In 1925, in the classic novel An American Tragedy, Theodore Dreiser portrayed a poignant yet powerful picture of youthful loneliness in industrial society and of the American mirage that beckons some of the young to disaster.
In 2012, an American tragedy of far greater urgency and public health importance is the alarming rate of homicide among young black men. Interracial homicide, whether the victim or the perpetrator is black, is abhorrent. Nonetheless, from the perspective of the health of the general public, the circumstances in which a young black man is both the victim and the perpetrator cause far more premature deaths.
Homicide is, far and away, the leading cause of death of young black men. In stark contrast, accidents are, far and away, the leading cause of death among young nonblack men and women of all races and ethnicities. Black men are 6 times more likely to die as the result of and 7 times more likely to commit murder than their white counterparts. One eighth of the population is black, but one half of all homicide victims are black. Their reduced life expectancy of more than 6 years would be improved more from eliminating homicide than abolishing any other causes of death except cardiovascular disease or cancer.1
From 1999 to 2009, among those aged 15 to 34 years, there were 106,271 homicides, 85% (89,887) among men and 49% (52,265) among black men. One major and hotly debated issue is firearms. Specifically, 81% (85,643) of all homicides were due to firearms, including 91% (47,513) among black men.2 All attempts to address this complex issue should include, but not be limited to, optimizing the health of the general public, the strength of the existing evidence, and the constitutional right of individuals to bear arms.
In most circumstances, public health practitioners are charged to identify threats to the health of the community and to bring scientific evidence to the attention of policy makers, even if the threats are lawful and whether or not policy makers choose to act on that evidence. For example, cigarettes are both lawful and popular, but public health support of laws controlling their exposure to the general population has contributed to the reduction of the premature mortality they cause.
To date, however, this has not been the case for firearms. For policy makers proposing new gun laws, establishing an evidence-based legislative record may be especially important.3 Nonetheless, federal public health practitioners are barred from such activities, due, in part, to the Anti-Lobbying Act and a 1996 action by the Congress of the United States, which defines such activities as “lobbying,” which is considered a felony. Instead, federally employed public health officials are instructed by legislators to consider only the existing totality of available evidence. To date, this primarily includes descriptive data that are useful to formulate but not test hypotheses.4 Nobody would disagree that individual behavior change is an important and necessary strategy for lowering homicide rates, but there is legitimate debate about whether it would be sufficient. It seems plausible, if not likely, that major societal changes amenable to responsible government but beyond individual control also are needed to achieve decreases in premature mortality from homicide among young black men.
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