Authors: Joseph Friedman,1 Philippe Bourgois1
1Center for Social Medicine and Humanities, UCLA
This blog post discusses the journal article: “Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia’s Puerto Rican inner-city” available open-access: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225376
The United States has astronomical rates of firearm violence compared to other high-income nations, and to explain this discrepancy it is important to consider what is unique about the US, and the deep roots of the ongoing crisis. To understand our country’s violence, we must understand its history, and the social and economic structures that engender violence, especially: poverty, racism, and the war on drugs. These are some of the main structural drivers of American violence.
Although large-scale mass shooting events garner the most press and public outrage, they represent a small fraction of all firearm homicides in the US. Across the US, gun homicide is startlingly common, and in some areas, it has become a fact of daily life. Too often, these most-affected areas are economically marginalized and racially segregated in inner-city neighborhoods, which have been rendered structurally vulnerable to violence.
The concept of “structural vulnerability” opens the black box of the social determinants of health, helping identify the policies and social forces that drive adverse health and social integration outcomes, such as premature mortality by firearm homicide, low educational levels, and exclusion from legal employment opportunities. A structural vulnerability perspective also highlights how these factors are systematically distributed along lines of race and class, and result in the large magnitude of health disparities prevalent across the United States.
The central role of racism and poverty in driving firearm violence are evident in the numbers: black men in America are 14-fold more likely to be murdered with a firearm than white men. In Pennsylvania, where our recent study was situated, that disparity rises to 30-fold. Furthermore, a clear “poverty-violence gradient” can be seen nearly ubiquitously in the US, and across the world, with a dose response curve between increasing levels of poverty and increasing risk of being victimized by violence.
Our study, published recently as part of a special collection on narcotics in PLOS ONE, took a multi-methods approach to understanding the drivers of urban gun violence, and especially the connection to prohibition and the narcotics economy. We combined a statistical analysis of trends in violence- and narcotics-related crime by race and poverty levels, with participant observation ethnography among the participants in drug-selling and firearm violence. For more than six years, our ethnographic team was immersed in the heart of Philadelphia’s most-impoverished, majority Puerto Rican neighborhood. We rented an apartment on a block surrounded by multiple heroin and cocaine sales points, and two of our co-authors (George Karandinos and Fernando Montero) lived there full-time. We were able to directly observe the sale of heroin and cocaine and participate in the routine activities of daily life in the neighborhood (e.g., hanging out in the neighborhood, talking about recent events). This approach, we hoped, would allow us to develop a more detailed and humanistic picture of the lives underlying the numbers.
Statistically, we recognized stark racial disparities in gun violence rates in Philadelphia (figure 1). From 2006 to 2017 the city-wide murder rate was 20.0 per 100,000 persons per year. Looking by neighborhood race, it was 5.8 for majority-white areas, 30.8 for majority-black areas, and 39.0 for majority-Puerto Rican areas. The murder rate in the narcotics-laden area that was our field site (identified in figure 2) was even higher, at 62.0.
We also observed what numbers like this mean in the daily realities of a community. As we tape-recorded interviews with residents, the sound of gunshots sometimes punctuated the flow of conversation. On nearly every block in the area, at least one homicide occurred during the time we studied this neighborhood (Figure 2, part B). In this small, approximately 10 square block area, it was rare for a month to pass without a homicide (Figure 2, part C) and at least half a dozen armed assaults and robberies. Nevertheless, the violence in our field site was not “random” or “totally senseless.” In fact, it was baked into the logic of the narcotics market that represented the main source of employment in the neighborhood.
Contextualizing the statistics, our article recounts the story of a young man, who we refer to here as Leo. He grew up in the poorest corner of Puerto Rican Inner-City Philadelphia, which was struggling in the wake of deindustrialization and neoliberal cuts to social programs. He was a bright young man, motivated to succeed. Leo had virtually zero local examples of successful male role-models in his social network; he knew almost no men who achieved economic stability and social mobility without engaging in the retail sale of narcotics. Furthermore, all of Leo’s immediate family and almost all of the young men and boys in his extended social network were either employed selling heroin and cocaine, incarcerated, or prematurely deceased. In short, the only “equal opportunity” employer that was available to him was the narcotics economy, which was ubiquitously found on every street corner in his neighborhood.
Leo got a job in the narcotics economy, selling heroin and cocaine, and ambitiously worked his way up to controlling a corner. By definition, Leo’s job exposed him to high risk of violence. The prohibition of narcotics inherently creates a highly lucrative market that can only be protected with violence. In a single day, hundreds of thousands of dollars of untraceable cash routinely flow through a neighborhood where the majority of residents live well below the poverty line. In this context, Leo was constantly under threat; he could be attacked at any time for his profit, product, or control of his sales location. He therefore needed to be able to perform violence at a moment’s notice, to protect his reputation and profits. In a clandestine market there is no legal recourse should product or profit be stolen by an employee or a competitor. Order, therefore, is generally maintained with violence or the threat of violence. Ultimately it was this need to maintain control that tragically resulted in the near-death of Leo’s employee. When a $500 stash of heroin went missing, a disagreement broke out among Leo and the employee who had been in charge of sales at the moment. Leo’s employee was joined by a group of friends, and Leo, outnumbered and fearing for his own life, drew his weapon and fired. Though Leo narrowly avoided being victimized himself, he lost 10 years of his life behind bars with no access to vocational, educational, drug treatment, or mental health services. Once in prison, Leo again found that the performance of violence was similarly necessary for his survival, if not more so.
We hope that the data presented in our analysis, both quantitative and qualitative, can paint a humanized and nuanced picture of the forces that push a large number of Americans into situations that expose them to high levels of firearm violence. We are energized by recently re-invigorated efforts in the medical community and general society around reducing the burden of gun violence in our communities. Here, we emphasize that much of the gun violence in the United States is not random. These deaths often represent nearly predetermined tragedies, baked into the policies and institutions of our constructed society, and therefore require structural solutions. They are also an urgent priority from a racial and class justice perspective.
We call for a “Marshall Plan” level of development in the urban inner-city. If a fraction of the money currently spent on policing and incarcerating low-income people was spent on formal education and employment opportunities, it could make a meaningful and positive impact on the structural contexts that push people into narcotics retail and the associated violence. Investing in jobs and schools in inner-city America is a social justice issue and a public health issue.
To read more about these solutions, hear these stories in the words of those who lived through them, and see the results in much more detail, read the open-access study here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225376