Homicide is a leading cause of death for Americans under the age of 45, and there are there are dozens of nonfatal assaults for every single homicide. While guns are not the only vector accounting for these deaths and injuries, they are among the most harmful. There are more than 300 gun-related incidents each day. The disparate burden of violence is carried by communities of color. Black Americans between the age of 15 and 45 are more likely to die from homicide than any other cause. Beyond the toll of gun violence on individuals, families and communities, it costs an estimated $280 billion in lost quality of life, wages, criminal justice and medical costs annually.
We know enough to cite these statistics about the human and economic impacts of gun violence, but do we know enough to explain why the situation is the way it is? To this end, we need to embrace the fact that the political and historical context of gun violence is just as important as understanding the tenets of Advanced Trauma Life Support. Without knowing the social and political factors that create this outcome, how can efficacious violence prevention policy be written? If we want to solve the problem of violence, we must be able to identify and measure its root causes in order to create timely, data-driven, nondiscriminatory policy.
We have historically chosen policy approaches that, at best, address symptoms of the underlying problem and, at worst, further racial inequity, discrimination and violence itself. Much of what has been done in the past by Republicans and Democrats alike has had a discriminatory impact and, far too often, a discriminatory intent.
Take these examples: the Home Owners’ Loan Act, part of the New Deal, under which a practice that came to be called “redlining” was utilized to indicate to appraisers where it was safe to insure mortgages; antimiscegenation laws that enforced racial segregation by criminalizing interracial marriage; the blood quantum requirements for Native Americans; and the War on Drugs exemplified by harsher punishment for crack cocaine over that for powder cocaine. Each of these policies continues to systemically destabilize families and communities by worsening economic, educational and health disparities for communities already subject to pervasive discrimination.
Ultimately, the combination of discriminatory policies layered on top of structural racism has created a vicious feedback loop: poverty and limited opportunity leads to increases in crime, violence and incarceration, which further poverty and weaken efforts to invest in the community. This vicious feedback loop exists not because individuals who live there are “more dangerous”—which was the underlying belief behind the “three strikes and you are out” policy—but because the opportunities for many to make choices away from violence have been ground down so systematically and comprehensively.
We must also engage in a conversation about what health equity means in this context and then develop and implement actionable solutions that will enable us to chip away at those concretized health inequities.
The Satcher Health Leadership Institute (SHLI) at the Morehouse School of Medicine is rising to this call to action with vigor. Supported by key partners and collaborators, SHLI is leading a comprehensive data tracker that will focus on COVID-19 health inequities among communities of color in its initial phase. In future phases, the tool will expand to include a variety of health outcomes, including homicide, tracking within vulnerable populations such as communities of color, persons living with disabilities, LGBTQ+, and more. The first of its kind, SHLI is ripping down the silos that have hindered a comprehensive approach to inequities. The goal: to track mental, behavioral and health outcomes, along with the social and political determinants of health. To do so, we are bringing together community leaders and organizations, health professionals, engineers, researchers and policy makers who can collectively provide the equitable changes.
How can this novel data tracker drive change? The Health Equity Tracker is designed to collate the best available data on a range of conditions, determinants and diseases together under a single platform. The combination of these data sources with original and powerful visualizations results in a novel, comparative approach to assessing health equity. As of this writing, the following sources are used on the Health Equity Tracker:
Five-year estimates from the American Community Survey: Data presented as population counts and percentages, health insurance rates and poverty rates at the state and county levels.
Five-year estimates of U.S. territories in 2010 from the American Community Survey: Data presented as population counts and percentages at the territory level.
“Case surveillance restricted access detailed data” from the Centers for Disease Control and Prevention: The numbers of confirmed COVID-19 deaths, cases, and hospitalizations at the state and county levels.
America’s Health Rankings: The prevalence of diabetes and chronic obstructive pulmonary disease (COPD) at the state level.
Over time, we plan to add additional sources to enhance existing variables and introduce new ones. The differentiator for the Health Equity Tracker is bringing all these interconnected and dynamic variables into one platform, thus reducing barriers to access the data and shed light on data quality and access issues.
Presenting data on the Health Equity Tracker reduces barriers to the data—another health equity issue. For example, the CDC’s “case surveillance restricted access data” set is available by application only and contains millions of lines of code. By using the powerful visualizations developed for the Health Equity Tracker, decision makers can draw insights to health equity issues and better guide decisions on resource allocation and other policies. Data-driven decision-making is empowered by making the data accessible to as many users as possible, including policy influencers and community leaders. This supports the strategy of identifying outsize burdens of disease, mapping areas where communities are most impacted, and identifying data gaps and data quality issues. This makes data actionable by highlighting impact and region, thereby guiding policy decisions.
The comprehensive data collected by SHLI on the social and political determinants of health in communities of color can be used to create a targeted approach for individuals and communities to meet their full health potential. In the case of violence prevention and intervention, that would entail allocating resources to prevent incidents and improve survival of violent injury.
To effect maximal change, we must be able to understand and engage with the depth and breadth of the problem—through targeted policy to address concentrated poverty, underfunded and underperforming schools and an unfair criminal justice system, among many other issues. This is critical because only policy can fix what policy created in the first place. Moving away from a siloed approach, we must focus our efforts to reduce violence in ways that reflects the broad complexity of a problem that is multifactorial in nature.
For too long, policy has been utilized as a tool of oppression. As our nation faces dueling public health epidemics, we now are in a phase where we are equipped with both the opportunity and responsibility to eliminate the health inequities that continue to decimate communities across the U.S. Honoring the indiscretions of the past begins with implementing actionable solutions to chip away at existing inequities so we can finally realize a healthy, equitable and inclusive society. The time is now.