The inequality of violent death (Part 2)

Injuries and violence kill more young people in the U.S. than any other cause of death. The burden of these deaths varies enormously by race, ethnicity and social class. Deaths by homicide, for instance, are more than eight times more prevalent among blacks than among whites, and homicide deaths are three times more common among American Indians and Alaskan Natives than among whites between the ages of 1 to 30 years old.

The figure below shows age-adjusted suicide and homicide rates in that age bracket by race and ethnic origin in the year 2010. The unit of measure is the number of deaths by suicide or homicide per 100,000 members of each population:

Age-adjusted suicide and homicide rates in the USA by race and ethnic origin, 2010.
Source: Prevention of injury and violence in the USA, by Tamara M. Haegerich and others, The Lancet (2014)

The unequal burden stands out heart-breakingly clear in life expectancy numbers. Homicide takes two full years off the expected life span of black males in Los Angeles County and homicide subtracts nearly five years from the expected life span of black males in some low-income urban areas of LA. The following chart shows poverty levels by Health District in Los Angeles County compared with life expectancy in years and expected life years lost due to homicide during the years 2001–2006:

Years off Your Life? The Effects of Homicide on Life Expectancy by Neighborhood and Race/Ethnicity in Los Angeles County, by Matthew Redelings & others, J Urban Health. Jul 2010; 87(4): 670–676.
Source: Years off Your Life? The Effects of Homicide on Life Expectancy by Neighborhood and Race/Ethnicity in Los Angeles County, by Matthew Redelings & others, J Urban Health (2010)

Root causes

Credible evidence supports claims that the excess deaths are partly a consequence of the kind of society we have built, a society that marginalizes certain classes of people, depriving them of high-quality education, job opportunities, and healthy neighborhood living conditions. The Lancet paper, written by researchers from the Centers for Disease Control and Prevention, explains:

Young people growing up in communities with concentrated disadvantage are more likely to witness violence, attend underperforming schools, and have poor employment opportunities; they are also more likely to be exposed to drug-distribution networks and can access firearms more readily than can young people not growing up in such communities. These social and environmental factors can greatly increase an individual’s risk of perpetrating violence and being a victim of violence. Thus, the link between socioeconomic status and injury is mediated by many conditions at home, at work, in communities, and within families and groups, with variations in effects noted across different types of injury. Social and economic factors fuel stress; challenge adaptation and coping mechanisms; contribute to social exclusion and isolation, residential instability, workplace pressures, and low community participation; and affect access to safe environments, safety equipment, and services. These factors can accumulate and interact to substantially affect experiences and risks.

Some researchers are convinced that neighborhood environment largely explains the racial and socioeconomic differences in death rates. A study of homicide risk in Atlanta in the 1970s, for instance, found no differences in homicide by race when household crowding was used as a measure of neighbourhood socioeconomic conditions. In the Los Angeles study, 75 percent of the neighborhood variation in homicide’s impact on life expectancy could be predicted from neighborhood poverty levels.

Higher socioeconomic status may not protect the health of people who are well off when they live in poor environments. Regardless of your socioeconomic status, you are more likely to die of an injury if you live in an area with high poverty levels. The study that reached that conclusion found no link between individual social position and suicide, but a 50 percent increased risk of suicide for people living in neighborhoods with low socioeconomic status, high racial concentration, and high residential and family instability.

Note how the risk of violent injury (and other injuries) rose with each step of decreasing neighborhood socioeconomic status in a ten-year study of hospitalizations in Memphis, Tenn, and surrounding Shelby County:

Source: xx
Source: A Population-Based Analysis of Neighborhood Socioeconomic Status and Injury Admission Rates and In-Hospital Mortality, by Ben L. Zarzaur and others, J Am Coll Surg. Aug (2010)

The following figure shows homicide risk by neighborhood qualities sorted into categories, such as increasing poverty and unemployment. The study is based on data from Rhode Island and Massachusetts during the years 1989–1991.

source xx
Source:  Homicide risk across race and class: a small-area analysis in Massachusetts and Rhode Island Annie Gjelsvik & others, J Urban Health (2004)

The bars, from left to right, sort the neighborhoods as follows:

  • Poverty: <10% 10%-19.9% 20%-29.9% 40%-100%
  • Single mother households: <10% 10%-9.9% 20%-39.9% 40-100%
  • Unemployment: <5% 5%-9.9% 10%-19.9% 20%-100%
  • Decreasing home ownership: 50%-100% 20-49.9% <20%
  • Decreasing higher education: 25%-100% 10%-24.9% <10%
  • Low education: <25% 25-39.9% 40%-100%
  • Racial ratio: <0.25 0.25-0.49 ≥0.5

Policy solutions

Some authorities say it might be best to target prevention efforts (e.g. public awareness campaigns, community policing, increased police patrols, collaborative involvement of neighborhood associations and local businesses) on high-risk neighborhoods, rather than diluting limited resources over a broader population or geographic area.

Others say that the U.S. needs to do more to confront the root causes of the inequality with strategies that reduce bias and discrimination and improve access to employment, safe housing, and high-quality education.

Cities such as Baltimore have tried to reduce the density of bars and liquor stores in high-crime neighborhoods because the density of alcohol outlets has been linked to higher rates of violent crime. The so-called Broken Windows theory has led to initiatives that try to reduce violence by restoring deteriorating neighborhoods and sealing or removing vacant buildings.

Researchers in Philadelphia found a significant association between the risk of violent assault and the presense of abandoned buildings and vacant lots, even after controlling for demographic and socioeconomic characteristics of the neighborhoods. Vacant properties also had the strongest effect size, prevailing over almost a dozen well-known indicators of disadvantage. The following figure shows the link between rates of violent assault and the number of vacant properties across every census block group in Philadelphia County between 2002 and 2006:

source xx
Source: Vacant Properties and Violence in Neighborhoods by Charles C. Branas & others, ISRN Public Health (2013)



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