Gun violence is an urgent public health issue. We are accustomed to media reports about the politics of gun ownership, but gun injuries belong in the same category as influenza and motor vehicle collisions. Nationally, all claim similar numbers of lives each year. Gun violence has become a silent epidemic among select Miami-Dade communities, leading to hundreds of intentional injuries every year. We call it “silent” because most of the burden is borne by just a handful of communities — ones that have been marginalized for decades.
We have witnessed this burden from two perspectives. One of us is a trauma surgeon at the Ryder Trauma Center, Jackson Memorial Hospital, extracting bullets from dying teenagers every week. One of us specializes in the geography of health and helped map Ryder’s gunshot-wound cases to look for patterns of injury across the city. Our study of gunshot-wound injuries in the county revealed that these injuries increased; trended toward younger, black — African American and Haitian — male patients; and remained stubbornly clustered around Liberty City (and nearby, predominantly black, low-income areas) for at least 11 years. Rarely do the geographical patterns of health outcomes tell such a striking story. In these communities, gun violence is anything but silent.
The persistence and gross inequality of this epidemic represents a stunning failure of basic governance: ensuring the safety and security of local constituents.
How did this happen? Surely analysis of other hospital records and police reports would show the same trends, though gun violence research has been stifled for years by the gun lobby’s efforts to limit the collection of gun-related data. But social issues such as race and poverty — long embedded in Miami politics — have deprived many communities of resources needed to strengthen communities from within. This has created a legacy of structural violence — the avoidable impairment of fundamental human needs — that has led to an entire generation of impoverished youth for whom violence and the “code of the street” are a way of life, while remaining invisible to those in power.
Some say that we should just “Lock ’em all up.” But this viewpoint ignores some of the basic dynamics of structural violence and street life. Violence is a response to inequality and lack of opportunity, and when it becomes part of a community’s social fabric, new violent offenders will be waiting to replace those packed into prisons. With a criminal record comes the denial of meaningful economic and educational opportunities and, therefore, engagement in desperate, high-risk income generation to survive. We need to confront the roots of violence to break the cycle, and this means overcoming generations of historic violence, neglect, and discrimination. It won’t be easy.
Recall the public outrage over lead in Flint’s drinking water in 2015, or the hysteria over the first local transmission of Zika in Miami in 2016. Miami residents should be just as outraged to hear that gun violence that leads to hundreds of intentional, yet preventable, injuries each year within our community. Gun violence has social costs, traumatizing youth and filling prisons, which tears families, neighborhoods apart. The economic costs are equally devastating and include increasing healthcare costs, creating social welfare program dependency, disinvestment in communities, and capital flight. It affects us all; it affects us as a city.
Several organizations, with impassioned, dedicated individuals, seek to reduce gun violence around the county. But without dismantling the unequal system of structural violence that leads to direct violence, needless deaths will continue.
A truly holistic response to gun violence requires a multipronged approach to ending the school-to-prison pipeline. We need basic food security, hands-on youth mentoring and educational programs, and economic opportunities that offer parents meaningful employment and that allow leisure time to care for their children. Most of all, we also need to work with organizations in affected communities (churches, schools, social service providers) to understand and prioritize their needs. These organizations stand ready and willing to promote proud messages of empowerment with local law enforcement as community partners, not enforcers of an unjust status quo.
In summary, we need to provide economic and youth developmental opportunities that are perceived as a better alternative than picking up a gun. This requires leadership that champions our youth and believes that eliminating poverty will make Miami-Dade stronger for everyone. We can do this, but we need systemic changes to allow our communities to flourish so that all of Miami’s children can develop their full potential.
Justin Stoler is an assistant professor of geography and public health sciences at the University of Miami. Tanya Zakrison is a trauma and acute-care surgeon at Ryder Trauma Center and an associate professor of surgery and public health sciences at UM.