The top American doctor has declared gun violence a public health crisis.

The announcement is driven by the fast-growing number of injuries and deaths involving firearms in the country.

The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.

Then-President Donald Trump dismissed Murthy in 2017, but President Joe Biden nominated Murthy again to the position in 2021. At his second confirmation hearing, he told senators that declaring guns a public health crisis would not be his focus during a new term.

But he has faced mounting pressure from some doctors and Democratic advocacy groups to speak out more. A group of four former surgeon generals asked the Biden administration to produce a report on the problem in 2022.

“People want to be able to walk through their neighborhoods and be safe,” Murthy told The Associated Press in a phone interview. “America should be a place where all of us can go to school, go to work, go to the supermarket, go to our house of worship, without having to worry that that’s going to put our life at risk.”

To drive down gun deaths, Murthy calls on the U.S. to ban automatic rifles, introduce universal background checks for purchasing guns, regulate the industry, pass laws that would restrict their use in public spaces and penalize people who fail to safely store their weapons.

None of those suggestions can be implemented nationwide without legislation passed by Congress, which typically recoils at gun control measures. Some state legislatures, however, have enacted or may consider some of the surgeon general’s proposals.

Murthy said there is “broad agreement” that gun violence is a problem, citing a poll last year that found most Americans worry at least sometimes that a loved one might be injured by a firearm. More than 48,000 Americans died from gun injuries in 2022.

His advisory promises to be controversial and will certainly incense Republican lawmakers, most of whom opposed Murthy’s confirmation — twice — to the job over his statements on gun violence.

Murthy has published warnings about troubling health trends in American life, including social media use and loneliness. He’s stayed away from issuing a similar advisory about gun violence since his 2014 confirmation as surgeon general was stalled and nearly derailed by the firearm lobby and Republicans who opposed his past statements about firearms.

Murthy ended up promising the Senate that he did “not intend to use my office as surgeon general as a bully pulpit on gun control.”

“It is now time for us to take this issue out of the realm of politics and put it in the realm of public health, the way we did with smoking more than a half century ago,” Murthy told the AP.

A 1964 report from the surgeon general that raised awareness about the dangers of smoking is largely credited with snubbing out tobacco use and precipitating regulations on the industry.

Children and younger Americans, in particular, are suffering from gun violence, Murthy notes in his advisory called “Firearm Violence: A Public Health Crisis in America.” Suicide by gun rates have increased significantly in recent years for Americans under the age of 35. Children in the U.S. are far more likely to die from gun wounds than children in other countries, the research he gathered shows.

In addition to new regulations, Murthy calls for an increase on gun violence research and for the health system — which is likely to be more amenable to his advisory — to promote gun safety education during doctor visits.