The stray bullet that ripped through Greg Jackson’s leg as he walked home in Washington, D.C., struck two arteries. The 2013 incident, which led to a 21-day hospital stay and a six-month recovery, began with law enforcement by his bedside in the emergency room.
“I was questioned and interrogated before I even met my nurse or my surgeon,” Jackson said.
Several years later, violence interrupted his life again when a family friend was killed by gunfire in 2019. Jackson remembers thinking that this crisis for Black Americans was being swept under the rug, receiving few of the resources needed to combat it beyond law enforcement.
“What we’ve seen for too long, especially in the Black community, is a criminal response to a public health epidemic,” he said. “That has fueled the cycle of violence and left so many folks untreated.”
The nation’s latest high-profile mass shooting killed seven people at a Fourth of July parade in Highland Park, Illinois. It was just one instance in a slew of holiday-weekend shootings that occurred in nearly every state, killing more than 220 people and wounding more than 560.
Gun violence has become the leading cause of death among children and adolescents in the U.S., according to a recent University of Michigan report, prompting many experts to rethink how the nation is combating it. While law enforcement has been the typical response to gun violence, particularly in Black communities, the problem increasingly is being declared a public health crisis.
Instead of relying solely on the criminal justice system to combat gun violence, health systems, advocacy organizations, and localities across the country are increasingly focusing on the social factors and underlying causes of the deadly trends. To reduce gun homicides, the public health approach takes into account “social determinants of health,” like poverty, ability to find stable employment, building safe green spaces for recreation, promoting educational opportunities and securing safe, affordable housing.
The shift could be particularly significant for Black Americans, who are more likely than other racial groups to be affected by this gun violence. Every day, more than 110 Black people are injured by bullets and 30 are killed, according to the advocacy group Everytown for Gun Safety.
The racial disparities are widening. As gun homicide rates increased more than 30% from 2019 to 2020 — reaching the highest rate in more than 25 years — Black men and boys faced the largest increase, according to the U.S. Centers for Disease Control and Prevention. Black men and boys ages 10 to 24 are now killed by gunfire at more than 21 times the rate of young white men and boys in the same age group.
The rate of gun homicides increased across all racial groups and for both men and women, according to the CDC. Urban and rural areas alike saw heightened rates, with the largest increases in counties with higher levels of poverty, one of many social factors that can influence the likelihood of an epidemic, from COVID-19 to gun violence.
Investing in a public health response
Last year, the CDC’s director spoke out against the gun violence epidemic for the first time in decades, calling it “a serious public health threat.”
Since the mid-1990s, the CDC has shied away from the topic after a Republican-led Congress, aided by lobbying pressure, passed legislation barring the nation’s top public health agency from spending resources to study gun violence. As a result, federally funded research came to a halt.
In 2018, after then-President Donald Trump signed a bill allowing the agency to conduct gun violence research, Congress agreed to split $25 million between the CDC and National Institutes of Health to research the epidemic.
“As social epidemiologists, we don’t think about just the incidence and prevalence of the disease, we also look at the social, cultural, political, and other factors that contribute to the disease,” said Mighty Fine, director of the Center for Public Health Practice and Professional Development at the American Public Health Association. “We use plot maps to show where diseases are popping up in certain communities because that helps us to understand what some of the underlying causes are, and you can pinpoint where the disease is more prevalent — and the same is for violence.”
Data collection and incidence tracking is critical to stopping the spread of diseases, experts say, as is identifying risk factors and root causes. Neighborhoods in the South saw the highest overall rates of violence exposure, according to a study by the American Journal of Preventive Medicine, yet the racial disparities in Northeast and Midwest neighborhoods were much wider.
Searching for solutions
Following mass shootings last spring at an Atlanta spa and a Colorado supermarket, President Joe Biden declared, “This is an epidemic, for God’s sake, and it has to stop.” More recently, in a speech following the Buffalo, New York, grocery store shooting that left 10 dead and a school shooting in Uvalde, Texas, he referenced CDC data, saying: “Guns are the number one killer of children in the United States of America. The number one killer. More than car accidents. More than cancer.”
He called for a number of policy solutions, including strengthening background checks and a ban on assault rifles.
Assault-weapon bans largely target mass shootings, in which high-powered rifles allow gunmen to kill large numbers of people in short periods of time. But in Black communities, the majority of victims are killed with handguns.
A public health approach means “identifying the individuals who are at higher risk for conducting acts of gun violence and working with them to better understand their needs and connecting them with the appropriate resources,” said Fredrick Echols, CEO of Cure Violence, an intervention program working to reduce shootings by treating violence as a disease. Concentrated disadvantage — which Black Americans are far more likely to find themselves a part of — exacerbates the likelihood of violence.
“At the root of gun violence — but also the root of heart disease, sexually transmitted infections, and other major public health issues — is systemic racism,” Echols said.
The public health approach, however, is not a simple solution given the complexity of the crisis, experts say.
“There’s been an effort to frame gun violence as a public health issue to, in some sense, depoliticize it and take it out of the very contentious debate we’ve seen over gun control,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation. “From what we’ve seen during the COVID pandemic, defining gun violence as a public health issue may actually politicize it more rather than less.”
Echols said that, in addition to public health, building relationships with community organizations and engaging local residents is important to reducing the violence. Yet, more than two years into the COVID-19 pandemic, some experts doubt a public health approach will be effective.
“Over the last couple of years,” said Levitt, “we haven’t exactly shown that we as a country are particularly good at addressing public health issues.”