One week ago, U.S. Surgeon General Vivek Murthy took the unprecedented step of issuing an advisory on gun violence, marking the first time his office has addressed the issue in such depth.
Murthy’s 32-page document is a clarion call to treat gun violence as an urgent public health crisis. It outlines an alarming increase in firearm-related deaths and injuries over the past two decades, explores the root causes of the epidemic, and delves into the cascading consequences for survivors, witnesses, families, and communities.
But his advisory comes at a time when guns remain a deeply divisive issue in American politics.
I spoke with Murthy to get a better understanding of the motivations behind the advisory, its intended impact, and the broader implications for public policy and community safety. We discussed whether a public health call to action can break through in today’s polarized climate, and he shared insights from his career and personal encounters with the devastating effects of gun violence, offering his perspective on why now is the time for a unified, public health-driven approach to this crisis.
Our conversation has been lightly edited for length and clarity.
Why did you decide to issue this advisory now?
I’ve been concerned about gun violence for a long time, dating back to my time as a doctor seeing patients and recognizing how many of them were struggling with the physical and mental health effects of gun violence. But over the last decade or two, we’ve also seen some real changes in how gun violence is impacting the country.
We’ve certainly seen an increase in overall gun violence-related deaths. But the ripple effects of gun violence on those who survive, on witnesses, on family members who lose loved ones, and on the millions of people who are reading about and hearing about these incidents every day — that impact is far greater than what many people may realize. And especially when we know that our kids’ lives are at risk — this is a leading cause of death among kids and teens — I believe that it should elevate it in terms of the urgency and the priority that we give.
What do you hope it accomplishes?
I wanted to put this advisory together to help people understand where we were with gun violence in terms of its reverberating impacts around the country. I wanted people to know that this is now the leading cause of death among our children and teenagers. I wanted them to know that this is a public health issue that we should address the way we’ve addressed other public health issues in the past.
Most importantly, I wanted people to know that there’s something we can do about this problem. This isn’t going to be easy. There’s a lot to do. But I wanted to issue this advisory so that people knew the extent of gun violence’s impact on the nation and the public health solutions that we could employ.
It’s not OK for us to just continue as if this is just a normal state of America. It shouldn’t be. It can’t be.
Given how much political polarization there is on this issue, how far do you think an advisory like this will go in influencing public policy?
I know many people feel worried that this issue has been polarized and politicized. But I firmly believe that if we take the issue out of the realm of politics and put it into the realm of public health, people will recognize that there are steps we can take to address gun violence. I certainly hope that this can help people see that despite the polarization of the past, we have an opportunity to come together and address an issue that’s affecting millions of Americans everywhere. It’s touched all of our lives.
When I travel around the country and talk to people of different backgrounds, different age groups, different political beliefs, what I find is there’s very broad agreement on the fact that people want to live in safe communities. They don’t want their kids to go to school and worry about a school shooting. They don’t want to worry that going to church or synagogue or a concert or grocery store is going to put your life at risk.
Many of the strategies that I’ve laid out are commonsense strategies that I think most people recognize would be helpful, and that public health experts around the country and medical organizations across the nation also agree would be helpful. We need to listen to more of those voices from on the ground, from people who are gun owners and people who aren’t gun owners, who collectively agree that we need to create a safer world for our kids. It’s these conversations on the ground, though, that give me hope that there’s much broader agreement on the concern and the solutions than perhaps our politics may reflect.
There’s such a history with the Surgeon General’s publications. Were there any lessons that you took from those past publications to apply to this one?
Yes, a couple of things: First, the Surgeon General’s publications in the Office of the Surgeon General have been used in the past to draw the country to action around critical issues. I think about smoking back in 1964, when Surgeon General Luther Terry issued the first Surgeon General’s Report on tobacco. That was a time when cigarette smoking was deeply interwoven into the culture of America. Forty-two percent of the country smoked. Kids and adults were both seeing advertisements for smoking all the time. Doctors smoked. It seemed like it was the normal thing to do.
Yet, despite that, when we realized that smoking is a public health issue, we took action to address it. That report catalyzed a series of programs, educational initiatives, youth advocacy efforts, as well as policies from lawmakers that ultimately helped reduce smoking from 42 percent in 1964 to below 12 percent, where it is today.
I firmly believe that if we take the issue out of the realm of politics and put it into the realm of public health, people will recognize that there are steps we can take to address gun violence.
I look at our country’s experience with car accidents, with car accident-related deaths. And here, too, you can see a moment where, rather than just accepting the high level of car accident-related deaths as the new normal, we said, “No, we can make cars safer. We can prevent this loss of life.” And that’s what we did.
Even on intractable issues, we can make progress when we see them for what they are: public health issues that require a public health approach. And so I do draw some inspiration from that. Here, too, the solution is complex, but it’s feasible, and it’s possible.
How can public health officials use this advisory to effectively communicate with people who are on the gun rights side of things?
The ideas in this advisory and the strategies that we lay out should be of interest to people across the spectrum. These are commonsense solutions that are informed by research, backed by public health, and that frankly make sense to a lot of families who believe that we should be investing more in research, investing more in mental health, and investing in a lot of the violence prevention strategies and firearm risk reduction strategies that we lay out in this advisory.
I do think that community organizations can use this, as well. We talk in the advisory about the role healthcare organizations can play in safe storage education. We talk also about the role that community organizations can play in building and executing community violence intervention programs, which have been proven to have a positive effect on reducing violence. And we also talk about what individuals can do to store their weapons safely.
We know that when weapons are left unlocked and loaded in the house, that increases the risk that a child may find the weapon and unintentionally harm themselves or others. It increases the risk of suicide in the home, as well. But safe storage is a practice that gun owners across the board can engage in, and right now, too many firearms are left in the home unsecured, and that creates a health risk.
There is something for everyone in this advisory, and I hope that people will take this to heart and see this issue as the public health crisis it is, but also see it as an issue where we can take action and we can reduce the toll.
You also have some legislative measures in the advisory that you mentioned, like banning assault weapons and expanding background checks. How does public health play into those legislative measures?
Part of what public health experts inside and outside government do is work with policymakers to help them understand those strategies and why they would be effective.
One thing I’m encouraged by is the fact that in the public health community and medical community, there is broad agreement on many of these strategies. In the advisory, several statements from many of these public health and medical organizations speak to not only broad agreement on these strategies but also the urgency of implementation.
How has your perspective on gun violence and gun violence as a public health issue evolved over your career?
I’m thinking back to when I was in medical school and training as a doctor, and I didn’t learn a whole lot about gun violence in medical school. But when I started practicing medicine, I started encountering patients who were struggling with the physical and mental health effects of gun violence.
I remember one man, in particular, whom I cared for when I was in my residency training, who had just been walking down the street one day when a stray bullet from a conflict close to him ended up hitting him and severing his spinal cord. He ended up being paralyzed from the waist down. He had a series of health complications that required him to come into the hospital for recurring infections thereafter.
You can imagine the mental health toll on him, in terms of PTSD and subsequent anxiety and depression, was considerable. Those experiences with patients like him have helped me understand just how pervasive the impact of gun violence is.
And as surgeon general, when I’ve traveled around the country and talked to people, I’ve just been struck by how often the issue of gun violence comes up, particularly among young people. I think about the middle school students, for example, whom I’ve spoken to who tell me that they’re scared to go to school at times because they’re worried about a shooting. I think about the high school students in the Midwest whom I sat down with who told me that going for a walk in their neighborhood meant hearing gunshots all the time, and they worried each time they left their homes about their safety.
I even met a mom some time ago when I was on a trip as surgeon general, a mother who had tragically been at an event in a mass shooting where she had to run from the shooter, and she happened to be wearing flip-flops that day. From that day onward, whenever she leaves home, she hesitates to wear flip-flops because she worries that if she’s in another mass shooting, she won’t be able to run and get away from the shooter.
These kinds of experiences, they stick with you.
You hear things like that, and you realize that down to the basic decisions we make about whether we should go to the grocery store, what kind of shoes we should wear today, is it OK to go to church or synagogue this weekend — these decisions are being affected by gun violence. And so all of that has helped me understand over time that the pervasive impact of gun violence here is one that we should not underestimate or write off.
