Sharp rises in gun violence are rooted in economic inequality and decades of systemic racism. The crisis deserves a public health response on par with that of the coronavirus.
We are emergency physicians in two of the busiest trauma centers in the country. We have witnessed first-hand the rise in gun violence this summer. We have also witnessed first-hand another unprecedented epidemic—COVID-19.
The fear, the blood, and the haunting family discussions related to gun violence are, sadly, part of our practice. But the pace of injuries and deaths is increasing. The hopelessness of these traumas is compounded by our exhaustion from this spring, when our rooms were full of patients gasping for air not from a gunshot wound, but due to severe COVID. The fear and frustration of our staff and our patients is palpable.
Gun-related deaths have skyrocketed to unprecedented levels, making it impossible to ignore any longer. This is occurring while our nation sees staggering death tolls due to COVID-19, as widespread protests against deaths of Black men and women at the hands of police continue, and as firearms become a more frequent presence at these protests. All of this is taking place in the context of an upcoming election. It is also taking place amid joblessness, lost income, loss of health, and loss of loved ones due to the COVID-19 pandemic. This has, in turn, heightened feelings of anxiety, grief, despair, and hopelessness, only further adding fuel to the fire of violence.
There are clear parallels between the rise in gun violence and the rise of COVID-19. Most strikingly, both gun violence and COVID-19 have claimed a disproportionate number of Black and brown lives when compared to white Americans. For example, in Chicago, the COVID-19 death rate for Black people is nearly two-and-a-half times higher than that of white people, and the death rate for Latinos is nearly twice as high as whites. Similarly, Black men are approximately 20 times more likely to die of gun-related homicide than white men of the same age.
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The rise in both coronavirus cases and gun violence this summer are also driven by similar underlying causes. COVID-19 may be caused by a virus, and firearm deaths by a gun. But at their core, the spread of each epidemic has similar root causes: lack of choice, pervasive economic inequities, lack of hope, and the fear of a loss of freedom.
For centuries, researchers and medical professionals mistakenly attributed poorer health outcomes of Black Americans to differences in genetic composition. We now know that is false. These differences are actually driven by a set of factors known as the social determinants of health, which influence a person’s overall health. Some of these include a person’s economic stability (income, employment status), their physical environment (neighborhood safety, walkability, access to grocery stores), education, and access to healthcare.
Only recently has the major contributor to these determinants been labeled as structural racism. In other words, racism is present not just in individuals, but in our society’s policies and institutions. Governmental programs, redlining, and personal discrimination have kept people of color confined to particular neighborhoods that see little investment and are thus impacted by crime and violence. Decades of Black Codes, Jim Crow laws, biased legislation, and discrimination have kept people of color from acquiring jobs that pay the same as those obtained by white people.
Work inequity continues to be an issue amid the coronavirus pandemic as well. Due to that inequity, many Black and brown people are less likely to have the ability to work from home, access healthy foods, purchase masks, and socially isolate. The differences between white Americans and Black and brown Americans persists even for those who must show up at a place of work. Someone who owns a private vehicle is able to minimize exposure to COVID-19 when traveling; someone who takes public transportation is not.
These same structural factors increase exposure to community violence, limit access to economic opportunities, and increase the likelihood of being caught in crossfire. They also increase the chance of gun suicide and partner violence, which are growing problems in Black communities.
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These unfortunate truths are the result of harmful government policies upholding racism, which were in place for Black Americans long before COVID-19 arrived. People of color have missed out on generational economic and social wealth that would aid them in surviving both COVID-19 and gun violence. We are now seeing the trickle-down effects of that racism this particular summer.
Although both gun violence and COVID-19 have resulted in disproportionate deaths among Black and brown populations—and have similar systemic causes—the government response to both could not be more different. Despite knowing nothing about the novel coronavirus in January, in just nine months the United States has determined its viral makeup, routes of transmission, symptoms of infection, rate of spread, mortality rate, and optimal testing. The response continues to be hindered by politics, but we have already started Phase 3 trials for a vaccine.
An urgent public health approach—like the one above—involves identifying the problem, completing research to determine risk factors and deterrents, developing and implementing initiatives to address the problem and its risk factors, evaluating the effectiveness of the initiative, and expanding it to save more lives. We are seeing this approach work (when implemented) to reduce the impact of the COVID-19 pandemic. We have not yet seen this same comprehensive approach to gun violence, despite it claiming tens of thousands of lives, and injuring hundreds of thousands—every year—for decades.
Last year alone, 38,000 gun-related deaths occurred in the United States. About 60% of those were suicides and 35% were homicides. The numbers this year will doubtless be higher, and will exact physical, mental, emotional, and economic tolls. Meanwhile, there are no Phase 3 trials for gun violence prevention—despite the fact that public health approaches have been (and continue to be) effective for not just infectious diseases, but also for motor vehicle crashes, HIV, child abuse, and behavioral health issues.
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Unfortunately, the lack of research and evidence-based practices around firearm injury prevention has led to an American public that sees gun violence as “not preventable.” This has resulted in physicians and public health professionals not knowing how to make an impact to decrease gun violence. So the gun violence epidemic continues to destroy families, devastate communities, and claim the lives of more innocent children.
It is unforgivable that COVID has taken such a heavy toll on populations of color. However, it may have sparked a deeply needed conversation in the United States about the true causes of these disproportionate deaths in these communities.
We desperately need governmental funding for long overdue research on gun violence. This will help create evidence-driven and science-backed initiatives that will decrease gun violence. We also need to analyze the populations most at risk and focus on the root causes of their disparate health outcomes: structural racism. This pandemic along with the persistent racial divide in our country have led to further anger, sadness, and distrust. All of this has resulted in an emotional storm taking place, and—without action—we can only expect this number of gun-related deaths continue to rise.
Dr. Ameera Haamid Dr. Ameera Haamid is an emergency medicine physician in one of the nation’s busiest hospitals and develops initiatives related to structural racism and social justice. She is a member of the advisory board and research council for the American Foundation for Firearm Injury Reduction in Medicine.
Dr. Megan Ranney Dr. Megan Ranney has fought COVID-19 on multiple fronts—in the emergency room as a physician, as a founder of #GetUsPPE, and in the media as a trusted expert. She is also a professor of emergency medicine and spearheads research in firearm injury reduction as the Chief Research Officer for AFFIRM.
