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U.S. Surgeon General’s Declaration: Embracing The Center’s Public Health Approach


For the first time, the U.S. Surgeon General has issued an advisory officially recognizing firearm violence as a critical public health crisis. 

The report outlines the devastating health impacts of firearm violence across the country. The advisory notes that while firearm violence is still near record high rates, it’s been particularly deadly among children and adolescents. Since 2020, firearm-related injuries have been the leading cause of death for youth ages 1-19, surpassing motor vehicle crashes, cancer, and drug overdose and poisoning.  

Much of the approach and recommendations in this landmark document were pioneered by the work of Johns Hopkins Center for Gun Violence Solutions, emphasizing evidence-based solutions to address the epidemic of gun violence. The Center believes implementing effective, evidence-based strategies can significantly lower gun violence. Our goal is to reduce gun violence 30% by 2030. That would equate to 14,400 lives saved from the more than 48,000 firearm deaths that occurred in 2022. The Center is pleased to see the surgeon general is aligned with the goals our research has promoted for decades. 

Embracing the Public Health Approach

The public health approach to addressing gun violence is a comprehensive strategy that focuses on prevention, intervention, and policy change to reduce the incidence and impact of firearm-related injuries and deaths. This approach is grounded in scientific evidence and aims to treat gun violence as a preventable issue rather than an inevitable part of society. 

A public health approach begins with understanding the scope of the problem through data collection and analysis. By tracking firearm injuries and fatalities, researchers can identify patterns and risk factors associated with gun violence. This data-driven method allows for the development of targeted interventions that address specific causes of violence within different communities. 

The programs and interventions to address behavior change laid out in the surgeon general’s advisory are a cornerstone of the public health approach. Policy change is also essential to the public health approach as it focuses on population-level strategies to reduce violence.  

Effective Solutions 

The Johns Hopkins Center for Gun Violence Solutions has long applied the public health framework to gun violence prevention. The rigorous and evidence-based research from the Center’s team has identified five key priority solutions shown to reduce gun violence. By focusing on comprehensive strategies that address the root causes of gun violence, we can develop solutions that are effective, sustainable, and equitable. The Center is very pleased to see the surgeon general highlight a number of these solutions in his advisory.   

Firearm Purchaser Licensing 

One of the primary policy recommendations of the surgeon general's advisory is the implementation of Firearm Purchaser Licensing. This strategy requires individuals to obtain a license before purchasing a firearm, which includes background checks, fingerprinting, and safety training.  

Research shows that states with strong licensing laws experience fewer firearm homicides, suicides, and mass shootings, highlighting the effectiveness of this preventative measure. 

For example, Connecticut’s firearm homicide rate was 28 percent lower and firearm suicide rate was 33 percent lower after implementing Firearm Purchaser Licensing. In contrast, Missouri repealed its version of the law in 2007 and experience a 47 percent increase in its firearm homicide rate and a 23 percent increase in its firearm suicide rate 

Risk-Based Firearm Prohibitions 

Another key recommendation in the surgeon general’s advisory is implementing risk-based firearm prohibitions such as Extreme Risk Protection Orders (ERPOs) and Domestic Violence Protective Orders (DVPOs). These policies involve restricting firearm access for individuals who have exhibited behaviors indicating a heightened risk of violence, such as those with a history of domestic violence or who are a threat to harming themselves or others. Such prohibitions are designed to prevent potential tragedies by temporarily removing firearms from individuals in crisis. 

Ensuring that domestic abusers are prohibited from possessing firearms is essential to saving lives. Nearly half of all women murdered in the United States are killed by a current or former intimate partner. More than half of those homicides are by firearm.  

Risk-based firearm prohibitions go beyond preventing domestic violence from turning deadly. Evidence suggests, if implemented properly, both ERPOs and DVPOs can prevent mass shootings and other gun violence. One analysis found that 10 percent of nearly 6,800 ERPO cases involved the threat of mass violence. A separate study found 68 percent of mass shootings from 2014-2019 involved a perpetrator who either killed family or intimate partners or had a history of domestic violence.  

Safe Firearm Storage 

Safe firearm storage practices are essential to prevent unintentional injuries and unauthorized access to firearms, particularly by children. The surgeon general's advisory underscores the importance of secure storage solutions, such as gun safes and lockboxes, and public education campaigns to raise awareness about the risks of improper firearm storage. While in many states, safe storage is essentially a personal choice, lawmakers can institute policies such as Child Access Prevention laws that impose criminal liability on adults if a child gains access to an unsecured firearm or the gun is stored in a manner where a child is likely to gain access to it. Criminal penalties can encourage gun owners to use proper firearm storage, which means locking unloaded firearms separate from ammunition.  

Properly storing firearms and ammunition is a simple way to keep guns out of the wrong hands, preventing both firearm suicide and theft. Child Access Prevention laws are associated with an 8% decrease in youth suicide rates. In addition, one estimate found approximately 380,000 guns are stolen every year. This can widely be attributed to improper storage practices. In a nationally representative survey, more than half of U.S. gun owners said they do not store their firearms properly. This is a simple step all gun owners can take to save lives.  

Regulation of Public Carry of Firearms 

Regulating the public carry of firearms is also emphasized in the advisory. Policies that limit where and how firearms can be carried in public spaces are critical in reducing the likelihood of gun violence in crowded and vulnerable areas. These regulations help ensure that firearms are carried responsibly and only by those with proper training and qualifications. 

Increased rates of public carry of firearms are associated with more shootings by police, firearm workplace homicides and violent crime overall. A 2023 study conducted by Center faculty found significant increases in firearm assaults in states that relaxed concealed carry permit restrictions. The research team examined what happened when 34 states weakened restrictions on concealed carry. They found that weakening of state concealed carry laws was associated with a 9.5% increase in firearm assaults. 

Community Violence Intervention 

The surgeon general’s advisory also advocates for community violence intervention (CVI) programs. These initiatives focus on preventing violence through outreach, conflict mediation, and support services for at-risk individuals. CVI programs have proven successful in reducing gun violence in various communities by addressing the root causes of violence and providing alternatives to criminal activity. Our Center advocates for states and municipalities to increase funding for these initiatives shown to be effective. 

Various forms of CVI are associated with substantial decreases in violence. For example, after Milwaukee instituted a homicide review commission, the city saw a sustained 52 percent reduction in homicides. Limiting urban blight and reinvigorating historically disinvested communities can also save lives. Research found programs that clean and rehabilitate abandoned properties are associated with a 39 percent lower gun violence rate.  

Promise for the Future 

The U.S. surgeon general's advisory on firearm violence as a public health issue represents a significant step towards addressing the gun violence epidemic in the United States. By following a public health approach long endorsed by the experts at the Center and advancing effective, evidence-based strategies, the surgeon general has shown he is amplifying our work to create a safer future for all Americans.