U.S. Surgeon General Vivek Murthy speaks in Washington, D.C., in 2023.
Photo by Drew Angerer, courtesy Getty Images
“There is no reason that secure firearm storage conversation should not be a part of what pediatricians do day in, day out for the entirety of their careers.”
— Annie Andrews
A landmark surgeon general advisory released this summer confirmed what many in public health already knew: Gun violence is a public health epidemic. The advisory also confirms that the way forward is through immediate evidence-based interventions that engage a range of communities.
U.S. Surgeon General Vivek Murthy, MD, MBA, released “Firearm Violence: A Public Health Crisis in America” in June, painting a stark picture of how gun violence has affected American health.
“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 said in a news release. “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.”
Suicide accounted for 56% of all firearm deaths in 2022 and 41% were homicides, noted the advisory. While mass shootings have increased, they still are only 1% of all firearm-related deaths, said Joshua Horwitz, JD, co-director of the Johns Hopkins Center for Gun Violence Solutions.
“Plenty of people don’t know that, and that’s one of the things we think this advisory can do,” Horwitz told The Nation’s Health. “It can really identify for average Americans that there’s a risk of having a firearm in your home. Most people who die by suicide are legally possessing those firearms.”
Firearm-related injuries are also the leading cause of death in children and adolescents, surpassing motor vehicle crashes, cancer and poisonings. And just over half of Americans have experienced a firearm-related incident or know a family member who has, according to the advisory.
While the statistics are sobering, the advisory lays out a plan to reduce and prevent firearm violence, including investments in community and firearm risk reduction, mental health care and critical research.
A two-decade freeze from Congress on funding gun violence research at the Centers for Disease Control and Prevention ended in 2018. Since then, researchers have learned more about what drives and contributes to gun violence, said Garen Wintemute, MD, MPH, an APHA member and director of the California Firearm Violence Research Center.
“There are lots of interventions that could be taken now based on the research evidence we already have while we’re gathering more evidence to support more interventions,” Wintemute told The Nation’s Health. “We don’t need to be stalled in the water waiting for five years’ worth of research to come to fruition. We can get busy now.”
Hospital-based violence intervention programs have shown success at reducing community risks. The programs, such as the University of California-San Francisco’s Wraparound Project, match violence prevention professionals with firearm violence victims to identify their short and long-term needs, such as housing, food and employment, said Nazsa Baker, PhD, the project’s research director and program manager.
Students at Columbine High School in Columbine, Colorado, place flowers in April at a memorial to students and a teacher who were killed by shooters there in 1999. A recent advisory from the U.S. surgeon general names firearm violence an urgent public health crisis and calls for immediate evidence-based interventions that can help end the epidemic.
Photo by Marc Piscotty, courtesy Getty Images
Baker said the programs are particularly needed in Black and Hispanic communities, which disproportionately bear the brunt of firearm violence. Although Black children and adolescents make up 14% of the country’s child and adolescent population, they account for about half of all firearm-related deaths among the age group.
“We need more research funding to evaluate if these programs can solve macro-level problems,” Baker told The Nation’s Health.
Some gun violence can stem from conflicts at school, which makes the advisory’s recommendation to boost access to mental health professionals in schools essential. Access in school settings is important given minority communities are also less likely to engage with mental health services on their own, said Taylor Rodriguez, MS, a research assistant at the New Jersey Gun Violence Research Center and a clinical psychology doctoral student at Rutgers University.
“When it comes to increasing access to care, one of the things that we have to really think about is doing it in a way that is normalizing and destigmatizing and allows for folks to reach out to a system that maybe they wouldn’t normally because mental health care is really underutilized,” Rodriguez told The Nation’s Health. “That’s a next step when we’re thinking about connecting folks who need it, especially for folks who are struggling when it comes to suicide or ultimately folks who have been touched by firearm violence, which is a lot of people.”
To further reduce risks, the advisory calls for safe gun storage laws, an assault weapons ban and regulating firearms the way other consumer products are by federal agencies.
Learning how to talk with families about safe gun storage should be a regular part of medical school curricula and clinical practice, said Annie Andrews, MD, a pediatrician and senior advisor for Everytown for Gun Safety. While safe storage is an issue across the lifespan, Andrews notes that children as young as age 2 are strong enough to pull a trigger on a firearm.
“Pediatricians are well-versed in counseling families on anticipatory guidance,” Andrews told The Nation’s Health. “We talk to families all the time about the importance of bike helmets, the importance of safety around swimming pools, the importance of locking up household cleaners. There is no reason that secure firearm storage conversation should not be a part of what pediatricians do day in, day out for the entirety of their careers.”
While Horwitz noted that passing federal gun safety policies will be a bigger challenge given political gridlock, he cited progress on the state level, such as the growth of extreme risk protection order, or “red flag” laws. The laws temporarily restrict access to firearms for people at risk of harming themselves or others.
“They were sort of in nascent form in Indiana and Connecticut just 15 years ago and in the last 10 years they’ve passed in another 19 states and the District of Columbia,” Horwitz said. “Now more than half the country is covered by this great suicide prevention tool.”
While politics is one reason why physicians may be hesitant to address gun violence in their clinical practice, Andrews said the advisory gives health practitioners fewer excuses to write off firearm violence as anything but a public health problem. She said real change will require buy-in from not just health care professionals, but health care systems and insurance companies to address the root causes of firearm violence.
“There’s all these things that practicing health care professionals and large health care systems could be doing to address this crisis,” Andrews said. “I hope that the surgeon general’s report will act as an incentive, motivation and create momentum for everyone working in this space. And people who are still sitting on the sidelines need to get involved.”
For more, visit www.surgeongeneral.gov.
- Copyright The Nation’s Health, American Public Health Association
