Reimagining: How to make Black communities safe from violence

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.

Eugenia South, MD, MSHP, 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.