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A Public Health Crisis

United States Surgeon General Vivek Murthy, MD, MBA, recently released a landmark Surgeon General’s Advisory on Firearm Violence, declaring firearm violence in America a public health crisis. Firearm violence is pervasive, with more than half (54%) of US adults or their family members having experienced a firearm-related incident in their lives. Over the last decade, the number of people who have died from firearm-related injuries, including suicides, homicides, and accidental deaths, has been rising, and firearm violence is now the leading cause of death among children and adolescents.

This new advisory is the first publication from the Office of the Surgeon General dedicated to firearm violence and its consequences for the health and well-being of the American public. The advisory details the impact of gun violence beyond death and injury, describing the layers of cascading harm for youth, families, communities, and other populations. With nearly six in 10 US adults worrying “sometimes,” “almost every day,” or “every day,” about a loved one being a victim of firearm violence, the effects of the public health crisis extend well beyond physical health—it has led to a collective trauma across society that warrants heightened attention.

“Firearm violence is an urgent public health crisis that has led to loss of life, unimaginable pain, and profound grief for far too many Americans,” Murthy says. “We don’t have to continue down this path, and we don’t have to subject our children to the ongoing horror of firearm violence in America. All Americans deserve to live their lives free from firearm violence, as well as from the fear and devastation that it brings. It will take the collective commitment of our nation to turn the tide on firearm violence.”

The rate of firearm-related deaths in our nation has been steadily rising, driven by both firearm-related homicides over the last decade and firearm-related suicides over the last two decades. Across all firearm-related deaths in 2022, more than half (56.1%) were from suicide, 40.8% were from homicide, and the remaining were from legal intervention, unintentional injuries, and injuries of unknown intent. Although firearm-related injury rates are difficult to measure due to challenges with collecting national injury data, studies suggest that there are at least twice as many nonfatal firearm injuries as fatal firearm injuries.

While firearm violence can affect anyone, it has a disproportionate impact on different communities. In 2022, for example, the Black community endured the highest firearm homicide rates in every age group, and Black youth accounted for about half of all firearm deaths among all youth, despite making up only 14% of the US youth population. That same year, the firearm suicide rate for those 45 years of age or older was highest among white people, and the firearm suicide rate for people under age 45 was highest among American Indian or Alaska Native people. Additionally, the firearm-related suicide rate in 2021 was 62.4% higher for veteran men than for nonveteran men, and 281.1% higher for veteran women than for nonveteran women.

Firearm violence also takes a significant toll on children in America. In 2020, firearm-related injury surpassed car accidents as the leading cause of death for US children and adolescents. When measured over a decade (2012 to 2022), children and young adults experienced a staggering increase in firearm-related suicide rates (a 45% increase for 15- to 24-year-olds and a 68% increase for children aged 10 to 14). Fears and worries about firearm violence are highly prevalent among youth, especially regarding school shootings. A nationally representative survey found that half (51%) of 14- to 17-year-olds in the United States worry about school shootings and nearly six in 10 report that they “have recently thought about what would happen if a person with a gun entered” their school or a school nearby. The effects of firearm violence and the threat that it poses to young people negatively affect their mental health.

The impact of firearm violence is felt beyond those who experience direct and immediate harm; rather, there is cascading harm across witnesses, family and friends, and the larger surrounding community. Research demonstrates that family members of victims of firearm violence experience increased risk of mental health challenges, including depression, anxiety, and PTSD. For communities, high levels of exposure to firearm violence have a negative impact on the public’s perception of safety. More than three-quarters of adults (79%) in the United States report experiencing stress from the possibility of a mass shooting and one in three adults (33%) say fear prevents them from going to certain places or events.

The advisory outlines an evidence-informed public health approach to addressing the crisis of firearm violence. This approach involves critical research funding, implementation of prevention strategies, and increased mental health access and support, including the following:

1. Critical research investments, such as:

• improving data sources and data collection;
• examining short-term and long-term outcomes of firearm violence; and
• conducting implementation research to improve effectiveness of prevention strategies.

2. Community risk reduction and education prevention strategies, such as:

• implementing community violence interventions;
• incorporating organizational violence prevention and emergency preparedness elements into safety programs; and
• encouraging health systems to facilitate education on safe and secure storage.

3. Firearm risk reduction strategies, such as:

• requiring safe and secure firearm storage, including child access prevention laws;
• implementing universal background checks and expanding purchaser licensing laws;
• banning assault weapons and large capacity magazines for civilian use;
• treating firearms like other consumer products, including requiring safety testing or safety features;
• implementing effective firearm removal policies when individuals are a danger to themselves or others; and
• creating safer conditions in public places related to firearm use and carry.

4. Mental health action and support, such as:

• increasing access to affordable, high quality mental health care and substance use treatment; and
• building on investments to enhance safety measures and evidence-based violence prevention efforts in learning settings.

While further research is needed to better understand firearm violence and its impacts, we can promote programs, policies, and practices right now that create safer conditions for the American people. This requires leveraging community leaders, working closely with at-risk populations, and educating the public on key protective actions. An all-of-society effort is required to help create safer conditions, build healthier communities, and save lives.

In concert with the Surgeon General’s Advisory, leaders at 10 of the nation’s medical organizations and the YWCA issued the following statements:

“Pediatricians have long understood that gun violence is a public health threat to children, and that its impact on families and communities can be devastating and long-lasting,” says American Academy of Pediatrics President Ben Hoffman, MD, FAAP. “The American Academy of Pediatrics welcomes the Surgeon General’s Advisory on Firearm Violence, which shines a light on why we must all come together to address this public health crisis.”

“By raising awareness of this public health crisis, the Surgeon General’s Advisory on Firearm Violence speaks to the gun violence that emergency physicians observe all too often, as well as the repercussions on the communities they serve,” says American College of Emergency Physicians President Aisha T. Terry, MD, MPH, FACEP.

“The American College of Physicians has long advocated for a public health approach and common-sense measures to help curb this escalating crisis,” says American College of Physicians Executive Vice President and CEO Darilyn V. Moyer, MD, MACP, and President Isaac O. Opole, MBChB, MACP. “We continue to address firearm injury through public policy and advocacy efforts, publication of related research and through events that examine the impact on clinicians and the public, and collaboration with others to enact change. We commend the Office of the Surgeon General for raising awareness of this growing epidemic.”

“Firearm violence has been a public health crisis in the United States for many years now, and we are pleased to see that the Surgeon General is addressing it in this advisory, laying out the stark statistics highlighting the scope of the problem as well as identifying some actionable solutions,” says American College of Surgeons Executive Director and CEO Patricia L. Turner, MD, MBA, FACS. “The American College of Surgeons has been working on this issue for decades and we stand ready to work with all stakeholders to end this epidemic of violence.”

“Across the country, physicians everywhere treat patients and families afflicted by firearm violence,” says American Medical Association President Bruce A. Scott, MD. “We see the physical and emotional harm firsthand, and we dread the too-often conversations with parents, spouses, and even children in which we tell them their loved one did not make it. Firearm violence is indeed a public health crisis, and the data now show it touches the majority of US adults. We applaud the Office of the Surgeon General for issuing this advisory and for outlining an evidence-based public health approach to addressing firearm violence.”

“The members of the American Psychiatric Association have become all too familiar with suicides and homicides involving gun violence and the additional impacts on people’s mental and physical health,” says American Psychiatric Association CEO and Medical Director Marketa Wills, MD, MBA. “The Surgeon General’s Advisory on Firearm Violence elevates this crisis in our national attention and emphasizes the damage gun violence has caused to families across the United States. It affirms that people with mental illness are especially vulnerable and includes prevention strategies that could help save lives.”

“APA applauds the Surgeon General’s Advisory on Firearm Violence, which serves as an urgent call for action,” says American Psychological Association CEO, Arthur C. Evans Jr., PhD. “Addressing gun violence is a pressing public health issue that requires solutions grounded in research, data, and the voice of communities. Now we must use this information to advance science-based public policy that saves lives and prevents injury.”

“Gun violence is a national tragedy. It’s a serious public health problem that is highly preventable,” says American Public Health Association Executive Director Georges C. Benjamin, MD. “The Surgeon General’s Advisory on Firearm Violence is important because it both raises awareness and offers evidence-based solutions to mitigate the risks of injury and death from gun violence.”

“The Surgeon General’s Advisory reminds us that it is our responsibility to keep children safe in homes and communities across the nation,” says Children’s Hospital Association CEO Matthew Cook. “We must come together to prevent gun violence. Our kids are counting on us.”

“Our nation's hospitals and health systems continue to meet the challenges posed by this public health crisis,” says Michael Dowling, president and CEO of Northwell Health, who initiated the creation of the CEO Council on Gun Violence Prevention & Safety. “The Surgeon General's Advisory reaffirms the heartbreak that America's caregivers have been seeing firsthand for many years, especially among young people.”

“As one of the largest providers of safety and support services for survivors of intimate partner violence, YWCA knows firsthand the dangers that firearms pose for women, children, and families,” says YWCA USA CEO Margaret Mitchell. “We are grateful for the Surgeon General’s attention to this critical issue.”

Surgeon General’s Advisories are public statements that call the American people’s attention to a critical public health issue. Advisories are reserved for significant public health challenges that require the nation’s immediate awareness and action. As the Nation’s Doctor and the 21st Surgeon General of the United States, Murthy has issued Surgeon General’s Advisories on Loneliness and Isolation, Social Media and Youth Mental Health, Youth Mental Health, Health Worker Well-Being, and a Framework on Workplace Well-Being.

— Source: Health and Human Services