Topic, we have not touched upon in a while at Angry Bear. The stats are there to support more rigid laws suppressing the illegal use of firearms and tighter controls on possession. I am sure there will be the naysayers. Ok, fine. Be polite in expressing an opinion. Don’t care about what Clarence thinks as he is no expert as well as the three-month Army wonder Samuel. My background? At one time I could part your hair at 500 yards with a stock out-of-the armory M14. Marine Corps is pretty good at training except I was already good. Still shoot once and a while. The problem as I see it, too many people have access to too many weapons they should not have access too. An access to dumb unneeded weapons as well. The doctors taking care of the wounded
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Topic, we have not touched upon in a while at Angry Bear. The stats are there to support more rigid laws suppressing the illegal use of firearms and tighter controls on possession. I am sure there will be the naysayers. Ok, fine. Be polite in expressing an opinion. Don’t care about what Clarence thinks as he is no expert as well as the three-month Army wonder Samuel. My background?
At one time I could part your hair at 500 yards with a stock out-of-the armory M14. Marine Corps is pretty good at training except I was already good. Still shoot once and a while. The problem as I see it, too many people have access to too many weapons they should not have access too. An access to dumb unneeded weapons as well.
The doctors taking care of the wounded have great concerns over the growing numbers of people coming to them for care after being shot. They have a legitimate reason to be concerned.
US Surgeon General Vivek Murthy: Firearm Violence Is a Public Health Crisis
by Jennifer Abbasi and Yulin Hswen
JAMA | JAMA Network Part 1 of 2
Consider these grim statistics: there were more than 48 000 firearms-related deaths in the US in 2022, equating to 132 adults and children dying every day. And firearms are now the leading cause of death among US children and teens.
This is a 2-part Q&A series with the US Surgeon General. In part 1, JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, interviews Vivek H. Murthy, MD, MBA, to discuss the issue of gun violence as a pressing public health crisis and the critical role of public health leadership in combating this issue.
What can public health leaders, medical professionals, and health systems do to mitigate gun violence and protect the health and safety of communities?
They can do a lot, says the US Surgeon General, Vivek Murthy, MD, MBA, who in June took the step of declaring firearm violence a public health crisis. A new advisory from Murthy highlights the impact of gun violence and, in particular, its toll on mental health and community safety. It also offers a public health approach to addressing the issue, with several specific recommendations.
In the first of a 2-part interview with JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, Murthy discusses the collective trauma from firearm injuries and deaths in US society. He explains why the crisis of gun violence must not be considered intractable. He outlines the part clinicians can play in safeguarding bodies and minds from the high price of firearm-related suicides, homicides, and unintentional deaths.
The following interview has been edited for clarity and length.
Dr Bibbins-Domingo: What is it that makes you as the surgeon general now issue an advisory declaring firearm violence a public health crisis?
Dr Murthy: I think many clinicians and folks in the world of public health understand that gun violence is a public health issue. My belief has always been that when you have large numbers of people who are dying and being injured for preventable reasons, that constitutes a health issue and one that we all have a role in addressing as clinicians and public health leaders. While we know such, I worry about the way gun violence is being understood over the years as a political issue and not a public health issue.
The goal of my advisory is to do a few things:
Number one, to shift how we think about this issue as a public health concern.
Second, to lay out the extent of the problem, which I think we profoundly underestimate.
The greatest price we pay with firearm violence are the lives lost, nearly 50 000 a year. But there are other costs as well. The ripple effects we see of gun violence extend to people who are shot and who survive. People who witness the incidents, family members who lose loved ones, and communities dealing with the trauma of an incident that took place in their neighborhoods. And the millions of people, including our children, who are watching and hearing about these episodes of gun violence every day.
It’s for that reason that 6 in 10 adults in America are now saying that they’re worried about losing a loved one to gun violence. It’s why more than 50% of our kids are saying that they are scared about a school shooting happening in their school. These profound numbers, they’re just not normal, and we shouldn’t accept this as just the way things are. We are really an outlier when it comes to other countries in terms of the toll of gun violence, and we can do better.
My goal with my advisory was to reframe this issue as a public health issue, lay out the full cost of gun violence but also lay out strategies that I firmly believe can help us because they follow a public health approach to addressing the problem and focus essentially on prevention and on treating the aftermath of these episodes, which includes the mental health aftermath. It’s high time for us as a country to rally together around these strategies.
Perhaps one last thing, which has really weighed heavily on me as a parent:
When you understand the fact that gun violence is now the leading cause of death among children and adolescents age 1 through 19. That, by the way, was not true 10 years ago or 20 years ago, then you start to realize that this is really a kid’s issue as well.
If there’s one thing that should bring us together to take action, to break with the status quo, with the old way of doing things, it should be when our kids’ health and well-being is at risk.
Dr Bibbins-Domingo: I think one of the things that the report lays out so nicely is just the full toll. Obviously, the people who die from violence are part of that, but I think you tie it so nicely to the mental health issues, as well as the overwhelming burden in children, and we should rally around that.
JAMA has published quite a bit on this because the numbers are so stark. What does it mean to take a public health approach to this? To reframe gun violence as a public health issue?
Dr Murthy: It means that we can do a few things.
One is that we can think and talk differently about this issue. Health is something that historically has brought us together. Not always, but historically, often, and because we all realize that our health is something that we all care about. It’s a shared concern. When it comes to gun violence, I have traveled around our country to big cities and small towns, and I have had town halls and small group meetings with thousands and thousands of Americans.
Whether people are young or old, whether they’re gun owners or not gun owners, everybody wants their kids to be able to go to school safely. Nobody wants to worry that going to the theater or going to work or going to church or synagogue means putting your life at risk. Yet so many people are feeling that way. We do have a shared desire to create healthier, safer environments and giving us a way to rethink and talk differently about gun violence is an advantage of a public health approach.
The other thing it does is it gives us a tried-and-true playbook to work from when it comes to addressing gun violence. This is a playbook we’ve used with tobacco and with car accident–related deaths over the years. What we typically do in a public health approach is we gather data, we analyze the data to understand which populations are most at risk, and we design interventions thoughtfully. We implement those. We study the implementation; we scale interventions that work. These are part of the tried-and-true approaches that public health has taken over the years.
Lastly, this is really important: people will sometimes look at this issue and say,
“Gosh, this feels intractable because it’s really impossible to make progress on this.”
Listen, I get that. I have been watching the same situation play out that other people have in terms of the politics and polarization around this issue.
But a couple of things give me hope. One is that in the last few years, we have seen Congress put a modest amount of funding toward gun violence research. I want to emphasize modest. There’s a lot more that has to be provided here. But that was the first time in decades they had actually done that and done so in a bipartisan way. Two years ago, we saw Congress pass a bipartisan Safer Communities Act, the first federal legislation in 30 years to start addressing gun violence. These were really important shifts, I believe, in how Congress has operated.
But finally, just think about our history in public health. There was a time half a century ago where people said,
“Smoking? Gosh, that’s an intractable issue in the country.”
In 1964, when my predecessor, Luther Terry, issued the first surgeon general’s report on tobacco, 42% of the country smoked. There were ads for tobacco everywhere. Kids were seeing them. Doctors were smoking. This was just part of the fabric of America—or so it seemed. But that report combined with all of the efforts it helped catalyze—education programs in communities; advocacy movements among youth and parents; policies from local, state, and federal lawmakers—they all helped to reduce smoking rates from 42% to under 12% today. We can make progress on these seemingly intractable issues, and this is one where I feel we’ve got to do a lot more because, again, it’s our kids who are at stake, but it’s also the mental health and well-being of the country that’s really in the balance.
Dr Bibbins-Domingo: I think that frames it well, and tobacco is obviously a great example. But also, the issue that you raised with automobile safety, where because we studied it, because we took several discreet steps along the way, driving is much safer than it was in the past . . . . The cars we use are much safer than they were in the past because we focused on the issues of safety and made a lot of incremental steps along the way. Framing it around health and safety, I think, seems to be a way forward that hopefully people can rally around.
Dr Murthy: That is my hope. I know it won’t be easy. These major changes on monumental issues that we face as a country require a lot of effort, persistence, determination, and a lot of conversations. But I think they’re well worth having because we’ve lived the alternative, which is to operate on this issue as if it’s a political and polarizing issue. That has not helped us save lives. It has in fact led to a circumstance where we are worried about our basic functions and day-to-day activities and we’re questioning and we’re living in fear. When you look at the data, when you hear the stories as I’ve heard all across the country, you start to realize that the fear of gun violence has really infiltrated the psyche of our country.
I talked to a grandmother who told me that her grandchild has stopped wearing light-up shoes, the shoes that flash when you step on them that are popular among kids. He stopped wearing them because he didn’t want to be a target for a shooter in case there was a shooting in his school. I’ve talked to middle school students who have told me that they’re worried about shootings taking place in their school.
There was a mother I spoke to who was actually at a public event where a mass shooting took place a couple of years ago, and she happened to be in her flip-flops at the time and had a hard time running away from the shooter and trying to protect her family. To this day, whenever she goes out, she worries about wearing flip-flops because she doesn’t know if she’s going to be in another situation where there’s an active shooter where she’s going to have to flee. You hear these stories, and you start to realize this is coloring our day-to-day existence. But this is a choice. It does not have to be this way, and I do not want us to accept this as a reality. We can certainly do better.
Dr Bibbins-Domingo: How can clinicians in speaking with their patients or family members give practical advice about reducing firearm violence?
Dr Murthy: I think clinicians have a really important role here. You could say perhaps I’m biased. My first and foremost professional identity is that of a clinician, and I just have great respect for our colleagues across the country who, not just for what they do in clinic and in hospitals every day, but really for the mindset and the values that they’re trying to bring to our public conversations on health issues like gun violence.
A few concrete things I have laid out in our advisory for clinicians: number one, having conversations with patients about safe [firearm] storage can actually be immensely helpful. As clinicians, we’re not strangers to safety conversations. Pediatricians talk to parents all the time about kids in pools—we don’t want kids to unintentionally fall into a pool and drown. We talk to them about safety with regard to driving. We talk about drinking and driving. It turns out that we lose far too many children in particular every year to incidents that often happen in the home with unlocked loaded weapons. The simple act of taking more care to store weapons carefully, unloaded and locked, can literally save lives and prevent injuries. That kind of education can be powerful.
It’s also important for clinicians, when they recognize a mental health impact of gun violence, to keep such in mind as they see patients and as they’re getting their history. If there is a history of gun violence a patient has experienced, [clinicians should] be mindful of the mental health consequences it may lead to. Sometimes that can last for years. It’s worth keeping in mind that 54% of Americans have either directly or through a family member experienced gun violence. It could be losing a loved one, being threatened with a firearm, or being shot and injured by a firearm. That means it’s unquestionable that if you’re a clinician out there, that you’re going to be seeing patients who have experienced the mental or physical harms of firearm violence.
Those are some things that clinicians can do. More broadly, there are community violence intervention programs, which can use many similar principles as hospital violence intervention programs—which seek powerful evidence-based methods of using human beings and relationships and dialogue and engagement to actually interrupt a cycle of violence that too often propagates in our communities. This is a place where I think health systems, both directly through what are called HVIPs, Hospital Violence Intervention Programs, and through their support of the community-based programs, can do a lot to help address gun violence.
Most importantly, I think the health systems need to support clinicians in doing this work and having these conversations with patients. Having trained in primary care myself, I’m aware that the easiest thing to do in health care is to add more to the list for primary care doctors to do. We’ve got to be mindful of that and make sure of when we’re making additional asks, we’re providing not just material resources, but the kind of technology and added support for clinicians to be able to have these important conversations with patients.