If North Carolina can fight opioid overdoses, advocates ask, why not recognize and treat gun violence as a public health threat too?
Rocky Mount police chief James Moore brought a blunt question to a statewide meeting of county health directors in Raleigh last year.
Why don’t more public health professionals work to the reduce gun violence that disproportionately kills black citizens in this state?
State data obtained by North Carolina Health News confirmed the disparity. In fact, black residents ages 20 to 29 died from firearm assaults at seven times the rate of other North Carolinians in recent years.
“There are some blocks that don’t go a week without someone’s house getting shot into. I’m talking you are in there cooking, bathing your children or sleeping and rounds are going into your house,” Moore said. “No one is helping them.”
A call to action
In the weeks since a 19-year-old used a semi-automatic rifle to kill 17 people at the affluent Marjory Stoneman Douglas High School in Florida, debates have swelled over how to best protect schools from shootings.
High school students on Saturday will lead “March for Our Lives” events across the country, North Carolina included, demanding that Congress pass stricter gun laws, with federal bans on assault rifle sales among them.
But gun violence in North Carolina is not primarily a schoolhouse issue. Gun murders here occur in private dwellings, outdoors or in vehicles most frequently, not classrooms.
Recently retired from 30 years in police work, Moore is one of a growing number of civic-minded North Carolinians calling for more than arrests and criminal prosecution to reduce this harm.
If this state can commit millions of dollars to reduce opioid overdoses, which disproportionately affects whites, he and other advocates say, why not work to disrupt gun violence too? Both stem from illegal activity; both have complex roots.
“I have a theory,” said Moore, speaking during a gun violence panel at the meeting last January. “The neighborhoods I’m responsible for, they are primarily African American and they are primarily poor.”
Deadly threat, muted response
Between 2006 and 2015, 58 percent of the 3,992 people who died from gun assaults in North Carolina were black, according to state data. Only 22 percent of the state’s population is African American.
More than half of the 2,328 African Americans killed with guns during that period were younger than 30. And that racial disparity holds for firearm assaults.
Racial data is not collected for every person treated in a hospital for a gunshot wound in this state. But the state’s 14 trauma centers tallied data on their 3,305 firearm assault patients between 2013 and 2017; 74 percent of those patients were black.
Because there is limited research on firearm violence, assumptions and potentially racial bias may fill in for facts when people consider what causes shootings, said UNC Chapel Hill epidemiologist Shabbar I. Ranapurwala.
“Firearm violence among black Americans is frequently dismissed as gang violence or black-on-black crime rather than being addressed as a public health problem,” said Ranapurwala, who has helped document disparities in federally funded studies researching life-threatening risks among black and white Americans.
Eric Toschlog, chief of trauma and surgical critical care at Brody School of Medicine at East Carolina University, has become a shooting prevention advocate. He’s says he is weary of watching young black men die while he tries to save their lives at Vidant Medical Center in Greenville, where he practices.
“It’s that ritual of seeing a young man, 18 to 20 years old, coming in with a gunshot wound,“ Toschlog said. “Then taking him to the operating room. Then having him bleed to death in surgery. Then facing 20 people who have gathered for him.”
Toschlog is collaborating with data scientist Sharon Schiro of the North Carolina Trauma Registry to map where shootings occur. That could help target future interventions for gun assaults.
The mapping will include locating suicides too, which kill more people in North Carolina than gun assaults. Nearly two‐thirds (60.5 percent) of all violent deaths in N.C. during 2015 were caused by firearms, including suicide (62.1 percent), homicide (34.6 percent).
Lots of questions persist about the whys regarding gun violence in North Carolina. But some specifics are known, thanks to data collected and published by the Injury and Violence Prevention Branch of the state Division of Public Health.
Firearms, usually handguns, are the weapons most often used during homicides in this state. Fatal shootings most often accompany disputes, other crimes and intimate-partner violence, which most often kills women.
Specifics are murky on the national level too. With the support of the National Rifle Association, the U.S. Congress restricts federal funding for gun violence research. So data is thin regarding when shootings are most likely to happen and how to stifle them.
Resulting knowledge gaps disproportionately affect black Americans too, said Ranapurwala, the UNC epidemiologist. In a 2017 research paper titled Do black lives matter in public health research and training?, he and co-authors compared potential years of life lost from 39 causes of deaths in the United States.
Homicides, most frequently caused by gunshot wounds, topped the list among black Americans. Heart disease stole the most potential years among white Americans. But the National Institutes of Health (NIH) awarded only 16 research project grants researching homicide in 2015, compared to 341 studies funded to better understand ischemic heart disease, the research found.
“If any other body of people was disproportionately affected by any other problem, we would handle it differently,” said James Gailliard senior pastor of Word Tabernacle Church in Rocky Mount, who became outspoken on this topic in 2014, after one teen shot three other teenagers and a 12-year-old child on a church-owned basketball court.
The U.S. Institute of Medicine and the National Research Council have proposed a research agenda that could acquire data needed to help guide prevention of gun violence. Among the questions they pose:
- What risk factors make a person more likely to shoot another?
- Can early education or technology, such as fingerprint-reading gun locks, reduce assaults?
- How about modifying physical environments where shootings happen often?
- What would be the effect of restricting some gun sales?
Some efforts to intervene have already been launched in North Carolina. A prevention strategy called Cure Violence Model inspired a public health project called Bull City United in Durham County. Participants use a disease-control model, including finding people at high risk of shooting someone and working with them to prevent assaults.
Reducing shootings where they are most common is an urgent need, said Greenville police chief Mark Holtzman, whose department staffs a gun violence prevention unit. Otherwise people who live in neighborhoods plagued by shootings, and those who live elsewhere, can start to view the violence as inevitable.
“It can’t be culturally acceptable to shoot into an occupied dwelling,” Holtzman said. “Just last week an individual came home and saw someone had shot into his house. Someone stood there with a shotgun long enough to fire multiple times into his house and no one called the police.”
After Moore spoke in Raleigh last year, Madison County health director Marianna Daly told him she had tried but failed to convince members of the N.C. Association of Local Health Directors to formally characterize gun violence as a public health hazard.
“I said we have a policy on our website about the pasteurization of milk. Why do we not have one on gun violence?” she said. “I got a lot of pushback about wording, a lot about gun rights.”
More than a year later, longtime Pitt County Health Director John Morrow revived Daly’s idea, which members will consider. Morrow was inspired by high school students demanding more protection after the Florida shooting.
This move comes as new evidence suggests gun violence may be on the rise in North Carolina. National public health, physician and trauma surgeon groups already promote the public-health link, noting this country has the highest gun homicide rate of all high-income countries in the world.
The North Carolina association has been slow to engage this issue, acknowledged current president Dennis Joyner. That’s probably due to the divisive politics regarding gun control policies and the lack of science-based guidance on prevention, he said. Joyner said he sees merit in Moore’s hypothesis that who is hardest hit may be in play.
“There is some validity probably to it when you look at data that demonstrate you’ve got this disparity,” Joyner said. “And that disparity impacts certain members of a community, a community that has less of a voice and less clout.”
It’s time, he said, to listen more closely.