Gun Violence: A Reckoning

Exacerbated by the COVID-19 pandemic, gun violence is rising to record levels, both across the country and in Philadelphia. Four Penn Medicine experts close to the epidemic of community violence speak up about the toll and call for bold, urgent solutions.

Photos by Peggy Peterson

“I am on call Wednesday night. The statistics indicate that then I will once again walk with the chaplain to a small room off the emergency room. I will open a heavy brown door and make eye contact with a room full of people; a mother, perhaps a father or a grandmother. They will look at me with tears welling up, their knees weak, and lean forward while watching my lips, bracing for news about their loved one. I will remain standing and reach out to hold the mother’s hand. My announcement will be short and firm, the intonation polished from years of practice. The words will be simple for me to say, but sharp as a sword for them to hear; ‘I am sorry, your son has died.’”

John P. Pryor, MD, who directed the trauma program at Penn Medicine’s Level 1 Trauma Center then at the Hospital of the University of Pennsylvania, wrote these words in the Washington Post in 2007. His essay decried the public’s “triage of compassion and empathy” that made them feel sympathy for the victims of mass casualty events he treated as a U.S. Army combat surgeon, but turn a blind eye to the daily deaths in the “War in West Philadelphia,” as he titled his piece.

That war had raged on for decades – and continues – not just locally in Penn’s surrounding communities, but as a distinctive national problem, according to C. William Schwab, MD, the founding chief of Trauma Surgery at Penn Medicine, now an emeritus professor.

“This is an American problem, something we see in almost no other country in the world, but it’s not a civil war,” he said. “It’s an uncivil war. It’s people against people shooting one another.”

Today, Penn’s trauma center is located at Penn Presbyterian Medical Center and named for Pryor, who was killed in the line of duty in Iraq just two years after decrying the “War in West Philadelphia.” At the John Paul Pryor, MD, Shock Trauma and Resuscitation Unit, physicians continue seeing a flood of patients who have been gunned down, mostly young Black men. By late August this year, when over 1,500 people had been shot in Philadelphia, nearly 300 of them fatally, the Philadelphia Inquirer editorial board noted that there had been shootings every day this year, save one (January 2). The near-daily onslaught flowed through the fall; by mid-November, only three days of 2021 had been free of a recorded shooting.

Though the crisis has been long and remains profound, from Schwab’s vantage point today, there is hope.

Seeds Planted in a Frozen Funding Landscape

Public apathy has been one of the biggest challenges to ending gun violence over the decades that Schwab has been studying the problem in response to seeing a flood of patients in the trauma center with fatal and nonfatal gunshot injuries. Too many people, he said, see the problem as “just a part of American life.”

But that was far from the only challenge. In the mid-1990s, federal spending budgets began to include an amendment that blocked government funding of research that could be used to promote gun control – chilling scientific efforts to understand, prevent, and respond to these violent deaths and injuries.

That chill didn’t deter Schwab and Therese Richmond, PhD, RN, of Penn Nursing. Together, around that same time, they co-founded the interdisciplinary center now known as the Penn Injury Science Center, where today Richmond remains the director of research. “When we did that, it was him and me,” Richmond said. “We were the people focusing on gun violence. It was not broadly looked at, not something a lot of people on campus were interested in.”

Schwab, as a trauma surgeon, and Richmond, as a trauma and critical care nurse, were confident in their mission. It was just as serious to address gunshot wounds at their root cause, they reasoned, as it was for heart attacks — both a major cause of emergency department care and sudden deaths. “What if in health care we didn’t fund research in cardiovascular health problems or stopped for 10 years because it’s not politically favorable?” Richmond asked. “What if we didn’t think beyond what brings you in with a heart attack and work to understand and treat blood pressure and cholesterol? If we didn’t do it, people would say we’re negligent.”

They built a community of scholars across disciplines at Penn, connected to collaborators around the country, spanning epidemiology, trauma and emergency medicine and nursing, pediatrics, psychiatry, psychology, and more disciplines. “We started as a mom and pop shop with $10,000,” Richmond said. “With the support of foundations we were fortunate to escalate our support to several million dollars that allowed us to grow the science, recruit new faculty, and develop the next generations of scholars interested in studying gun violence.”

Meeting the Moment

The need for understanding and acting to end gun violence is as great as ever as the casualty count continues to grow. For the physicians who continue to treat these violent traumas, every night on call becomes a night they are prepared to face a family’s tragedy, just as it was for Pryor in 2007, and as it was in the mid-1990s, when Richmond and Schwab saw the need to unite under a new research center.

But the landscape of battle has shifted: The uncivil war of gun violence has converged with the COVID-19 pandemic, as well as with the rising movement for racial justice. In 2021, too, U.S. federal agencies have once again begun distributing grants for research into gun violence, the freeze on such funding now thawed after nearly two decades.

And there are also new opportunities for change. This fall, the Penn Injury Science Center and Penn Trauma were among the partners forming a new West/Southwest Collaborative Response to Gun Violence of community, university, health system, and government stakeholders to address gun violence together in Philadelphia.

They are building on years of steady effort to understand and stop the violence. Schwab cites the growth of federal data on fatal and nonfatal injuries – begun as a pilot program in nine states in the 1990s, now representing 30 states – as a huge step forward over the last two decades.

“It is two things: Having more data and more young scientists who are now able to fund their work are rays of optimism,” Schwab said.

The seeds of injury science scholarship planted by Schwab and Richmond in the 1990s have grown into what Richmond describes as a “vibrant ecosystem” that is well-situated to try novel strategies. “One of the places we have watched evolve over the past two decades is a much stronger recognition that one of the most significant contributors to gun violence is social determinants,” she said. “Inequalities in neighborhood opportunities, intense poverty, investment in some areas of the city and disinvestment in others, leave some populations marginalized and at higher risk.” This wider social view opens up perspectives to understand and try social interventions that may have nothing to do with guns, from prevention by investing in neighborhood green spaces to social service support to help victims recover from psychological harm, and communities to heal.

At this pivotal moment – mired in a long and deepening crisis, yet informed by more years of insight from new angles – four individuals at the front line of the uncivil war today share their perspectives below. You will meet:

• An emergency physician who emphasizes the profound pain for of her Black colleagues seeing Black bodies – including friends and neighbors – on gurneys night after night.
• A mother who recounts her family’s and community’s decade-long emergence from an impossible loss.
• A trauma surgeon and researcher who acknowledges the long trajectory of recovery after patients leave the hospital, and how post-treatment intervention and prevention go hand-in-hand.
• A physician-scientist who draws a line between fears for her own young Black sons’ safety and research on the disproportionate impact of neighborhood-level investments in Black communities.

Collectively, these essays convey a breadth of research-backed insights, emotional impacts, and ongoing challenges that characterize the uncivil war of gun violence today. Though all four essayists work in health care, they emphasize that solutions will require collaboration with government, communities, and individuals across sectors. Their call to armistice is growing louder as more voices join in unison.

— Introduction by Rachel Ewing

Recognition

By Chidinma Nwakanma, MD

When Black doctors see themselves in their patients, another trauma goes unremarked and unmeasured. An Emergency Medicine physician voices this pain.

“That could have been my son…”

A white physician remarked sorrowfully as the Emergency Room (ER) and trauma teams finished tending to the multiple gunshot wounds of a young white man. In his voice was a mix of helplessness, distress, and surprise, as it is not the norm that gunshot victims at my hospital are white.

But for the Black doctors, nurses, techs, registrars, clerks, and environmental service workers in the ER, seeing dead and wounded Black patients has become our norm.

We see our sons, brothers, fathers, uncles, and cousins in the victims of gun violence who come in daily, sometimes multiple times a day. We hold our breaths as we pull bloody, lifeless bodies from police cars and place them on gurneys, hoping not to recognize the victim’s face. But sometimes we do. Many of the Black ER staff have experienced the trauma of seeing and even caring for their wounded loved ones while working. For one of my colleagues, this has happened twice. In one incident, he recounts working diligently as part of the trauma team to save the life of his childhood friend who had been shot. Unfortunately, his friend died in the ER. In the Black community in West Philadelphia, a large proportion of people have been indirectly or directly been victims of gun violence. As Black ER staff members, we literally see ourselves in the victims. We are witnessing the crippling of our communities firsthand.

In addition to seeing victims of gun violence who are members of my racial community, I also experience the added mental strain from caring for victims from my physical community. Last year, my now-husband bought a house in the Cobbs Creek area of West Philadelphia. His plan was to invest in a Black neighborhood and he was charmed by the sense of community he found there. I moved in shortly after and the privilege we had to choose to live in this community is not lost on me.

I’ll never forget receiving an alert on the citizen app about a “shooting in the Cobbs Creek area” on my first full night living in my neighborhood. I headed to work subsequently, pulling up just behind the police car dropping off the young Black man who had been shot blocks from my new home. I parked, dropped my bags, and quickly ran to the trauma bay to join the team in tending to his injuries.

Since then, I’ve walked a few short blocks from my house to memorial rallies of my slain patients. I am not alone in this experience of living in the same community as the gunshot victims who I treat.

For a lot of the Black staff in the ER, gun violence is not a disposable gown they can take off and discard once they leave the threshold of the hospital grounds. It is not something they can clock out of once their shift is over. It is inescapable and ubiquitous, permeating both work and home life, often leading to feelings of helplessness and detachment.

I asked several Black ER colleagues about their feelings surrounding gun violence and heard an answer come up repeatedly: Numbness. The feelings of sadness, anger, frustration that we once felt at the beginning of our tenure in the ER have quickly been replaced with an almost robotic emotionlessness. One of my coworkers told me about her surprise at feeling “almost no emotion” when one of her sons was shot in his senior year of high school. Another coworker expressed her inability to cry and emote in response to major emotional life events, which she attributed to the exposure to constant trauma at work.

Many studies have highlighted the impact of violence exposure on mental health. Significant increases in anxiety, depression, aggression and even suicide have been observed in adolescents and adults as a result of vicarious trauma. The disproportionately high exposure to gun violence fatalities experienced by racial minorities leads to a higher prevalence of mental health issues in Black/Latinx communities. However there is little to no evidence illustrating this impact in the workplace.

As gun violence has surged over the past year, we have seen an increase in violence affecting women and children. Unfortunately, the sight of wounded and dead Black men has become commonplace in our workday. However, this new victim demographic has seemingly dislodged this emotional callous that had formed from years of witnessing gruesome trauma. Seeing people who look like our wives, mothers, sisters and even babies on a trauma gurney reminds us that even the most vulnerable in our communities are endangered.

The flash of recognition that prompts a white colleague to say, “that could have been my son,” is a human reaction – but for us Black physicians and staff members standing at their side, it is too familiar to be shocking anymore. Comments like this show a lack of empathy and connection to Black victims, and they show that our non-Black coworkers cannot truly understand how deeply gun violence cuts us, too. There is a deep, complex emotional toll from constantly seeing Black wounded and dead bodies and hearing the desperate cries of their families. As we work to address the crisis of violence in our communities, this is another trauma that we must recognize and heal.

About Chidinma Nwakanma, MD

Chidinma Nwakanma, MD, is an assistant professor of Emergency Medicine at the Perelman School of Medicine; physician lead in the PPMC Emergency Department for inclusion, diversity, equity & antiracism; and director of the underrepresented minority visiting clerkship program. With colleagues Elinore Kaufman, MD, and Zaffer Qasim, MBBS, she is engaged in planning for community- and hospital-based violence-prevention and intervention initiatives.

Reverberation

By Cheryl Graham-Seay

For each life lost in a flash of gun violence, their loved ones’ suffering endures. A mother shares her journey from loss to community advocacy amid broken social systems.

It was the most horrific, painful day in our lives.

My 18-year-old son was killed on our front porch 10 years ago in front of his father. Eight months after losing Jarell I lost my position at Penn Medicine because of organizational restructuring. I was unemployed, relocated to a new neighborhood, and now my husband and I found ourselves drained emotionally, physically, and mentally. I exhausted my retirement funds because I could not find employment and my husband struggled to do his contracting work because Jarell was his partner. He just didn’t have it in him.

We sought counseling. Our therapist was an older Jewish white lady who was empathetic, brilliant, and cussed a little. At first I thought, no way this lady is going to be effective with our healing process, but boy was I wrong. She was so instrumental in giving us both the push we needed to work our way through the devastation of losing Jarell. We went to counseling for five years. It was a stepping stone to functioning in our lives.

The main motivation that keeps us inspired to push on 10 years later is our firm belief in our faith, numerous prayers, support, and God’s grace and mercy. Had it not been for those things, I don’t know where we would be today. With our faith, we persevered in our community service work and established the Jarell Christopher Seay Love and Laughter Foundation to keep it moving. Our mission is to unite communities by connecting families while helping to protect our children through gun violence prevention, safety, and education.

We participated in rallies in D.C. with other organizations in the city, sat on the 19th District Philadelphia Police Advisory Board, led peace marches and vigils, participated in panels on violence prevention, and many other events and activities across the city. We found that we got most satisfaction and fulfillment when we saw children and parents in the community who would stop us and say, “We remember you, you lost your son Jarell to gun violence, you took us to the beach in Wildwood, we were at your backpack giveaway, received holiday gifts, or we were in your LIPP [Ladies in Power for Peace] girls’ empowerment or Defenders summer safety program.” When we hear things like that, it really helps us to continue to heal, and most of all brings us joy to know that Jarell’s memory lives on.

No one, no matter what side of the gun you are on, should have to lose their life because of gun violence. It’s a choice that a person makes and does not have to happen. It makes me so angry to know that someone chooses to be the judge and jury over one’s life by shooting them. No one has the right to claim that! What you take away is more than just one victim’s life.

Gun violence is the most traumatizing pandemic we’ve witnessed. The devastating effects on everyone involved remain for a lifetime. Those who lose a family member always have that empty feeling. The injured face a lifetime of rehab, pain, and a multitude of medications. Family and friends change. For the past 10 years we lost a sense of time because of our grief process, while the world went on around us. Life changes in a number of ways for many over a decade. In 2016 I was rehired by Penn Medicine as a community health worker and started all over again. I recently received my associate’s degree with honors and am now working on my bachelor’s in Human Services. After all of this, I’m starting to feel like myself again. A decade has passed since losing my Jarell and all I do is in honor of his memory.

As a community health worker I’ve grown to be very humble. I’ve worked one-on-one with patients as young as 18 years old and as seasoned as 96 years old. My job is to support my patients as they work hard to improve their health and deal with everyday life issues, family, and more. As a member of their community, I’m someone who is relatable to them, and that it makes it all more meaningful.

In my role, I also witness broken systems all the time. Systems that are meant to help never seem to work in sync. The welfare program provides just barely enough to make it through. If you make $10 to $20 more in pay, you become ineligible for benefits, and then comes the stress and depression. The system doesn’t promote growth in education or physical or mental health, or provide dignity.

Gun violence is a public health problem that is still not recognized enough. The systems meant to deal with it are broken, too. Too often, just like in social services, it’s just a band-aid approach. There are many layers to work through. Money is a huge part of the problem. Prevention receives little funding, while the prison and justice systems get all the funding needed to house criminals and do not provide effective training and rehabilitation to reintroduce them to society.

The systems put into place hundreds of years ago are not relevant to society today because they treat justice, education, mental health, and other systems as separate problems. These social systems must come together at one time and start chipping away at our nation’s problems, gun violence especially. In one of the richest countries in the world, we are drowning in the failures of antiquated policies, corruption, and injustices. We have scholars, scientists, and experts who care about this problem but still don’t know how to work effectively in unison to address these issues. Until that happens I don’t see change.

Meanwhile, we will continue to honor Jarell’s memory through our work to serve the community. Jarell was a giver. He loved life, family, and his community. Our motto we use and printed on the back of our shirts reads, “Let LOVE Be the Power that Rules YOU!” That is our forever motivation.

About Cheryl Graham-Seay

Cheryl Graham-Seay is a Penn Medicine community health worker in the Penn Center for Community Health Workers, a national center of excellence where the IMPaCT program for community health workers originated. Graham-Seay is co-founder with her husband, Joel Seay, of the Jarell Christopher Seay Love and Laughter Foundation. The Foundation’s programs include an annual backpack giveaway for kids in West Philadelphia that includes safety and martial arts presentations; Ladies in Power for Peace, a program for girls in grades 6 to 8 to learn about healthy eating, self-care, and staying safe; and the Defenders summer program for younger students focused on safety. The Foundation has received funding for its antiviolence efforts from the Philadelphia District Attorney’s office, Penn Medicine CAREs grants, other grants, and through its own regular fundraisers.

Recovery

By Elinore J. Kaufman, MD, MSHP

Leaving the hospital after a gunshot wound is only the beginning. A trauma surgeon and researcher advocates for deeper understanding of the lasting impacts for victims and linking recovery with prevention.

“You are going to be okay.”

As a trauma surgeon, I frequently meet people on the worst day of their lives. While the X-rays get taken and the tubes and medications go in, I reassure them, saying things like, “I’m so sorry this happened to you. We are going to take great care of you. You are going to be okay.”

I want to share with them my confidence that they are being treated in one of the world’s leading trauma centers where they will benefit from the best we have to offer in knowledge, skills, training, and resources to stop their bleeding, repair their injuries, and help them recover. I am telling them the truth: Three in four patients with a firearm injury due to interpersonal violence survive, and of those who make it to the hospital, the proportion is closer to 95 percent. There is nothing better in my specialty than to see a critically injured patient heal and walk out of the hospital.

But for many patients, that marks only the beginning of their recovery. They need a lot more before they can be okay.

Even bullet wounds that pass through skin or muscle without harming critical anatomical structures can still shatter patients’ sense of safety. Researchers at Stanford have shown that the emotional and social challenges patients encounter mean that for many, even if they recover physically, they never fully achieve “recovery of the self,” or the ability to return to important roles, identities, and functions.

Most of my firearm-injured patients were shot in their own neighborhoods, near their homes, most often while they were simply going about their usual activities. When they leave the hospital, many live with fear for their lives, become reluctant to set foot outside, or must contemplate the costs of moving far from home.

This dangerous combination of physical, economic, social and emotional impacts of trauma means that approximately 20 percent of survivors suffer a second violent injury. It’s a pattern Dr. John Rich of Drexel University explored in his crucial book Wrong Place, Wrong Time: When patients feel threatened, they are more likely to carry weapons. When they have pain and symptoms of depression or anxiety, they are more likely to use alcohol or drugs. When they are out of work, they are more likely to engage in marginal or underground economic activity. These factors all increase their risk of criminal justice involvement and repeat injury.

Systemic racism has a major impact in recovery after trauma. The overwhelming majority of firearm-injured patients that I treat at Penn are young Black men. The structures and systems of disadvantage that put them at risk for injury in the first place also interfere with their recovery by erecting barriers to employment, educational access, health care, and housing.

All these factors pile up on top of the physical aftermath of trauma and trauma surgery. Some patients may have major fractures and reconstructions to heal. For others, our team may have opened their chest or abdomen and removed, reconnected, or rearranged vital organs. Post-surgical home care and doctors’ visits mean that patients must ask for help with the most basic activities. And many patients report that that there is no one with whom they can talk openly about their experiences. Depression and post-traumatic stress disorder are present in up to half of gunshot-injured patients years after injury, according to research published last year in JAMA Surgery by a team of my Penn Medicine colleagues.

When we see what patient go through after they leave us, we have to ask, how can we help... more? What role can our hospital play in bringing about comprehensive recovery? The Penn Trauma team is partnering with concerned clinicians throughout the United States to identify effective strategies and to collect the long-term data that can help us understand what works. How clinicians treat our patients can make a difference. Patients value when the health care team acknowledges the impact of their injury and addresses their broad concerns. Inspired by the work of Dr. Rich and others, trauma centers around the country have developed hospital-based violence intervention programs that provide wraparound services, peer mentoring, and case management to help patients recover. To connect with patients, these employ individuals who do not have medical training but do have a shared background and an extraordinary ability to build trust and form lasting bonds with patients and to connect them to the comprehensive services they need to thrive. In a new program supported by grant funding made available through the Pennsylvania Commission on Crime and Delinquency, Penn Trauma has brought on staff our first Violence Intervention Specialist. Across the board our team has welcomed him, recognizing how much unmet need our patients have.

Physicians must also advocate for interventions in our communities and cities. Physical and mental health care and economic support are critical. Time and time again, local, state, and federal government signal that these patients, their families, and their communities don’t deserve focused policy or resources to prevent the kind of harm they have suffered or to help them recover.

To achieve strong public policy, the public must better understand that firearm injury is pervasive and profoundly harmful but also preventable – and that its victims are real people who matter. News media have a critical role in the public understanding of the gun violence epidemic, but too often, the victims of gun violence are invisible or are reduced to one line on a screen. When we studied media reporting on gun violence in Philadelphia, we found that half of shootings never even made the news. And when incidents are reported, follow-up is limited, root causes are not addressed, and the victims’ perspectives are missed. Journalists at the Initiative for Better Gun Violence Reporting have taken this on, aiming to expand coverage that represents the experience of individuals and communities most impacted, and that addresses the prevention strategies we really need.

As a surgeon, I don’t meet my patients until they have been injured – they are already not okay. But as a researcher with an eye to public health, I know that each patient I meet indicates a series of missed opportunities to prevent harm. It is imperative that we expand comprehensive support for our patients’ recovery. But we can do even better: We can avoid the need to recover to begin with. Violence prevention is complex, but it is not intractable. We need effective, tested, interventions at the individual, neighborhood, and community level. Most urgently we need remedies for the structural injustices that concentrate violence in neighborhoods and communities of color. As Dr. Eugenia South writes in this issue of the magazine, decades of systematic disinvestment in Black communities have caused disparities on every axis, but interventions as seemingly simple as cleaning up trash, planting trees, and repairing buildings can strengthen neighborhoods, prevent violence, and improve health. The same goes for repairing our unequal school system and providing meaningful employment opportunities. There’s plenty of work to be done. When I know that I am releasing my patients from the hospital into the arms of a community and society that understands what they are going through and that values them entirely, I will truly be able to say: “You are going to be okay. We’ve got you.”

About Elinore Kaufman, MD, MSHP

Elinore Kaufman, MD, MSHP’16, is an assistant professor of Trauma Surgery at the Perelman School of Medicine. Kaufman’s research interests include health policy and health services, ranging from qualitative assessment of patient-centered care in the trauma bay to national analyses of drunk-driving prevention policies and gun control laws.

Reimagining

By Eugenia South, MD, MSHP

Gun violence happens most in places that bear the brunt of generations of inequity. An Emergency Medicine physician and researcher says that if Black lives really matter, we must invest in Black neighborhoods.

Walter Wallace Jr. was shot by police near his home in West Philadelphia.

The shooting happened in the community in which I attend church and work as an Emergency Medicine physician. Wallace, a 27-year-old Black man, was rushed to Penn Presbyterian Medical Center for care last October, and our team worked hard to save his life. They could not.

Gun violence killed Black people at alarming and unprecedented rates last year, and this surge has been palpable in my emergency department. I have participated in countless thoracotomies, a procedure involving a large incision to open a patient’s chest to stop bleeding from a bullet. In December, after my team performed a thoracotomy in our final – but unsuccessful – attempt to revive a young Black man, we held a moment of silence to honor his life. After, as I stripped off my bloody gown, I broke down and sobbed.

My tears were from intense sorrow, because I could not help but imagine my two Black sons, ages 7 and 3, lying lifeless on the gurney. My tears were also from anger, because I know gun violence, including at the hands of police, is preventable.

As a nation, we have made a choice to largely ignore what the evidence says about creating safe neighborhoods. We have declined to fund place-based interventions, such as parks and trees, that actually work to protect citizens on a broad scale. And through our inaction, we have decided that Black lives do not, in fact, matter as much as white ones.

Urban gun violence disproportionately affects segregated Black neighborhoods marked by concentrated disadvantage. Over time, a lack of investment into neighborhoods’ physical infrastructure has led to a crumbling housing stock, blighted spaces, and a dearth of green space such as trees and parks. These conditions trace to legacies of state-sanctioned structural racism such as redlining, as well as other long-standing and ongoing discriminatory real estate and bank lending practices.

More recently, mass incarceration extracts resources and talent from Black communities, and an on-the-ground police surveillance state feeds prisons with bodies. The inevitable results – entrenched poverty, lack of economic opportunity, underfunded and failing public schools, and deteriorating neighborhood environments – are the root causes of gun violence.

Caring for victims of gun violence early in my career motivated me to turn to science for answers on prevention. I have worked with a team of researchers at the Penn Urban Health Lab to study place-based interventions that promote safe communities. Philadelphia, like many cities, has tens of thousands of dilapidated vacant spaces, often filled with trash, used condoms, and needles. For people living nearby, these undesirable but unavoidable spaces result in fear, stigma and stress.

Several simple, low-cost, structural change to the neighborhood environment can improve safety and foster well-being. Our research recently demonstrated that investing in structural repairs to the homes of low-income owners – including electrical, plumbing, heating, and roofing repairs – is associated with reductions in crime on the block of those homes. As more homes are repaired, the drop in crime is larger. Securing abandoned houses with working doors and windows has also been shown to be associated with reduced violent crime.

Our research has also demonstrated that turning vacant land into clean and green space reduces gun crime. People living nearby feel safer and less depressed, and they forge deeper social connections with their neighbors. In fact, some residents reclaim these spaces for social activities such as barbecuing and gardening.

Green space has consistently been associated with health benefits. Simply walking past an urban space with grass and trees calms the body, including lowering heart rates. Stress reduction and the positive impact on mental health may explain why being near trees has been associated with lower risk of gun assault among Black adolescents. In another study, we found that for pregnant women with a history of anxiety or depression, urban tree canopy was associated with less stress.

Clean and accessible parks, trees, and micro-green spaces should not be a luxury amenity reserved for those living in affluent, mostly white neighborhoods that have benefited from decades of intentional, government-backed investment. And yet that is precisely the situation we are in, with Black, formerly redlined neighborhoods having the least amount of green space in the present day.

The family of Walter Wallace Jr. reported that he had bipolar disorder and was experiencing a mental health crisis the day he was killed. I have often wondered: What if he had come to my emergency department as a mental health patient instead of a shooting victim? What if he never reached crisis level because his neighborhood conditions supported mental health?

Reimagining safety means making intentional decisions to address the root causes of gun violence through policy changes and financial investment in Black people and Black neighborhoods. One promising opportunity is to reallocate dollars from expansive police budgets – which make up the largest budget item in most big cities – to evidence-based non-police interventions. Place-based initiatives – including restorative natural outdoor spaces – should be at the top of the list. 

About Eugenia South, MD, MSHP

Eugenia South, MD, MSHP’12, is an assistant professor of Emergency Medicine in the Perelman School of Medicine, vice chair for Inclusion, Diversity, and Equity in the Department of Emergency Medicine, and faculty director of Penn’s Urban Health Lab. She can be found on Twitter @eugenia_south. An earlier version of the essay above was first published in the Washington Post in March 2021 as part of its “Reimagine Safety” series.