US Surgeon General declares gun violence a public health crisis

Overall, firearm deaths rose to a three-decade high in 2021, driven by increases in homicides and suicides, the alert said. In 2022, more than half of all firearm deaths were suicides, while 40 percent of firearm deaths were homicides.

“I want people to understand the full scope of gun violence in our country and see it as a public health issue,” Murthy said in an interview. “I know it’s polarized and politicized, but if we see it as a public health issue, we can come together and implement a public health solution.”

In 2020, gunshot wounds were the leading cause of death among children and adolescents ages 1 to 19 in the United States. Among adolescents, deaths from firearms are higher than those from traffic accidents, cancer, and heart disease.

“This is not just a problem of police law and order work. We need a more public health approach to curbing and preventing gun violence,” says Alexander McCourt, who researches gun laws at the Johns Hopkins Center for Gun Violence Solutions.

One of the reasons for the warning is the increasing number of mass shootings over the past decade, which he said has had a significant impact on the country’s mental health and well-being, Murthy said.

Deaths from gun violence are an American phenomenon. Data from the U.S. Centers for Disease Control and Prevention and the World Health Organization from 2015 showed that the U.S. had a gun death rate 11.4 times higher than 28 other high-income countries. The discrepancy is even greater among young people: In the 29 countries studied, 90 percent of all gun injuries in this age group occurred among children 14 years and younger.

“We are clearly the underdogs, and not in a good way,” Murthy said. “There are parents who are worried about school shootings when they can’t get their kids to school.”

The report advocates for measures that put more distance between firearms and people at risk of harming themselves or others. These include laws to prevent children from having access to firearms, mandatory universal background checks on firearm purchases – including gifts – and a ban on the civilian use of assault weapons.

“We did a study a few years ago that showed that in states that banned high-capacity magazines, there were fewer mass shootings,” said David Hemenway, a professor of health policy at Harvard TH Chan School of Public Health and director of the Harvard Injury Control Research Center, which conducts firearms research. “And when there were mass shootings there, fewer people were killed.”

Despite the high number of gun deaths in the United States, legislative efforts often hinder the implementation of stricter gun laws, the health secretary’s statement said, perpetuating lax regulations that contribute to the frequency of mass shootings. According to an analysis by the Harvard TH Chan School of Public Health, some research shows that mass shootings are more likely in states with more lax gun laws.

“Although we see great efforts at the state level, they are not always implemented because some states have strict laws and others border states with less strict laws. This can water down the laws and make them less effective,” McCourt said.

The report also highlights the impact of mass shootings, which account for about 1 percent of all firearm deaths, but the frequency of mass shootings is increasing. Mass killings, which report states involve four or more victims in addition to the perpetrator, affect a higher proportion of women, white people and children compared to other homicides.

The Surgeon General’s Council says High school students who have been exposed to school shootings are 20 percent more likely to stay home from school due to safety concerns than their peers who have not experienced school shootings.

“I remember meeting with a group of high school students who told me that they constantly hear gunshots while walking in their neighborhood and that this makes them worried when they walk in their own neighborhood,” Murthy said.

Health insurance data from 2007 to 2021 found that adolescents between the ages of birth and 19 who were injured by a firearm had a 117 percent higher rate of pain disorders and a 68 percent higher rate of mental disorders than adolescents who were not injured by gun violence.

The scourge of gun violence is not the same for everyone. The report cites a national study conducted at Northwestern University in 2019 that found that gun homicides and poverty are closely linked. Among people living in poverty, the number of gun deaths is 27 percent higher.

Murthy expressed concern that the public is unaware of the psychological trauma caused by pervasive gun violence.

There are “people who witness these events or family members who suffer the loss of a loved one,” Murthy said. “They all have negative psychological consequences.”

Black people in America face the highest risk of gun death, at a rate of 27 per 100,000, compared to 6.2 for all other racial and ethnic groups combined. White people ages 45 and older have the highest gun suicide rate, at 14.8 per 100,000, while among those under 45, American Indians or Alaska Natives have the highest gun suicide rate, at 12.3 per 100,000. The gun suicide rate is also significantly higher among veterans.

The report calls for a public health approach to reducing gun violence. The recommendation advocates for increased funding for gun violence research to develop prevention strategies that include community violence interventions. These interventions include “credible ambassadors and practitioners” who prevent violent conflict by distributing resources in communities, including health care and job placement, the Surgeon General’s recommendation states.

“We have faced difficult and complicated public health challenges … and through a thoughtful, scientific approach to public health, we have been able to make real progress,” Murthy said.