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Abstract
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"If it's not a health problem, then why are all those people dying from it?" Dr. David Satcher gave that quote about violence to The New York Times nearly 30 years ago, just after he took over as director of the Centers for Disease Control and Prevention.
What is sometimes called the public health approach to violence is a relatively recent development. It requires a fundamental rethinking of our relationship to violence--for all of us as a society and for each of us as individuals. It means understanding that violence is not someone else's problem. Whoever we are, it's our problem.
It also requires a rethinking of what violence is. Narrowly construed, violence involves physical force and death or injury, which can be physical or psychological. Many argue (as I do) that there is also structural violence, where political or economic power stands in for physical force and the adverse outcomes are disparities in health, life expectancy, and a broad array of social and economic conditions (1). The structures by which those disparities are produced have been built consciously and with a purpose. Most of us have contributed, knowingly or otherwise, to keeping those structures intact.
Let's return to "all those people" Dr. Satcher had in mind. America has lost more civilians just to firearm violence in the past 10 years than we had combat fatalities in World War II. (I include homicide and suicide here. Both are intentional, and a bullet doesn't care whose finger is on the trigger.) At 2018 rates, in the next 11 years we could fill a second Arlington National Cemetery to the current capacity of the one we have, with civilians who die of gunshot wounds.
It doesn't have to be this way--a simple fact that should make us angry and hopeful all at once. With motor vehicle-related deaths and injuries, for example, America mobilized. We put smart people on the case, charging them to study the problem and make recommendations for change. Policymakers acted on those recommendations, and the result has been a largely downward trend ever since.
With firearm violence, we have taken the opposite approach. Over and over, in Washington and across most of the United States, we have deliberately turned our backs on the problem. The result: Trend lines for motor vehicle and firearm deaths have intersected.
Now the coronavirus pandemic is driving an increase in violence, particularly firearm violence (2). That violence, like the pandemic itself, is shining a powerful spotlight on stark disparities and lethal abuses of power that threaten our existence as a free society.
For compelling reasons, we are now focused sharply on disparities in the risk for violence by race and ethnicity. Our focus is first on individual tragedies...
Language: en |