U.S. Surgeon General Declares Firearm Violence a Public Health Crisis
On June 24, 2024, U.S. Surgeon General (“SG”) Vivek Muthy issued an advisory declaring firearm violence in the United States a public health crisis. While the information provided in the advisory is not new, the issuance of an official advisory from the SG – which are “reserved for significant public health challenges that require the nation’s immediate awareness and attention” – highlights continued momentum at the federal level toward treating firearm violence as a public health issue. Importantly, the SG explicitly acknowledges that addressing firearm violence demands addressing the social determinants of health and the structural contributors to inequities in the U.S., including structural racism.
Like all public health issues, addressing the factors that drive firearm violence is key to its effective reduction. A reactive approach is not, and never will be, sufficient; instead, as the SG acknowledges, the public health approach demands that we address systemic causes of broad societal issues with a focus on prevention. In the context of firearm violence, the SG details a public health-based approach that includes:
Research Investment
Community Risk Reduction and Education
Firearm Risk Reduction; and
Mental Health Access and Support
In the advisory, the SG notes that investing in safe and supportive physical environments and housing is one key strategy to decrease risk of firearm violence exposure. Preamble’s Rental Transition Program aims to help individuals who have been impacted by firearm violence and are who experiencing housing instability by facilitating their transition into safe, secure, and stable housing. To read more about our work, click here.
At Preamble Initiatives, we believe that every person deserves to enjoy the highest possible level of wellbeing. Addressing the systemic barriers to wellbeing – including systemic discrimination and racism and lack of investment – is key to creating a better world for everyone. The work is never done, but we are encouraged by the commitment from the SG to addressing firearm violence and look forward to continuing to take steps toward addressing the myriad factors that contribute to firearm violence and harm wellbeing. Reducing firearm violence is key to building a better world; in the words of the SG, “[t]he safety and well-being of our children and future generations are at stake.”
A full summary of the Advisory is below.
Advisory Summary:
The advisory describes “the public health crisis of firearm violence in America and . . . strategies for firearm injury and violence prevention, with a focus on the health and well-being of children, families, and communities.” The advisory reviews the impact of firearm violence in the United States, detailing specifically the impact on communities, children and adolescents, and families. The advisory also reviews factors contributing to firearm violence, including socioeconomic, geographic, and racial inequities. At the end of the Advisory, the SG proposes a public health-based approach to addressing firearm violence. key takeaways from each section are noted below.
1) Firearm Violence in the U.S.
First, the SG highlights the upward trend in firearm violence in the United States, including increasing trends of firearm violence involving children and of firearm-related suicides. The SG also discusses the disproportionate impacts of firearm-related injuries, noting that – across all ages – firearm homicide rates are highest among black persons. Additionally, the SG notes that, while men are significantly more likely to die from firearm-related injury than women in the U.S., women are disproportionately impacted by intimate partner-linked firearm violence.
The SG also touches on mass shootings in the U.S.; though they make up for a small percentage of firearm-related deaths, the SG notes that “mass shooting incidents cause outsized collective trauma on society and have a strong negative effect on the public’s perception of safety.”
Finally, the SG discusses the long-ranging impacts of nonfatal firearm-related injuries, noting that “[t]he impact of surviving a firearm injury includes short-term and long-term health consequences,” including “new limitations to physical functioning, physical disabilities from injury, increased diagnoses of chronic pain . . . post-traumatic stress disorders, anxiety, depression, and substance use disorders."
2) The Collective Toll of Firearm Violence Exposure in the U.S.
Next, the SG discusses the impact of firearm-related violence on communities, families, and children, noting that “[f]irearm violence leads to cascading harm across society” and “exposure to firearm violence can contribute to elevated stress levels and mental health challenges and threaten the sense of well-being for entire communities.” Quoting the 2030 Healthy People Report, the SG notes:
“children and adolescents exposed to violence are at risk for poor long-term behavioral and mental health outcomes, such as depression, anxiety, and post-traumatic stress disorder, regardless of whether they are victims, direct witnesses, or hear about the crime.”
3) Contributing Factors to Firearm Violence
The advisory then discusses two significant factors contributing to firearm violence in the U.S.:
1) Socioeconomic, Geographic, and Racial Inequities
The SG notes that social determinants of health significantly influence gun violence rates. The SG specifically highlights structural factors that increase the risk of firearm violence, including poverty, income inequality, social capital, social mobility, and living in an area with low social service spending.
Importantly, the SG specifically names the connection between racism and firearm violence, stating:
“[s]tructural, institutional, and individual racism have also contributed to inequities in exposure to firearm violence in the U.S. For example, structural racism has contributed to inequities in economic, housing, and educational opportunities that are associated with risk for violence and other health conditions among racial and ethnic minority groups. Racial and ethnic minority population groups are more likely to live in neighborhoods with concentrated economic disadvantage due to imposed economic setbacks, historic divestment, and harmful discriminatory policies like redlining.”
2) Lethality, Availability, and Access
The SG also discusses the role that the availability of, lethality of, and access to firearms in the U.S. plays in driving firearm violence rates, highlighting that the presence of a firearm in a home is associated with higher rates of homicide, suicide, and unintentional firearm injury, and that the use of firearms makes fatal outcomes more likely in violent situations and suicide attempts. The SG also discusses the ways that endemic improper firearm storage practices contribute to unintentional firearm injuries and deaths, particularly among children.
4) Public Health Approach to Firearm Injury and Violence Prevention
The SG concludes the advisory with a discussion of the merits of applying the public health approach to firearm injury and death, explaining that:
“[a] public health approach is designed to prevent and reduce harm by changing the conditions and circumstances that contribute to risk of firearm violence as measured by deaths, injuries, as well as the reverberating mental health and emotional impacts [of firearm violence].”
The SG repeatedly notes that firearm violence in the U.S. is an “emergency” that requires an iterative, cross-sector approach. The SG lists the following elements of a strong public health approach to gun violence reduction in the U.S.:
1) Critical research investments
Here, the SG acknowledges the impact of “historical underfunding for firearm violence prevention research,” which “has created challenges for expanding the evidence-base and implementing life-saving policies” and proposes the following investments:
a) Improving data sources and data collection to inform prevention activities
b) Expanding research to examine short-term and long-term outcomes of firearm violence and evaluate specific prevention strategies
c) Conducting implementation science research to improve effectiveness of prevention strategies
2) Community Risk Reduction and Education Prevention Strategies
The SG proposes the following risk reduction and education strategies:
a) Implementing community violence interventions to support populations with increased risk of firearm violence involvement
b) Incorporating organizational violence prevention and emergency preparedness elements into safety programs
c) Encouraging health systems to facilitate education on safe and secure firearm storage
d) Addressing structural determinants that increase the risk of firearm violence
3) Firearm Risk Reduction Prevention Strategies
The SG proposes the following strategies “that build distance in terms of time and space between firearms and people who are at risk of harming themselves or others,” including:
a) Requiring safe and secure firearm storage, including child access prevention laws
b) Implementing universal background checks and expanding purchaser licensing laws
c) Implementing effective firearm removal policies
d) Banning assault weapons and large-capacity magazines for civilian use
e) Creating safer conditions in public places related to firearm use and carry
f) Treating firearms like other consumer products
4) Mental Health Access and Support
The SG notes that “the mental health burden and trauma for those exposed to firearm violence warrants greater attention and action through increased mental health supports and trauma-informed resources.” The SG recommends the following strategies to reduce this mental health burden and trauma:
a) Prioritizing increased access to affordable, high-quality mental health care, substance use treatment, and other trauma-informed resources
b) Enhancing safety measures and mental health resources in learning settings for children and adolescents
