Earlier last month, United States Surgeon-General Vivek Murthy declared gun violence a public health crisis. To bring gun deaths under control, Murthy recommended a slew of measures, including an assault weapon ban, background checks, and restrictions on guns in public spaces. It’s an important declaration amidst a frustrating lack of progress on gun violence. On the other hand, given the politicization of gun violence and the upcoming election, it's also easy to dismiss as politically motivated.
Crime, mass shootings, and other gun-related issues are on the rise in the United States. With over 42,000 gun-related deaths recorded in 2023 alone, the US is more affected than any other developed nation. Among American children and teens, gun violence has been the leading cause of death since 2020, surpassing car accidents, cancer, birth defects, and pneumonia.
Gun violence is on the rise in the United States. Source
Even so, in a nation where over 80 million civilians own some 393 million firearms, the declaration is bound to stir up controversy. In elections, the ruling Democratic and Republican parties find little common ground on the issue, putting the government in a deadlock. For decades, little helpful legislation has been passed. Meanwhile, people continue to be shot down in the streets of American cities and in the halls of American schools. The news is filled with so many scenes of violence and grieving families that many Americans are now desensitized to gun violence. This has left many wondering: how did things get to this point?
The Issue
Out of the many threats within the scope of public health, few are as complex or controversial as gun violence. While gun deaths have always happened, recent years have been unusually bad, even for the United States. One contributing factor is the Opioid epidemic. This is not the first time drug use has led to a gun violence uptick: another example was the rise of crack/cocaine in the 1980s and 1990s. These spikes largely happen because illegal drugs lead to increased competition and conflict, which in turn leads to violence that easily spreads beyond drug markets. The hardest hit areas will be poor communities, but the entire nation will eventually feel the effects.
After years of rising violence, the arrival of the COVID-19 pandemic in 2020 finally pushed gun deaths to an all-time high (although per capita deaths remained slightly below levels seen in the late 20th century). As the world went into an unprecedented lockdown and COVID slammed vulnerable communities, mental health and social services took a serious hit. The pandemic also disrupted drug markets and put many in dire economic straits, amplifying existing contributors to gun violence to an extreme.
Drugs are a major contributor to gun violence.
Tackling the current gun crisis is difficult because the root causes are varied, ranging from socioeconomic factors and mental health issues to domestic violence and systemic inequalities. For example, urban areas often experience higher rates of gun violence, correlating with poverty, unemployment, and limited access to education and healthcare. However, that does not mean rural areas are immune, particularly with regard to suicides, which make up a significant proportion of gun deaths.
Above all, America has a unique gun culture that makes combating violence all the more complicated. That culture was baked into the supreme law of the land in 2008 when the US Supreme Court ruled in District of Columbia v. Heller that the 2nd Amendment of the US Constitution gave Americans the right to carry guns for self-defense.
The 2nd amendment's protections are ideas that date back to the birth of the nation, when state militias were considered vital for security, alongside a central military. However, it wasn't legally clear until DC v. Heller whether the law actually protected the right of the broader public to own guns. In a country where many consider restricting firearms the only way to control the rising death toll, the Supreme Court’s ruling makes such restrictions a potential infringement on key liberties. As such, policymakers have a limited range of options when it comes to fighting gun violence.
Easier gun ownership makes gun crime easier, but bearing arms is also a key American right.
What Constitutes a Public Health Crisis
A public health crisis is a situation where a population's health is at significant risk. They therefore often require population-level interventions to prevent widespread illness and death. Though usually associated with drugs or infectious diseases, the term is broader than most think. In the case of gun violence, the underlying issues require similar solutions to other public health issues, such as research, community engagement, education, and policy reform.
Because gun violence has killed at epidemic proportions for decades, Surgeon-General Murthy’s declaration is actually considered late by many experts. In recent years, numerous health organizations, including the American Medical Association (AMA) and the American Public Health Association (APHA), have declared gun violence a public health crisis.
The relevance of gun violence to public health is clear. However, it is indeed a much more political issue than most other public health crises. America’s liberals and conservatives are currently extremely polarized on the topic, and views on guns have become an integral part of people’s political identities. That doesn’t mean that gun violence isn’t a public health crisis, just that political infighting will create more bumps in the road to a solution.
Fighting the Crisis
The first step in tackling such a threat involves studying its patterns, causes, and effects. That way, risk factors can be identified and interventions formulated based on evidence. Unfortunately, this type of research on gun violence is easily stifled. Gun rights defenders often accuse researchers of political advocacy, depriving them of funding. Laws like the 1996 Dickey Amendment have effectively halted federal research funds by prohibiting their use for promoting gun control. However, the situation has improved in recent years. Research funding by US government agencies like the CDC has increased and public interest has skyrocketed.
While the public health declaration does seek to reframe this issue, it doesn't mean that politically controversial measures discussed in the past are being done away with. More politicized interventions are still necessary. This may include a wide range of laws, including increased background checks, red flag laws, and bans on high-capacity magazines and assault weapons.
Beyond gun regulation, there is of course law enforcement. Many are quick to think that funding police departments will reduce crime, but research indicates a lack of correlation between police spending and gun violence rates. In fact, many actions by the police only aggravate the conditions of vulnerable police. It's never as simple as banning more guns or deploying more cops. In this case, more focused actions, rather than broad measures such as stopping and searching people on the streets, could achieve better results than simply hiring more officers.
Addressing gun violence from a public health standpoint also requires interventions that go beyond gun regulation, incorporating mental health services, education, economic support, and community engagement. One example is Cure Violence, an organization that treats violence as a contagious disease like Measles or Polio and employs "violence interrupters" to mediate conflicts. Such initiatives have shown promise in reducing violence in high-risk communities but could save far more lives if implemented on a larger scale.
The Mental Health Angle
Given the simultaneous post-pandemic rise of mental health issues in the US, mental healthcare could be an area for less politicized interventions. The perpetrators behind gun violence often have histories of mental illness and lack of proper treatment. Staunch gun rights advocates are especially quick to point out that shooters are the problem, not guns. So what easier measure is there than to improve mental health?
Given that over 20% of Americans suffer from mental illness, better mental health measures could have a major effect on gun violence and countless other issues. Unfortunately, this is easier said than done, especially in the US. Currently, 28% of adults with mental illness report being unable to access treatment. Mental health services are often uninsured, and the cost of treatment is the primary obstacle to treatment for millions of Americans. Meanwhile, discriminatory attitudes linger about mental health, making it even harder for sufferers to seek help. With a topic so intimate and taboo, talking to a stranger for help, even when that stranger is a medical professional, can be suffocating for those who are already unhealthy.
Gun violence is a far larger issue than it should be, but not because of a lack of ideas or tools. Given the state of other developed nations, the United States should stand out for its low rates of gun violence, not the other way around. Whether, the Surgeon General's declaration itself is a shallow political gesture or not, a bigger role for public health is a step in the right direction. Unfortunately, there is a long way to go.
Very good analysis on a complicated topic