Firearm violence devastates entire communities, tearing families apart and leaving survivors with lifelong disability. As a surgeon I see the physical, mental, and psychologic toll that this violence inflicts on victims and those close to them. Young teens struggle to take their last petrified breaths as we attempt to control the damage. When given the news, their parents’ loss and anguish is indescribable. Even if survivable, lives are changed forever through the physical and psychological morbidity.

In our busy trauma center, we see many victims of firearm violence. Most of these victims are Black and come from specific Boston communities: Roxbury, Dorchester, and Mattapan. Where one lives is no coincidence, nor is the violence that plagues these communities.

Like the incidence of many chronic diseases, Black Americans in general and young Black men in particular, are vastly overrepresented among victims of firearm injuries. In fact, homicide is the leading cause of death for Black men under the age of 44, much of which is firearm-related. The American social narrative around firearm homicides revolves around blame and individual responsibility of the victims.

These narratives presuppose that those shot are somehow engaging in criminal activity or otherwise at fault for the circumstances leading to their victimization. These narratives inherently blame the victims, while ignoring a larger part of American history that crafted the geographic and social landscape that leads to the plague of firearm violence.

There is a long history of structural racism in the United States with redlining among the most visual and enduring examples from the 20th century. As part of the New Deal, the Federal Housing Authority (FHA) was charged with backing home loans in an effort to propel the economy and build the middle class. The FHA created maps of urban areas to describe the risk of investment. Areas that were deemed hazardous and unworthy of government backed home loans were those neighborhoods with largely Black or minority populations, effectively precluding Black families from gaining equity through homeownership and devaluing entire communities as a result. These “redlined” areas today remain among the most impoverished with the lowest rates of homeownership, highest rates of unemployment, and the worst educational attainment.

In our recent study, we look at the incidence of firearm violence in Boston. We show that historically redlined areas like Roxbury, Dorchester, and Mattapan have among the highest levels of gun violence in the city. These areas are among the most segregated, with high shares of minority populations and among the highest rates of poverty in the city. We go on to show that this increased firearm violence is a result of the concentrated disadvantage that redlining created in these areas. Our study demonstrates that the enduring impact of racism on the neighborhoods in which people live has led to the higher rates of firearm violence, particularly in urban communities that have been precluded resources for decades.

Much like many designations, race is a social construct. Social designations drive the way we think about groups of people and the narratives that we build for these groups, including the false beliefs of individual responsibility around firearm violence. This criminality narrative is reinforced by the continued preclusion from resources in these devalued communities.

Boston is only one among many cities in the United States that segregated its citizens, stripping Black communities of wealth and health. The conditions that drive firearm violence have been fostered by government-complicit practices. To solve this pandemic of violence, we must demand government responses to this continued devaluation through reparative actions.

Michael Poulson is a resident physician at Boston Medical Center.