In a landmark announcement, the U.S. surgeon general declared firearm violence a public health crisis in the nation Tuesday.

Dr. Vivek Murthy warned in the advisory that gun violence poses a “serious threat to the health and well-being of our country” that has not just a serious physical toll, but also a mental one.

It is the first time the government’s leading public health body has homed in on guns.

“As a doctor, I’ve seen the consequences of firearm violence up close in the lives of the patients I’ve cared for over the years. These are moms and dads, sons and daughters, all of whom were robbed of their physical and mental health by senseless acts of violence,” Murthy said in a video Tuesday.

The rate of firearm-related deaths reached a nearly a three-decade high in 2021 — driven by spikes in gun homicides and firearm suicides, according to the 40-page advisory.

It noted that in 2022, 48,204 people died from firearm-related injuries, including suicides, homicides and unintentional deaths. Of the firearm-related deaths in 2022, more than half, 56.1%, were from suicide, and about 40% were from homicide, according to the report.

“Unfortunately, the problem has continued to grow,” Murthy said, citing a statistic that 54% of adults in the U.S. report that they or a family member have experienced firearm-related incidents — whether they were personally threatened or injured by firearms, fired them, witnessed shootings or lost family members to gun violence. 

“Many of these harms are disproportionally felt in our communities. Black individuals endure the highest rates of firearm homicides, while suicide rates are highest among veterans, older white individuals and younger American Indian and Alaska Native people,” Murthy said.

Perhaps most jarring is gun violence’s effect on children —since 2020, it has been the No. 1 cause of death among children and adolescents, surpassing car accidents, drug overdoses and cancer.

“I have sat with parents who have lost a child to firearm violence. I have listened to their stories and felt their pain as they described the holes in their hearts. As a father, I know a parent’s worst nightmare is to lose a child, to feel like you can’t protect your child from harm,” Murthy said.

The advisory was met with backlash from the National Rifle Association.

“This is an extension of the Biden Administration’s war on law-abiding gun owners,” Randy Kozuch, the executive director of the National Rifle Association of America’s Institute for Legislative Action, its lobbying arm, said on X.  

“America has a crime problem caused by criminals,” Kozuch said. “The reluctance to prosecute and punish criminals on the part of President Biden and many of his allies is the primary cause of that. That’s a simple fact.” 

Guns — by headlines and numbers — are a very American problem.

In 2015, the rate of firearm-related deaths in the U.S. was 11.4 times higher than the rates in 28 other high-income countries, according to data from the Centers for Disease Control and Prevention and the World Health Organization. 

There are mental and emotional ramifications to firearm violence, as well.

The report said mothers who witness at least one shooting in their communities are up to 60% more likely to meet the criteria for depression. Siblings of children and adolescents who died from firearm injuries exhibited a 2.3-fold increase in psychiatric disorders. Mothers exhibited a 3.6-fold increase and fathers a 5.3-fold increase, according to the advisory.

Meanwhile, 51% of U.S. teens ages 14 to 17 say they worry “about a shooting happening at my school or a local school near me.”

The advisory seeks to tackle gun violence from a public health approach — similar to those used in the past to address cigarette smoking and decrease motor vehicle deaths.

It suggests increased federal investment in firearm violence research, community-based intervention and education programs, and encouraging health systems to talk with patients during routine medical visits about safe and secure firearm storage.

It also encourages policymakers to pass laws about safe storage, implement universal background checks, ban assault weapons and large-capacity magazines for civilian use, increase mental health care and implement effective firearm removal policies under extreme risk protection orders and domestic violence protection orders.

There are many such laws exist on the state level, but they have faced opposition to passing on the federal level. The Giffords Law Center, a gun violence prevention group that tracks state gun laws, says data shows “states with strong gun laws have fewer gun deaths.” 

Murthy’s advisory said: “A public health approach can guide our strategy and actions, as it has done in the past with successful efforts to address tobacco-related disease and motor vehicle crashes. It is up to us to take on this generational challenge with the urgency and clarity the moment demands. The safety and well-being of our children and future generations are at stake.” 

Major health communities and some lawmakers praised the effort.

The American Public Health Association said it “welcomes” the report, adding: “Gun violence is a major public health crisis — and is preventable. We call on all Americans to raise their voices and take action to end this devastating threat to health of our families and communities.” The American College of Surgeons said the principles of the advisory “closely align with our decades of work.”

Meanwhile, Gun Owners of America, a nonprofit lobbying organization that defends the Second Amendment, wrote on X that Murthy “abused his authority” in making the declaration.

Rep. Brad Schneider, D-Ill., said on X that the report “cements what we’ve long known” and that “now it’s Congress’s turn—we need to meet these findings with action.” Rep. Maxwell Alejandro Frost, D-Fla., said on X that “it’s time for Congress to take a public health approach to prevent the harm and trauma of this epidemic from devastating yet another life and community.”

Murthy called on Congress this month to require a tobacco-style warning for visitors to social media platforms. He called social media “an important contributor” to what has been described as today’s mental health crisis among young people. In his vision, the warning would include language to alert users to the potential mental health harms of websites and apps.