In a perspective published in the JAMA Health Forum, researchers from the Duke University School of Nursing and Duke’s Sanford School of Public Policy have shed light on the stark racial inequities that exist in firearm-related injuries and deaths in the United States. The perspective provides a comprehensive analysis of the disproportionate impact of firearm violence on communities of color.

“Racialized violence shows up as a health care issue daily in our homes, schools, and health care systems,” says Rosa M. Gonzalez-Guard, PhD, MPH, RN. “It is the stomach ache that my own children have at home because of the anxiety of going to school because of fear of bullying, a racial slur, or school shooting. It is the child in our local Durham Public Schools’ school that gets into a fight and gets injured and is treated by the school nurse. It is our patient that we are taking care of in the emergency department with a firearm injury. We see the physical, psychological, and social impacts of firearm violence every day.”

Key Points

The perspective’s findings are alarming, revealing that in 2022, firearm injuries became one of the top five causes of death across the nation. More concerning is the fact that firearm-related fatalities have now surpassed motor vehicle accidents as the leading cause of death for individuals under the age of 19. The data indicates a clear racial divide, with American Indian or Alaska Native, Black, and Hispanic or Latino individuals experiencing significantly higher rates of firearm homicide compared to their non-Hispanic White counterparts.

“The finding that stands out to me in the area of firearm violence is the drastic disproportionate burden that Black, American Indian, and Latino children face as a result of firearm injury,” remarks Gonzalez-Guarda.

During the COVID-19 pandemic, major U.S. cities saw an exacerbation of these disparities. Black children were found to be 100 times more likely, and Hispanic or Latino children 25 times more likely, to suffer firearm injuries than non-Hispanic White children. These statistics underscore the urgent need for targeted interventions to address the root causes of such inequities.

The Role of Systemic Racism

The Duke University researchers argue that systemic racism plays a central role in perpetuating the cycle of firearm violence in racially minoritized populations. Historical and ongoing forms of structural racism have created conditions that foster interpersonal violence, particularly in urban communities plagued by concentrated poverty.

“Systemic racism and racialized violence can manifest as barriers to accessing equitable healthcare, resulting in disparities in health outcomes, mainly for marginalized communities,” says Schenita D. Randolph, PhD, MPH, RN. “Additionally, the experiences that one may encounter of racism and discrimination where they work, live, and play can have a profound effect on mental, physical, and emotional health, thus contributing to high blood pressure, depression, and anxiety. And this is not just what is reported, through my own lived experiences and the experiences of others in my community -- I have seen this play out.”

Economic factors such as unemployment and underemployment, compounded by racial bias in housing, education, and healthcare, have limited access to resources for marginalized communities. This has led to increased exposure to risks, resulting in higher levels of stress, trauma, and ultimately, interpersonal violence.

A Framework for Change

The perspective advocates for a multifaceted approach to combat firearm violence, emphasizing the importance of using an equity lens to implement structural and community-level interventions. It calls for the dismantling of oppressive systems and the promotion of equitable access to high-quality education, housing, and economic opportunities.

“Nurses play a critical role in reducing mortality inequities related to gun violence,” Randolph insists. “They serve as first responders to gun violence providing trauma care and medical attention and they are educators and advocates.”

“Nurse’s first need to recognize that our current day firearm violence crises is rooted in systemic racism and therefore is a racialized public health problem,” adds Gonzalez-Guarda. “Nurses need to recognize that treatment is prevention in this case, and lead practice, programs, policies, and research to support the healing of historically oppressed populations that have experienced historical and current day trauma.” 

By addressing systemic racism and fostering environments where protective factors can thrive, the Duke researchers believe that it is possible to create safer communities for all individuals, irrespective of their racial or ethnic background.

Moving Forward

As the nation grapples with the epidemic of firearm violence, Randolph and Gonzalez-Guarda believe that this perspective serves as a critical reminder of the deep-seated inequities that fuel this public health crisis. It is a call to action for policymakers, community leaders, and healthcare professionals to work collaboratively towards a future where safety and justice are not determined by the color of one’s skin. Randolph and Gonzalez-Guarda demonstrated this need for interprofessional collaboration by teaming up with Jay Pearson, PhD, MPH, of Duke’s Sanford School of Public Policy.

“Nurses are leaders in health care and in addressing inequities,” says Randolph. “In addition to our strengths as leaders, we need other disciplines and collaborators who can offer policy lenses and who have a strong understanding of the racial and systemic contributors that are associated with inequities. Dr. Pearson is an expert in applying theoretical frameworks to systemic structural inequality and its impact in public policy decision-making.”

“It is important to understand the historical, societal, and political influences on health to be best positioned to address it. Working with Dr. Jay Allen Pearson, a social, population health, and political scientist, allowed us to provide a richer more nuanced description of the fundamental systemic causes of firearm violence that helped us make a case to label it as racialized violence,” adds Gonzalez-Guarda.

The full perspective, “Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities,” is available in the April 4, 2024, issue of the JAMA Health Forum and can be accessed online for a detailed understanding of the findings and proposed interventions.