Shows a young African American man in contemplation, he's holding a child close to his chest.
Bull City United, Durham County's violence reduction project, participated in Week of Peace vigils in eight city neighborhoods plagued by gun violence in January. Source: Bull City United, Durham County Department of Public Health.

By Catherine Clabby

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?

shows a smiling African American man in a suit and bowtie
During his 30-year career in police work, James Moore was police chief in Rocky Mount from 2012 to January 2018, when he retired. He intends to remain an advocate for a public health response to gun violence. Photo courtesy City of Rocky Mount.

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.

Shootings also threaten people out of the line of fire, Moore stressed. Children in some urban neighborhoods regularly hear or see gunshots, exposures that can bring potential long-term health risks.

“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.

Shows stark disparities between blacks and whites in number of gun deaths.
Black men in North Carolina ages 20 to 29 are killed by gun violence at eight times the rate of all other men of that age combined. Source: North Carolina Violent Death Reporting System. Analysis by Injury Epidemiology and Surveillance Unit, Injury Violence and Prevention Branch, North Carolina Division of Public Health.

“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.

Despite making up only 22 percent of North Carolina’s population, most people killed by gun assaults in this state are black. Source: North Carolina Violent Death Reporting System. Analysis by Injury Epidemiology and Surveillance Unit, Injury Violence and Prevention Branch, North Carolina Division of Public Health

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.

Limited understanding

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).

Graph shows kinds of murders in North Carolina by gender, circumstance
Source: North Carolina Violent Death Reporting System, 2015 annual report (published 2018). Injury and Violence Prevention Branch, North Carolina Division of Public Health

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.

Change stirring?

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.

a man with a bullhorn speaks to a group of somber-looking people gathered outside at a vigil.
Bull City United, Durham County’s violence reduction project, participated in Week of Peace vigils in eight city neighborhoods, such as this East Durham community, that are plagued by gun violence in January. Source: Bull City United, Durham County Department of Public Health.

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.

Gun Homicide Rates by Age and Race, shows much higher rates for African Americans than any other race

“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.

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North Carolina Health News is an independent, not-for-profit, statewide news organization dedicated to covering health care in North Carolina employing the highest journalistic standards of fairness, accuracy...

Catherine Clabby (senior environmental reporter) is a writer and editor. A former senior editor at American Scientist magazine, Clabby won multiple awards reporting on science, medicine and higher education...

3 replies on “A Call for Gun Violence Prevention”

  1. While this column appears to attempt to address causes and solutions, it turns out it is merely another example of liberal ideology blaming the gun.

    “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”.
    This is also a lie.
    The Law says that you cannot use federal funds to do research that attempts to blame the gun. You can get Fed money for research into gathering data about homicides and violence, but not gun homicide and violence.
    Data of the full spectrum shows a very different pattern.
    Like what the CDC discovered, when Obama wrote an imperial decree funding research, and then ignored the findings when the CDC showed that defensive gun use is much more wide spread than the liberal would have you believe.

    I notice none of the data in the article addressed the main reason why blacks kill so many other blacks.
    It is the drug war. When an undocumented pharmacists has a business dispute, he cannot call the BBB, or the cops, or a lawyer. He picks up the best tool to settle that illegal dispute, a gun. If he does not have a gun, he picks up a knife. If he does not have a knife, he uses a stick, or a fist.

    Some cities have collected some data, but for some reason, the Feds will not.
    Up to 90 percent of the people murdered in the US each year have a criminal record.
    Almost all of the murderers had a criminal record before killing someone.

    The biggest predictor of being murdered in this country is wether you have a criminal record.

    Using stats from the FBI UCR, in 2015, black people had a 11.3 per 100k chance of being killed
    with a gun. Same as gun free Africa.

    Whites had a 2.3 per 100k chance of being killed with a gun, same as gun free Europe.
    And we have 300 million guns.
    Regarding suicide, that seems to be a white privilege thing.

    Young privileged white men kill themselves far more often that disadvantaged black youths.

    Almost every single mass shooting occurs in a no gun zone.

    5 percent of the counties in the US create over 95 percent of the murders and violent crime.
    Coincidentally, these same counties have a large urban area that has been under Democrat control for 40 years.

    These are interesting pieces of data, which for some reason the gun control crowd seems determined to ignore.
    And focus on disarming more victims (no gun zones) violating more law abiding( gun control) and for some reason, these well meaning folks advocate to protect criminals (sanctuary cities).

    We do have a problem in this country. It is not the guns.

    We need pure research to help determine a better solution. Not research directed at disarming more victims.

    1. Bravo Keith. I agree this is a sad and terrifying scene, the violence acts of our youth and the aftermath haunt many children and adults alike. I did notice, like you, that no statistics were given on the offenders.

      What color and economic status did they hold? How old were they? Did they have prior criminal records? Were their weapons obtained legally? The answers show where focus should be given.

  2. In all of the debate over gun violence, generally I do not hear anything about:
    1. The disintegration of the family unit, particularly the absence of a father figure in homes/community.
    2. The correlation between gun violence and violent video games and movies, not to mention the “hip-hop” culture which clearly glorifies violence.
    3. The cultural decline which devalues human life in general.
    4. The overall lack of respect for authority, including and especially law enforcement.
    It is already against the law to murder. It is also against the law for convicted felons to own and possess firearms. The school shootings took place in “gun free zones”. The answer is not more “laws”. Which begs the question: “Why does the conversation immediately go to stopping the sale of guns”?. I will say, thank you Catherine for clarifying (for the uninformed) that semi-automatic guns are not the cause of most gun violence. With all of the media hype, you would think that is the only weapon used for murder.
    This is not an easy, simple of popular topic to address and too many people do not want to have a “conversation”.

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