The U.S. surgeon general, Dr. Vivek Murthy, on Tuesday declared gun violence in America a public health crisis, recommending an array of preventive measures that he compared to past campaigns against smoking and traffic safety.
The step follows years of calls by health officials, including four of Dr. Murthy’s predecessors, to view firearm deaths through the lens of health rather than politics.
The National Rifle Association has vigorously opposed this framing and promoted legislation that effectively quashed federal funding for research into gun violence for a quarter-century.
Dr. Murthy’s 32-page advisory calls for an increase in funding for firearm violence prevention research; advises health workers to discuss firearm storage with patients during routine medical visits; and recommends safe storage laws, universal background checks, “red flag” laws and an assault weapons ban, among other measures.
“I’ve long believed this is a public health issue,” he said in an interview. “This issue has been politicized, has been polarized over time. But I think when we understand that this is a public health issue, we have the opportunity to take it out of the realm of politics and put it into the realm of public health.”
Gun rights organizations were scathing about the new advisory, deriding it, sometimes in unprintable language, as justification for curtailing the rights of law-abiding gun owners. A spokesman for the N.R.A. called it an “extension of the Biden administration’s war on law abiding gun owners.”
“America has a crime problem caused by criminals,” said Randy Kozuch, the organization’s chief lobbyist. “The reluctance to prosecute and punish criminals on the part of President Biden and many of his allies is a primary cause of that. That’s a simple fact.”
Public-health-based gun reform has been an uphill battle in the United States, whose political parties are lodged in a stalemate over many of the measures the report recommends, including assault weapons bans and background checks for gun buyers.
For decades, opposition by gun-rights groups had a chilling effect on scientists, who feared Congress would cut their budgets if they were accused of conducting “advocacy research,” said Andrew Morral, a senior behavioral scientist at RAND.
But that barrier is falling, as the Centers for Disease Control and Prevention resumes funding for research into gun violence. “There is a surge of interest,” said Dr. Morral, RAND’s Greenwald Family Chair in Gun Policy. “There is a sense that this is low-hanging fruit that hasn’t been studied.”
He said he was confident that, as in the areas of tobacco and climate change, public opinion on gun violence would respond to “a slow and eventually unsurmountable body of evidence.”
Dr. Murthy said he was prompted to act by a rising death toll from firearms, especially among children. In 2020, gunshot wounds surpassed car accidents as the leading cause of death for children and adolescents in the United States.
Recent years have brought a surge in new gun ownership, and with it, an alarming rise in firearms suicides among young people. In cases where children and adolescents died by unintentional gunshot wounds, around three-quarters of the firearms used had been stored loaded and unlocked, the Centers for Disease Control and Prevention has found.
“We have to look at this now for what it is, which is a kids’ issue,” Dr. Murthy said. Traveling around the country, he said, he had regularly heard from students who were afraid of getting shot in their neighborhood or at school.
“As a country, we are actually more united than I believe we understand,” he said.
Dr. Murthy’s advisory on gun violence was his second splashy move in two weeks, coming on the heels of an announcement that he would push for a warning label on social media platforms, advising parents that using the platforms might damage adolescents’ mental health.
The position of surgeon general functions largely as a bully pulpit, tasked with communicating scientific findings to the public. Occasionally, warnings from the surgeon general have succeeded in shifting the national conversation, as in a landmark 1964 report about the health risks of smoking.
After that announcement, Congress voted to require a printed health warning on cigarette packs, and smoking began a 50-year decline. In 1964, around 42 percent of adults smoked daily; by 2021, 11.5 percent did.
Dr. Murthy said he saw a public health campaign against gun violence as a similar challenge, requiring a combination of education and awareness campaigns, culture shifts and policies. “There wasn’t one single strategy that ultimately worked with tobacco,” he said. “That’s what I’m thinking here, too.”
Jonathan M. Metzl, a professor of sociology and psychiatry at Vanderbilt University in Nashville, argued in a recent book that public health strategies from “the tobacco wars, the seatbelt wars, or other last-century profits-versus-people contests” were ill-suited to the national debate around guns, which are rooted so deeply in political identity.
Dr. Metzl said he had interviewed thousands of gun owners while researching his book, “What We’ve Become: Living and Dying in a Country of Arms,” and concluded that they viewed guns not as a health risk, but as a form of protection.
“Guns are not only a health problem, they are a democracy problem and a race problem and a pluralism problem,” he said. “The public health framework doesn’t address that. The frame is too limited for the problem we’re facing.”
Dr. Mark Rosenberg, a gun violence researcher who helped establish the C.D.C.’s National Center for Injury Prevention and Control, said he had consulted with Dr. Murthy on the advisory and welcomed it. Dr. Rosenberg said he was fired in the late 1990s under pressure from Republicans who opposed the center’s research.
“Was I disappointed that it took 40 years to get this idea out there? Yes, I was disappointed,” said Dr. Rosenberg, the president emeritus of the Task for Global Health.
But he added that it often takes a long time for scientific work to be translated into policy; two centuries passed before preventive treatments for scurvy and smallpox were disseminated into the population, eradicating those diseases, he said.
“I’m delighted that the surgeon general has been able to release this report,” he said. To translate the recommendations into law, he added, “we’ve got a huge fight ahead of us.”
