Surgeon General's Warning

Guns are hazardous to your health

Surgeon General Joycelyn Elders's crusade to promote health education and awareness encompasses the "epidemic," as she calls it, of gun violence. Frank and opinionated, she told us what Americans need to do--now.

Q: The National Centers for Disease Control and Prevention recently said that gun-related deaths and injuries make gun violence one of the major public-health hazards in the country. Do you agree?

A: Yes, I do. Homicide, often involving guns, is a disease that is the leading cause of death for young black men, and the second-leading cause of death for all people aged fifteen to twenty-four. That makes it the leading health issue, particularly when guns are used in combination with drugs and alcohol. And the statistics show that is most often the case. Guns kill more teenagers than the other big killers--heart disease, cancer, and AIDS--combined.

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Q: What does that tell you about America?

A: That tells me, first of all, that guns are far too accessible and too readily available. There are over 200 million guns in our society--and that's just the legal ones, the ones we know about. Every ten seconds, another gun is produced. And every fourteen minutes, some person in America dies from gun-inflicted action.

Q: Your two predecessors, Doctors Koop and Novello, had good intentions as surgeons general. In Koop's case, he was shunned by Reagan, who didn't want to acknowledge AIDS. And one always felt that Novello's heart was in the right place but that she never had George Bush's ear. How do you intend to use your position?

A: I've pretty much always used my positions as a bully pulpit. What that means is strongly advocating for the things I feel are really important. Gun violence, to me, is the highest-priority public-health issue, and I have to make sure Congress is aware of it, the American people are aware of it, the president is aware of it, and that we all

begin together to develop policies to exterminate the disease--the epidemic, really--of gun violence.

One of my favorite sayings is, "When you're dancing with a bear, you can't get tired and sit down. You wait until the bear gets tired, then you sit down." Now I want you to know that this old dancer is getting real tired, and I'm ready to recruit some new partners to dance with the bear so we can eliminate the horrors created by gun violence.

Q: Have you often spoken to the president about the gun-related health crisis? He's mentioned it in several speeches when promoting his health-care package.

A: The president came into office pretty well educated about a lot of these issues. Don't forget, I'd had five-and-a-half years to work on him (laughs).

Q: A recent National Rifle Association president said, "All guns are good guns. There are no bad guns. The whole nation should be an armed nation." How do you handle that?

A: That's a very irresponsible position. I don't know how anybody can say that who looks at what's happening to our young people and what's happening to our country, all because of guns. The NRA is putting themselves in a position where people will no longer trust them. They've been trusted in the past, but now their credibility is on the line.

Who is the NRA anyway? They are usually middle-income people who only think of themselves, who want to have no government, really, except self-rule by themselves. I think that little cracks are starting to emerge in the NRA armor.

Q: When President Clinton presented his health-care bill, he proposed a seventy-five-cents-per-pack tax increase on cigarettes to help pay for the plan. Is it too much to equate the dangers of cigarettes and the dangers of guns by putting a hefty tax on handguns and bullets, as Senator Moynihan has proposed?

A: I absolutely would support that. I think we should have a very, very heavy tax on handguns and on bullets.

Q: Are you going to tell the president that?

A: I think he's already heard that.

Q: Are you going to push him on it further?

A: Well, we're going to work on that.

Q: I'll take that as a yes, yes?

A: Understand that I can't get out ahead of the president. Now, you have to realize that.

Q: Along the same lines, one of your predecessors, Luther Terry, pushed Congress to enact the first health warnings on cigarette packaging, wording that has gotten stronger in the years since. How about the same thing for guns? Something like, "Warning: keeping a gun in your home makes you three times more likely to become a homicide victim," which is true.

A: I know it is. Certainly we have to find some kind of warning to put on guns for sale. And that's not too far-fetched. But what I really want to do is take the guns out of the hands of irresponsible people.

Q: You want to make it harder to possess guns?

A: Oh, absolutely. I want to make it as hard as possible. I support a total ban on handgun ownership for anyone under eighteen. Uzis should be absolutely banned from entering this country. Automatic weapons of any kind should not be for sale in America. For that matter, toy Uzis should not be available for kids, either. There would be a minimum seven-day waiting period between applying for a gun permit and obtaining a gun.

Q: What's the rush? Why not a month?

A: I'm being generous. We can always look at lengthening it later. Nobody with a criminal record would ever be allowed to buy a gun. All assault weapons would be banned, completely. And everybody who still possesses a gun license would receive mandatory education and training by professionals on how to handle a gun. After all, I can't drive my car until I pass a test proving I know how to handle a car. Gun owners would have to be evaluated by how they scored on their written and firing tests, and have to pass the tests in order to own a gun. And I would, as I say, tax the guns, bullets, and the license itself very heavily.

Q: What can you, as surgeon general, do to help?

A: What I can do is to go out and talk about the problems and solutions, make people aware of the scope of the problems, get them to become advocates for a turnaround, and convince them to develop an action plan, targeted to their community, to deal with young people. [They need to] find out what the kids want to do--dances, midnight-basketball leagues.

We can begin to address the issue of guns by teaching our young people how to deal with situations in nonviolent ways. Someone said to me the other day, "What our adolescents need is not so much health care, but healthy caring," and I agree. Parents and churches need to provide that. Curricula in our schools [need to] provide that.

Q: Isn't that putting an awfully big burden on already shaky school systems?

A: If I had anyplace else to put it, I would. I feel that we can't educate children who are not healthy, and we can't keep them healthy if they're not educated. There has to be a marriage between health and education. You can't learn if your mind is full of unhealthy images from daily life and confusion about right and wrong.

Q: As a longtime advocate of early sex education and condom use for teenagers to reduce unwanted pregnancies, what do you believe is the relationship between unwanted children and gun-related violence?

A: We know that there are several predisposing factors to gun violence: poverty, lack of education, lack of good parenting, lack of jobs, living in an environment where violence is seen every day, all the time. And children being born to children are likely to have all of these predisposing factors.

Q: Did you ever think that your job would take you from dealing with only Arkansas's problems to those of the entire nation?

A: No. Ten years ago, I had done everything that Joycelyn Elders ever thought she would do and wanted to do. I was a doctor, I was a professor, I'd been president of all the important academic clubs. [But now] my biggest challenge is to educate the American people, to make access to health care available for all, and to make sure that prevention plays a big part in health care. In the case of guns, prevention means we prevent homicides and devastating, expensive gun injuries by preventing those who shouldn't have guns from getting their hands on guns. [We must] deal with all of the contributing factors to gun violence as a whole, because it's like a leaky bucket--if you've got a bucket with six holes shot through it, [and] you plug up five, you've still got a leaky bucket.

Ken Kelley is a freelance writer for national magazines.