The US Surgeon General, Vivek Murthy, recently put out a 40 page report titled: “Firearm Violence: A Public Health Crisis in America.” The report is entirely informational, without any policy force, but Murthy is hoping it will have the same long term cultural effect as the Surgeon General’s warning about the health risks of tobacco.
I wrote about this exact issue in 2018, and the conversation has not changed at all since then. The core question is – is gun violence a public health issue? The answer to this question, I argued, is an unambiguous “yes”. The medical profession has an absolute interest in and significant role to play in public health, and the health of the public is affected by many factors, not just disease.
Smoking is an excellent example. This is a behavior deeply rooted in culture, and yet has a significant negative health impact that is a legitimate target of the medical profession. Perhaps the best analogy to gun violence is car safety. There is a tremendous amount of research into car related deaths and injuries, and how best to mitigate them. This has lead to seatbelt laws and car seat laws for children.
Murthy’s stated hope, perhaps overly optimistic, is that the report will help shift the conversation on gun violence away from the current political deadlock to one of public health and safety. Part of this strategy is to simply focus on the numbers, which are sobering.
But of course, they were in 2018 also. I wrote: ” In 2016 in the US there were 15,592 deaths involving guns (not including suicides, which average around 22,000), including 346 mass shootings, 732 children, and 3,234 teens.”
Since then the numbers have gotten worse. According to the report: “The age‑adjusted rate of firearm‑related homicide increased by 62.5% from 2012 (3.8 per 100,000) to 2022 (6.2 per 100,000), with an absolute increase from 11,622 to 19,651 deaths over the same period.” Gun violence is now the leading cause of death in children and teens (surpassing car accidents), with deaths in 1-19 year olds at 4,603 in 2022.
The report also points out that death is only one outcome. For each person killed by a firearm there are about two people who are injured. In addition there are the loved-ones of those killed, and those who have witnessed gun violence or been threatened with violence. The report notes that in a recent survey 54% of Americans have experienced some form of negative firearm-related incident.
The raw numbers is the one thing about which there seems to be broad agreement. Unfortunately gun violence has been made part of the political culture wars, and any discussion of gun safety is portrayed as a violation of the second-amendment rights of gun owners. The NRA, for example, was quick to criticize the report by saying that it is “an extension of the Biden Administration’s war on law-abiding gun owners.” That is the exact frame that Murthy is hoping to change.
Previous examples of pushing back against treating gun violence as a public health issue include the Dickey Amendment – A 1996 congressional appropriations bill stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention [CDC] may be used to advocate or promote gun control.” This effectively chilled any research into gun violence by any federal agency. This de facto policy has since been reversed and federally funded gun violence research has resumed.
Another example are the various states, most notably Florida, that tried to ban physicians from talking to patients or parents of their patients about gun safety at home (so-called “gag laws”). The Florida law was struck down by a federal appeals court as violating the first amendment rights of physicians. But explicit in these gag laws was the claim that gun safety is not a legitimate medical issue.
It is a good thing these laws were struck down. A survey recently released by the CDC found that: “Of respondents with a loaded firearm and a child or adolescent aged ≤17 years in the home, 25.2%–41.4% reported that a loaded firearm was kept unlocked.” We see in this one study the need for federally funded research into gun safety and the need for physicians to talk to their patients about gun safety at home.
At the very least I hope the report moves the conversation on gun safety forward and helps establish a couple of important premises. First, gun safety is a legitimate medical and public health issue. Second, we need more data, and research is a good thing.
But further, exploring ways to make gun ownership more safe, and funding research to explore and better understand the issue should be viewed as non-partisan, even apolitical. Of course, science is used to inform policy, but the science itself should be objective, and viewed that way. Suppressing research and professional discussion is completely unacceptable.
Firearms as a Public Health Crisis