The U.S. surgeon general has issued an unprecedented warning about the deadly and far-reaching effects of gun violence, a move that could draw resources to the issue and influence public policy.

Dr. Vivek Murthy’s advisory on June 25 marks the first time that the Office of the Surgeon General has issued a publication focused on gun violence, an epidemic that claimed more than 48,000 lives in the United States in 2022, the latest year for which complete data is available.

Over 32 pages, Murthy labels gun violence an “urgent public health crisis,” pointing to an increase in gun deaths and injuries over the past two decades and to cascading effects — including trauma and other mental health issues — that spread beyond those who are wounded or killed. 

Historically, the surgeon general has reserved advisories for significant public health challenges that “demand the American people’s immediate attention.” Murthy noted a recent national survey that found that more than half of U.S. adults reported that they or their family members have experienced gun violence — by being threatened with a gun, witnessing a shooting, being shot themselves, shooting in self defense, or losing a family member to gun violence. 

“There are many experts and leaders who work tirelessly each day to protect families and communities from the trauma and suffering that have become all too common in our country,” the advisory reads. “But it will take more — the collective commitment of the nation — to turn the tide on the crisis of firearm violence in America.”

The advisory comes a year and a half after The Trace first reported that a group of former surgeons general had called on President Joe Biden to direct Murthy to issue a report on gun violence. 

“There is little question that firearm violence is a public health crisis,” the former surgeons general wrote at the time. “And yet, unlike for homelessness, opioids or other determinants of health, there has never been a U.S. Surgeon General’s Report on gun violence in America. Not one.”

The advisory is not a full Surgeon General’s Report. In an advisory, the surgeon general and his staff review available scientific evidence and provide recommendations for how the issue should be addressed. A report is a longer, comprehensive review prepared by experts on behalf of the surgeon general. 

Both advisories and reports are often landmark publications with the potential to influence public policy and resource allocation, and rally public attention. The first modern Surgeon General’s Report, released in 1964, concluded that cigarette smoking was a cause of lung cancer. That report and more than a dozen follow-ups led to national efforts that helped cut smoking rates by nearly two-thirds. 

Since the 1980s, several reports have studied HIV, suicide, and mental health, and at least one examined youth violence, though not exclusively gun violence. 

In May 2023, Murthy issued an advisory about the effects of social media on youth mental health, leading to calls for policy changes to better protect young people online. Last week, Murthy called for warning labels on social media platforms to advise parents that social media is potentially damaging to the mental health of teenagers.

The gun violence advisory found that the rate of firearm-related deaths in the U.S. has been rising and reached a near three-decade high in 2021, driven by increases in homicides over the past decade and suicides over the past two decades. Children and young people in particular have experienced a “staggering increase.” 

“The increasing number of children and adolescents dying from firearm-related injuries and the reverberating mental health impacts on society make firearm violence an urgent public health crisis in America,” Murthy wrote.

An infographic included in the Office of the Surgeon General’s June 25 gun violence advisory.

The report does note that after the spike in violence in 2020 and 2021, gun homicides declined in 2022, according to data from the Centers for Disease Control and Prevention. Provisional CDC data shows homicides decreased in 2023, and data from police departments and other sources indicates that the decline was historic. Suicides, however, have not declined.

“It’s good to see the surgeon general recognize this problem, its magnitude, and the enormous impact that it has on health,” said Daniel Webster, a researcher at the Johns Hopkins Center for Gun Violence Solutions.

The surgeon general does not have the authority to enact significant policy changes himself, but his recommendations do influence hospitals, local and state health departments, and other government agencies as they make policy. 

“For years to come, people will look at this document,” Webster said. “It is a path to take to have lower rates of gun violence. I also am realistic enough to know that there will be parts of the country and parts of the political spectrum that will ignore it at best, and at worst, try to discredit it.”

Citing past research, the advisory describes layers of harm for families and communities, including collective trauma and fear that affect mental health and well-being. Socioeconomic and racial inequities play a role, as does the availability of firearms. The advisory notes: “The presence of a firearm in the home has been associated with higher risk of being a victim of homicide and suicide among all household members, and an unlocked firearm in the home is associated with higher risk of suicide and unintentional firearm injury among children and adolescents.”

Murthy lays out an approach to mitigate gun violence by drawing on successful strategies used in other public health crises, like smoking and motor vehicle deaths. The advisory highlights the need for increased research funding, data collection, community violence intervention programs, and safe firearm storage education.

Murthy also calls for better access to affordable mental health care and substance use treatment, and throws his support behind certain legislative measures, including banning assault weapons and expanding background checks to all gun sales.

“It is up to us to take on this generational challenge with the urgency and clarity the moment demands,” the advisory reads. “The safety and well-being of our children and future generations are at stake.”