 deaths per 100 million miles driven) has decreased by more than 93% in 2021 (1.38 deaths per 100 million miles driven).”

U.S. surgeon general’s advisory on firearm violence

SN: What does the firearms research landscape currently look like?

Hemenway: Things are better now: More funding is available, and there are lots more firearm researchers. We’re learning so much more so much more quickly than we did in the past. You have to realize that for 25 years, the federal government has basically not funded any research in this area. Until recently, it’s been a field where the people at the CDC — our lead public health agency — were afraid to say the word “guns” or “firearms.” 

Lee: After passage of the Dickey Amendment in 1996, the federal government stopped appropriating funds for firearms research to the CDC (SN: 5/3/16). And by 2012, Congress also stopped appropriating funds to the [National Institutes of Health. After the Dickey amendment was reinterpreted], Congress appropriated $25 million for firearm research in 2020, which was split evenly between the CDC and the NIH. 

Twenty-five million may sound like a lot of money, but it really is a paltry sum compared to how much firearm violence affects Americans. For comparison, the National Heart, Lung, and Blood Institute gets over $3 billion every year. 

SN: What have we learned from firearm research over the decades?

Hemenway: The one area where the evidence is now overwhelming is that that a gun in the home increases the risk of suicide. And not just for the gun owner, but the gun owner’s spouse and the gun owner’s children, too. 

Goldstick: I think a lot of that is because the fatality rate for a suicide with a firearm is so high — about 90 percent. 

Lee: We also know that increased firearm prevalence is associated with increased firearm deaths, both homicide and suicide.

SN: What big questions remain in the field today?

Hemenway: There are an enormous number of questions, from very basic, foundational questions to what works [to reduce gun violence], and then how to roll out what works in a way that makes sense.

Goldstick: There are way more unanswered questions than answered questions. How can we change communities to make them safer and not just focus only on individuals?

Lee: The big question I have is how can we move forward and think about firearm violence as a public health problem and not as a divisive issue. At the end of the day, I know that my clinical and public health colleagues, as well as the patients and families I take care of, would all like to keep our children, our families and our communities safer. So how can we work together to find a solution?

SN: Do you think this advisory could move the needle on gun violence? 

Hemenway: What moves the needle on major public health issues is not one thing, it’s all the things together, it’s everybody making a difference. 

Unfortunately, the issue of gun violence has become part of the culture wars, which is so sad when people are dying. We should all be able to get together and figure out reasonable ways to help reduce the problem.

Lee: I think the advisory is an important first step to acknowledge the depth of the problem — and it also outlines different strategies to address it. I’m hopeful that, over time, we will be able to decrease firearm injuries and deaths in the U.S.