The nation’s top doctor said the United States is “falling short” in protecting the public health of children and adolescents from the impact of social media and firearm violence — and both are areas where he wants Congress to take additional action.

Surgeon General Vivek Murthy is no stranger to the task of influencing the federal government’s public health priorities and the nation’s understanding of the biggest public health issues.

Between his tenure as surgeon general in the Obama administration from December 2014 to April 2017 and his current role under President Joe Biden since March 2021, he’s had one of the longest careers as surgeon general since the 1950s — more than five and half years.

The surgeon general job has taken different forms over the years, with some physicians serving more as an advocate for healthy behavior and others pushing novel and sometimes controversial policy changes.

The late C. Everett Koop gained prominence in the Reagan administration for a surgeon general report recognizing that nicotine could be as addictive as cocaine and heroin and spearheading a mass mailing to all households educating about AIDS. Under President Bill Clinton, Joycelyn Elders was forced to resign over her comments on sex education.

Murthy has straddled that line, offering increasingly bold proposals in his effort to tackle the youth mental health and loneliness crisis. 

“It became increasingly clear to me during my first term as surgeon general that the mental health challenges we faced were far bigger and deeper than we were acknowledging as a country and certainly than we were responding to,” Murthy said this week in an interview.

This year he has issued two calls to action — both met with mixed reception from industry and the broader health community — tackling the impact of social media on youth mental health and reducing the public health impact of firearm violence.

“Our most sacred responsibility as a society is to take care of our children, and when it comes to protecting them from the harms of social media and gun violence, we are falling short, and we’ve got to do better,” Murthy said. “The ripple effects are extraordinary for anyone who has had a child in their life.”

His priorities have shifted since his first Senate confirmation in 2014, and many of his ideas are shaped by the ongoing conversations with community members that he began having after taking the job. Some of those conversations inspired the first federal report on electronic cigarettes in 2016, he said.

Murthy joined the Biden administration in the middle of the COVID-19 pandemic. Even amid that crisis, he said he understood that loneliness and isolation from the pandemic could have wide-ranging mental health implications.

“We’ve got to approach these issues with the urgency that they deserve,” Murthy said. “Our problem is not a lack of good ideas, it’s the will to implement those ideas and to ultimately protect our kids.”

Social media 

Murthy published an editorial in the The New York Times on June 17 calling for social media companies to use warning labels illustrating the adverse effects the platforms can have for youth. The call to action also advised Congress to take steps to reduce online harassment and exploitation of children and adolescents online and echoed an advisory he had issued the prior year.

His 2024 push ultimately came with congressional backing: The Senate passed its package of two children’s online safety bills last month, 91-3, despite some industry objections.

Numerous lawmakers have cited Murthy’s guidance and his op-ed in their support for the package and the need to take action. Murthy called the congressional action “really important steps forward,” but he cautioned against drawing early conclusions on the impact. 

“History is full of well-intended measures that didn’t have the full impact that they needed to have,” he said. “Until we have data that shows us that the ultimate changes that are being made are resulting in a safe environment for our kids and technology that is safe for our children to use, then our job won’t be done.” 

By contrast, the House has faced obstacles advancing its companion bills. The Energy and Commerce Committee canceled a June 27 markup of an online privacy bill after it received opposition from tech companies and some LGBTQ advocacy groups.

It’s unclear whether the House will take up the Senate version after the August recess, but Murthy stressed the urgency of the problem.

“I certainly would welcome the opportunity to keep working with legislators as they fashion solutions. With that said, what’s really important is time here,” he said.

But the surgeon general stopped short of saying whether he would advocate for House passage of the Senate-passed legislation.

“When legislators have questions and need technical assistance, you know, we’re always happy to help them,” he said, adding that he’s spoken to members of Congress from both chambers about his advisories and calls to action related to social media.

“It’s taken us long enough as a country to take the steps that we’ve already taken from a legislative perspective,” he said, “and we have to get the job done.”

Firearm violence

Murthy has likened strategies to mitigate the impact of gun violence to the adoption of seat belts and airbags in automobiles.

Both safety features were initially underused, and the automotive industry lobbied against requiring them. But both are now required under federal law and greatly reduce the risk of automobile fatalities.

“The political polarization that we see around gun violence often obscures how much agreement there is in the general public about measures that have to be taken,” said Murthy, who thinks people can unite around a shared concern about the mental and physical consequences of children whose families experience gun violence.

His office released an advisory and report on the public health threat of gun violence on June 25, shortly after calls from advocates on the issue.

According to the report, the federal government spent $878 million researching motor vehicle crashes in children and adolescents between 2008 and 2017. In that same period, the federal government spent $12 million on firearm injury prevention research — money spent through the National Institutes of Health and the National Institute of Justice. 

“We have a long way to go for Congress to raise the level of funding for gun violence to what’s actually needed to help us understand more about the factors that are contributing to gun violence, understanding who is most deeply affected, to understanding what solutions work and are most effective, and hence need to be scaled up further,” Murthy said.

Congress allocated new funding specifically for gun violence research at the Centers for Disease Control and Prevention and the NIH for the first time in decades for fiscal 2020. Murthy said he was “encouraged to see Congress allocate some funding for gun violence research” but that the government was still “massively underfunding research” on the issue.

He said there’s a lot more that researchers still need to understand to ensure that gun violence prevention programs are effective.

“And all of that requires funds, funds that can’t be entirely provided at the scale that’s needed by the philanthropic sector, but that really need [the] government to step in,” he said.

But increasing federal funding for that research is likely a hard sell with lawmakers. The House and Senate have proposed vastly different topline numbers for Labor-HHS-Education spending in fiscal 2025, and the inclusion of any money for firearm violence-related research is a sticking point for some Republicans.

Congress did come together in 2022 on a bipartisan gun control and mental health law, the first such compromise since the assault weapons ban in 1994.

But smaller endeavors haven’t made headway.

Murthy sees the key to changing attitudes about funding this research as taking a cue from Congress’ speed and efficiency in passing broad COVID-19 relief in 2020.

“Congress moved during a complicated year to get resources to families and to communities and to put measures in place to help accelerate vaccine development,” he said. That, in combination with action in 2021, resulted in billions of dollars for schools to reopen safely.

“We can move when there is an urgent threat that we’re facing, and gun violence represents one of those threats,” Murthy said. “It may not feel as urgent, given how desensitized sometimes we become to stories about gun violence, but the truth is, the urgency is still there.”  

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