Each act of gun violence should not be treated as an isolated incident and everyone who has experienced gun violence, including the emergency department physicians and trauma surgeons who treat its victims, ought to “step back and ask a ‘why’ question,” said Camara Jones, MD, MPH, PhD.
Dr. Jones is the research director on social determinants of health and equity in the Division of Adult and Community Health at the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion. Speaking to physicians at the 2016 AMA Interim Meeting during a session on gun violence, she argued that widespread availability of firearms accounts for the nation’s high overall death toll from guns but that the disparate racial impact of gun violence “has everything to do with racism.” Her talk came days before the AMA joined a “call to action” on gun violence and was one of several instances when attention at the meeting turned to issues of race and medicine.
“When I say the word ‘racism,’ I am talking about a system,” said Dr. Jones, whose three-year term as president of the American Public Health Association ended this month. “I’m not talking about an individual character flaw, or a personal moral failing, or even a psychiatric illness that some people have suggested. I’m talking about a system of power, and it’s a system of structured opportunity and of assigning value.”
Dr. Jones argued that physicians should take into account how systemic racism contributes to gun deaths and injuries as well as other health outcomes of concern in order to look for broader fixes that go beyond what they can address in a strictly clinical setting.
She noted that health disparities are found outside the U.S. too, and that perceptions of race are driven by local culture and history.
“I, here in Orlando, am clearly black. But in some parts of Brazil I’m just as clearly white. And in South Africa I’m clearly colored,” Dr. Jones said. “So here I am with the same physical appearance in those three settings, but the social interpretation of my appearance in each of those settings would assign me to a different racial group. And furthermore, if I were to stay in any of those settings long enough … my health outcome would probably take on that of the group to which I’ve been assigned, even though I’d have the same genes in all three places.”
It is widely understood that “racism unfairly disadvantages some individuals and communities,” Dr. Jones added. “But it shouldn’t take us long to recognize that every unfair disadvantage has its reciprocal unfair advantage so that racism is also unfairly advantaging other individuals and communities.”
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