Citing 'collective trauma,' surgeon general issues advisory on gun violence

(TND) — U.S. Surgeon General Dr. Vivek Murthy issued an advisory on firearm violence Tuesday, saying it poses an urgent threat to the health and well-being of our nation.

“What is especially devastating is how this has affected our children,” Murthy said in a video released with his advisory. “Firearm violence has become the No. 1 cause of death among children and adolescents, more than car accidents or drug overdoses.”

Gun violence results in “collective trauma and fear” for Americans, with cascading harms across society, the surgeon general said.

Nearly 50,000 people died from gun-related injuries in 2022, according to Murthy’s report.

But he said gun violence impacts many others: those who witness the violence, those who lose a loved one, and those who wake up every morning in affected communities.

Over half of American adults or their family members, 54%, have experienced a firearm-related incident, according to the surgeon general’s report.

And nearly six in 10 adults worry about a loved one being a victim of firearm violence, the report stated.

“Firearm violence is a public health crisis,” Murthy said. “Our failure to address it is a moral crisis.”

Last year, Murthy issued advisories focused on an "epidemic" of loneliness and isolation and the potential dangers of social media use for children and teens.

Gun violence is contributing to the mental health challenges that we are facing today, he said Tuesday.

Murthy laid out a public health approach to reducing gun violence, noting similar approaches have helped to reduce smoking and improve vehicle safety.

For example, he said, such an approach contributed to a more than 70% decline in the prevalence of cigarette smoking among U.S. adults.

Can a public health approach reduce gun violence?

“Well, we haven't been very successful, to be quite honest with you, with many other approaches,” criminologist Alex Piquero said.

Time will tell if this approach will move the needle, said Piquero, a professor at the University of Miami and a former director of the Bureau of Justice Statistics.

“It won't hurt,” he said. “However, we have to measure this in an incremental step, I think.”

Piquero said a person doesn’t have to personally experience firearm violence to be affected, and that’s what makes this a public health issue.

“By moving it out of quote-unquote the criminal justice space, you're making the issue on par with these other public health issues that most Americans deal with on their own personal level,” he said, referencing the issues of smoking, fentanyl and suicide. “And so, I think that that's the approach here.”

Advocacy groups quickly responded to the surgeon general’s advisory.

Brady, a group that advocates against gun violence, said they hope this surgeon general report “will have the same resounding impact on the gun violence epidemic” as past surgeon general reports have had on other issues, such as smoking.

“Surgeon General reports are renowned publications that take an evidence-based approach to our nation’s most urgent public health issues,” Brady Board Chair Dr. Joseph Sakran said in a news release. “Seeing as firearms are now the leading cause of death for children and teens in the U.S., there’s arguably no public health issue that’s more urgent or that warrants the commission of a Surgeon General report more than gun violence.”

The National Rifle Association’s executive director, Randy Kozuch, issued a statement via social media that was critical of the surgeon general’s advisory.

“This is an extension of the Biden Administration’s war on law-abiding gun owners,” Kozuch said. “America has a crime problem caused by criminals. The reluctance to prosecute and punish criminals on the part of President Biden and many of his allies is the primary cause of that. That’s the simple fact.”

Piquero said he thought the advisory steered clear of politics.

“It doesn't take political sides,” he said. “It's a document about trying to improve a problem that affects so many Americans.”

The surgeon general’s report noted that more than half of gun-related deaths are suicides.

That fact isn’t lost on Veterans Affairs, which last fall reported an increase in veteran suicides after back-to-back years of declines. Veterans are at a higher risk for suicide than the general population.

Over 70% of veteran suicides involved firearms in 2021. And since then, the VA said it has promoted secure storage of firearms, including the distribution of more than 400,000 gun locks.

The Jed Foundation (JED), an organization focused on mental health for teens and young adults, applauded Murthy for the advisory.

The solution to gun violence is a holistic, public health approach, JED said.

“As an adolescent suicidologist and gun owner myself, I understand the intricacies of firearm violence in America,” JED Senior Clinical Director Kurt Michael said via email. “What I can tell you is that firearm violence is a serious issue plaguing young people across the country. Suicides account for the majority of gun deaths in the United States with firearms as the leading method of suicide. Behind these statistics are real people who are forever changed due to easy access to lethal means like firearms.”

The advisory also noted racial discrepancies with gun violence.

That’s something Piquero has studied, and he said he’s glad that the surgeon general included that facet of the issue.

Piquero and a colleague, John Roman, published a research letter last month that showed firearm violence is not equally distributed.

“We found a staggering set of estimates as well in our work where the rate for 15- to 19-year-old Blacks in 2021 was 27 times higher than it was for whites. ... That's staggering when the differential is that big,” he said.

There are structural conditions at play in those racial discrepancies, he said.

Firearm violence is concentrated in disadvantaged inner cities, which are often over-represented by Black Americans, he said.

Then, there’s the way folks adapt to those surroundings.

“A very famous sociologist named Eli Anderson wrote this book called ‘Code of the Street,’ where he talked about how individuals who grew up in these environments almost have to use violence as a sign of respect,” he said. “So, if you believe that that kind of interaction is what helps plant the seeds for violence to occur, then you understand some of the conditions and potential motivations for that to occur.”

Murthy said the public health approach to reducing gun violence should include community violence prevention programs, firearm risk reduction strategies, improved access to mental health care for those exposed to or at risk for firearm violence, and better-funded research to inform and evaluate the prevention strategies.

For example, among children and adolescents, federal research dollars between 2008 and 2017 totaled $878 million for motor vehicle crashes.

During the same period, firearm injury prevention federal research dollars totaled $12 million, his report noted.

It’s been extremely difficult, if not impossible, to do the kind of research on firearm violence that we do for other health problems, said Dr. Garen Wintemute of UC Davis Health. He’s an emergency room doctor and the director of the university’s Violence Prevention Research Program.

How many Americans are killed by illegally obtained guns?

“Unfortunately, we don’t know with any precision,” he said via email. “The origin of firearms used in fatal shootings is often never established, and policies established by Congress set severe restrictions on the use of what data do exist.”

Answers to some basic questions like that don’t exist, which points to the lack of research cited by the surgeon general’s advisory, Wintemute said.