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Vivek Murthy, gun politics and public health

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US Senate meeting room. (US Government image)

Vivek Murthy, President Barack Obama’s nominee for Surgeon General of the United States, would be, if confirmed, the youngest holder of the post in history. A 36 year old physician at the prestigious Brigham and Women’s Hospital in Boston, Murthy has impeccable credentials and an impressive record of accomplishment in medicine and public health. He would also be the most visible spokesperson for health care issues and public health in the American government.

Unfortunately for Murthy, a powerful group has taken an interest in derailing his candidacy. Worse still for his chances, that group is the 5 million-strong National Rifle Association (NRA).

Health, politics and… guns?

The NRA is an unusual entrant into the nomination process for Surgeon General, normally a low-stakes affair. The group – which bills itself as the country’s oldest civil rights organisation – focuses almost all of its considerable budget and lobbying efforts on opposing new gun control measures. The NRA took credit for – and was undoubtedly  influential in – the blocking of proposed federal gun control measures that the vast majority of Americans supported after the Sandy Hook school massacre.

The NRA doesn’t object to Murthy’s qualifications, his experience or his youth. Instead, they seem mostly concerned about his Twitter updates from two years ago:

Vivek Murthy

Murthy isn’t the most outspoken gun control advocate in the country. He’s not even the most outspoken medical figure on the subject. During his Senate confirmation hearing, he said, “I do not intend to use the surgeon general’s office as a bully pulpit for gun control. My priority and focus is going to be on obesity prevention.”

But Murthy has called for moderate new gun control measures, both on Twitter and in an open letter to Congressional and administration officials after the Newtown massacre. And for the NRA – and, it appears, for a growing number of Senators who either support the group or fear it – that is simply too much.

As a result, Murthy’s confirmation has gone from a sure thing to a toss-up. Though he made it through the first stage – recommendation to the full Senate by the Committee on Health, Education, Labor and Pensions – there seems to be doubt about his chances in the full Senate. In theory, the 55 Democratic Senators should be able to confirm him easily, given that only 51 votes are needed. But Democratic Senators up for re-election in November from more conservative states are wary of running afoul of the gun lobby, which has a history of decisive intervention in elections.

Guns are a public health issue

Quite frankly, Dr Murthy has a point in his assessment that gun violence is a public health issue.

Since 1970, an average of almost 33,000 Americans a year have died from firearms injuries – homicide, suicide and accident. Any issue causing 33,000 deaths a year is, in and of itself, worthy of medical attention, but the impacts of gun violence are not limited to that stark figure.

What certainly, incontestably, is a public health issues is the much greater number of people are injured non-fatally by firearms – 78,622 in 2008, according to research conducted by the University of Pennsylvania. Those injuries should not be dismissed. According to the Surviving Gun Violence Project:

“In most contexts, in addition to physical injuries, trauma and mental health problems resulting from gun violence can be severe. These include flashbacks (reliving or remembering the event), involuntary memories, nightmares, dissociative states, or physiological and emotional arousal or withdrawal.”

These injuries are lasting and significant. They impose significant costs – emotional, physical, financial and psychic – on survivors, their families, emergency responders and witnesses. These costs are not a special, privileged category; nor are they a fixed cost for a free society. Like other types of premature violent death and injury such as road traffic accidents, they can be reduced by carefully crafted and implemented regulations.

They must also impose a major cost on America’s health care system.  On nurses’ and doctors’ time. On others who are forced to wait for treatment because a gunshot wound has taken priority in the trauma unit. On blood bank levels.  On patient beds. On insurance premiums.  The list goes on and on.

And yet there are significant, self-imposed restrictions on the government’s ability to fund or conduct research on what the full extent of these costs are, and how best to address them.

Dr Murthy is acting as a responsible medical doctor and scientist in asking that those restrictions should be lifted, and the NRA is impeding the basic processes of good public policymaking in opposing him.

But there is a broader issue with the NRA’s anti-Murthy activism as well.

Everything is about guns now

The Murthy confirmation fight demonstrates that the borders of the debate over gun policy are expanding. In a better world, that expansion would entail a broader examination of the harms of gun violence, and a more rational conversation about the balance between public safety and gun ownership.

In this one, it means the NRA is on the offensive.

In recent years, the NRA and its allies have broadened their reach. Where once the gun lobby was focused entirely on proposed national legislation, it has become involved in a much greater range of policy debates. Expanding into the realm of foreign policy, the NRA opposed the Arms Trade Treaty and succeeded in halting its ratification. Across dozens of states and hundreds of municipalities, the NRA and its affiliates have succeeded in expanding concealed-carry laws, blocking attempts to disarm perpetrators of domestic violence and expanding the controversial Stand Your Ground concept of self-defence. In some cases below the federal level, the NRA has succeeded in advancing virtually all of its causes at once.

Guns, in other words, are colonising the national conversation. The overarching debate over 2nd Amendment rights and the use of force by private individuals is a legitimate one; and certainly more research needs to be done to quantify the relationships between firearms and the harms of armed violence.

But the attempt to block Vivek Murthy’s confirmation for advocacy of limited gun control measures and better data gathering should not be part of that debate. Instead, the campaign against him should be vigorously and forthrightly opposed and shown for the naked political tactic that it is.

 

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