Two major public health problems have been ravaging Chicago long before city officials even understood them to be issues with stark neighborhood distribution and broad sociological roots. In Chicago, nearly everything that is tied to location is tied to race and socioeconomic status, and these conditions are certainly no exception. In a city with a long history of racism and one of the worst track records for Urban Renewal and Public Housing in the 20th century, these two contemporary public health issues affect areas scarred by a legacy of social and economic dislocation. In addition, these issues prey primarily on some of Chicago’s most vulnerable youth, taking advantage of the city’s deeply divided history and acting to reinforce those divisions today through the city’s built, social, cultural, and political environments. In the absence of a strong public health response, these two public health menaces will certainly continue to pose a serious threat to the poorest Chicagoans. However, policymakers treat only one of them as a legitimate public health issue.
For those unfamiliar with Chicago, it is the city in which the maxim “location, location, location” carries even greater weight than in it does other large American cities. Poverty, disease, educational attainment, and demography are all spatially patterned. This is as true today as it was a century ago for the Great City on the Lake.
The pockets of poverty and disease in found in the city’s South Side form the city’s former “institutionalized ghetto” to which African American Chicagoans were restricted for nearly a half-century, and where a large share of the city’s minority population currently resides. The other large pocket of disease incidence and low socioeconomic status include the city’s predominantly Latino west-side neighborhoods, and a second pocket of “Black Chicago” just north of the Latino west side. These two diseases are ever-present public health concerns for these neighborhoods. They have an impact on residents every single day, whether they are infected or not.
Outcome A is one of the most salient concerns facing Chicagoans today, but despite its strong place-based ties and impact on neighborhood life expectancy, quality of life, and health is rarely constructed as a public health problem. Outcome B is one of the city’s most widespread health concerns and is treated as a public health issue of tremendous importance. These two outcomes are similarly distributed and have similarly deleterious impacts on neighborhood health. So why is outcome A not considered a true public health issue?
Outcome A is gun violence, mapped as homicides in Chicago neighborhoods from 2008 to 2011. Outcome B is asthma, mapped as childhood asthma prevalence by neighborhood from 2003 to 2005.
Gun violence is an ever-present concern for residents of Chicago’s most dangerous neighborhoods, and the threat of gun violence, unfortunately, is almost as ubiquitous as asthma within poor, predominantly racial and ethnic minority, neighborhoods. However, resistance to potentially salutary policy shifts is powerful. For example, recent laws prohibiting handgun sales in the city were struck down in a landmark 2010 Supreme Court decision, McDonald v. Chicago.
There is a growing national movement to recognize the public health significance of gun violence, but it has been met with stiff opposition from the gun-rights lobby and politicians at local, state and federal levels. Gun violence is a ubiquitously strong threat to Americans of all stripes and colors, but support for Second Amendment rights is often just as strong.
The debate over the intersection between public health and gun violence came to a head recently with the failed nomination of the eminently qualified Dr. Vivek Murthy to the federal office of Surgeon General.
Dr. Murthy has taken a series of strong political stances on gun rights issues, stances that drew the ire of Second Amendment supporters of both parties in the Senate, many of whom decried Dr. Murthy’s nomination as a political choice for what they viewed as a medical position. Although the office of the Surgeon General has been used for political purposes in the past, perhaps most notably with former Surgeon General James Holsinger, Jr.’s strong anti-homosexual stances in 2008, or more broadly, with the long-running debates over funding for abstinence education or the legality of particular abortion procedures, Dr. Murthy, unlike Dr. Holsinger Jr. is not expected ultimately to become the Surgeon General because of his political stance.
While gun violence is a broad national concern, it often seems impossible to discuss it from an apolitical public health perspective. From the increased emotional stress and mental health tolls related to living in a neighborhood like Washington Park in Chicago, where gun violence and the threat of death looms large—a public health aspect of gun violence that is chronically overlooked—to the health-related impact of shootings themselves, gun violence is undoubtedly a public health issue.
Unfortunately, until broader American society, and policymakers at all three levels of government, recognize the rather obvious ties between gun violence and public well-being, it will be impossible to discuss strategies for gun violence reduction in an apolitical and scientific manners without the kind of political inflammation that characterized the tenor of Dr. Murthy’s nomination.
The question then becomes how best to inform policymakers and the American public about the myriad public health concerns related to gun violence. For an issue around which public health officials appear only to gain legitimate invitations to join the political discussion to offer thoughts on the intersection between mental health and gun violence in the wake of a major gun tragedy, this is no small task. Data visualization is a powerful means of portraying the public health impact of gun violence. And the media can play a role in drawing attention to creative interventions. For example, filmmakers Steve James and Alex Kotlowitz featured a unique anti-violence initiative in Chicago, now known as Cure Violence, in the FRONTLINE documentary The Interrupters.
Ultimately, if there is a singularly consistent and unfortunate truth to the debate over gun violence, it is that major tragedies like Sandy Hook—or violence and death like that Chicago residents experienced on a hot weekend recently in Chicago, which is seen rarely as a tragedy because of different values placed on life—have changed neither how public policy deals with the problem of gun violence nor how American political society views gun violence as a loaded issue.
Gun violence is as place-based as asthma. It is as deadly as “…a good-sized airplane crash every three days” and as linked to increased social dislocation and poverty as cholera or yellow fever were in the 19th century. These comparisons, bit by bit, can shift the conversational focus on gun violence towards the formulation of practical, apolitical, public health-based strategies that reduce gun violence and the political tension surrounding this polemical issue.
In this case, outcome A resembles outcome B too much for policymakers throughout the American political system to continue treating outcome A as an issue beyond the scope of public health. The costs to America’s most vulnerable and socially dislocated citizens, and indeed American society as a whole, are simply too great for policymakers to ignore. As in Chicago, gun violence is a public health crisis for the entire nation, and a concern that American citizens can work together to address. Collective voices are a must, and we must not run out of breath.
Edited by Dana March