It has been almost a year since police arrested four demonstrators staging a sit-in at the University of Chicago Hospital with students, residents and activists gathering in the lobby on January 28 to demand a Level 1 adult trauma care center for the South Side.
At the time, and since then, the hospital has said it lacks the resources to support a trauma care center, leaving much of the South Side very much a “trauma desert,” or a region with no easy or fast access to trauma care – and leaving, according to critics, many South Side adults and youth, who comprise such a large share of gun hospitalizations, at risk of death.
Even as Chicago is on pace to record the lowest crime and homicide total in years, if not decades, the issue still lingers and feelings run high as providing trauma care centers appears to be the “low hanging fruit,” according Dr. Marie Crandall of the Feinberg School of Medicine at Northwestern University.
Crandall published a study last April, which determined that the crude mortality rate (the rate not adjusted for difference in severity of injury) for victims shot more than five miles away from a trauma center is 8.73 percent, as compared to the rate of 6.42 percent for those within five miles—this difference accounts for 6.3 additional deaths per year. Some wounded South Side residents even need to be rushed, for example, to Cook County Hospital on the near West Side – or to the suburbs.
And protesters said this could mean a higher death toll simply because the country’s third largest city doesn’t have the of care required near some of the most dangerous and shot-up neighborhoods in the nation—neighborhoods like West Englewood, which saw five homicides in a nine-day stretch in November of this year, and Mount Greenwood, which saw a 55 percent increase in violent crime from 2011 to 2013.
“There’s something about the condition of being shot that makes it more likely that the injury benefits from immediate surgical intervention,” Crandall said. “That made a difference in terms of 21 percent mortality.”
The higher hanging fruit, Crandall said, is addressing the socio-economic factors causing gun violence.
“The strategies need to be ones of prevention, and identifying lack of resilience in communities, endemic poverty, lack of jobs, poor community engagement as risk factors,” Crandall said. “Those are things that can be addressed with a public health approach.”
A public health approach, according to Dr. Romesh Nalliah, means “thinking about the greater good; how can you reduce the cost and the burden of the disease.”
In November, Nalliah and his fellow researchers presented their study on firearm-related hospitalizations nationwide at the American Public Health Association annual meeting in Boston. Their study concluded that the highest risk group was young, black, male and uninsured – a population that comprises much of the South Side neighborhoods that would be served by a trauma center at U of C.
Crandall seconded this. “We know trauma discriminates,” she said. “The folks who were shot in areas more than five miles away from a trauma center are even more likely to be African-American, young, and uninsured.”
So the question becomes: how much can the absence of a U of C trauma center discriminate?
The answer is anybody’s guess, but Nalliah’s study — which pulled data from hospitals around the nation — showed that adolescents and young adults from 15 to 40 years old made up 76 percent of hospitalizations, and 48 percent of all people hospitalized for firearm-related injuries were black.
Even these high numbers seem an underestimation.
“[In the data we used] 20 percent of the race information is suppressed because there are a few states that do not disclose race information,” Nalliah said. “Even if in the last 20 percent, every single one of them was white, it would still be an under-representation of whites and an over-representation of blacks.”
One of the study’s other major conclusions was the astronomical costs for firearm-related hospital stays.
Over the eight years covered by the study, hospital charges totaled $18.9 billion just for firearm related injuries– and that, too, is an underestimation, according to Nalliah.
“We only have hospital charges related to hospitalized patients, we have no information after the stay, we have no ER information,” Nalliah said. “It already sounds bad, but it’s underestimated.”
Gary Slutkin, the founder of Cure Violence, the non-profit previously known as CeaseFire, said the problem of gun injuries and deaths has been radically misdiagnosed.
“Violence actually meets the dictionary definition of disease,” Slutkin said. “The number one risk factor for violence is preceding exposure to violence, just like preceding exposure to the flu. Same for cold, same for T.B. It’s entirely something that’s transmitted.”
Cure Violence’s method of prevention centers on behavioral change. “You need to look at who is doing it, where it is, and how you reach them. You need a new kind of worker, a worker who has credibility and trust and access,” Slutkin said. “We call these workers interrupters, or behavior change workers.”
Workers with Cure Violence are specially trained to de-escalate potentially violent situations – such as payback shootings and the cycle that it generates – and talk down people considering using violence.
“They’re able to help [people in the neighborhood] to reassess and not transmit the infection. They work like health workers,” Slutkin said.
Slutkin said in its first year Cure Violence saw a 67 percent drop in shootings and killings in West Garfield, its pilot neighborhood. Their method has also been implemented in similar form in Baltimore and New York City with some applauding the method and others claiming that Cure Violence is oversimplifying and has taken on a celebrity status.
Despite these alternative methods and the existing roster of firearm restrictions and penalties, Chicago policymakers continue to endorse a stricter punitive approach to ending gun violence. In October, Mayor Rahm Emanuel endorsed the still-pending Illinois House Bill 2265, which would extend the mandatory minimum sentence for carrying an unlicensed gun from one year to three.
Many groups are fighting this bill, saying it captures too many minorities for too long, increasing an already overcrowded prison and jail system.
Tracy Siska, executive director of the Chicago Justice Project, says policies like the mandatory minimums are almost completely ineffective.
“The mandatory minimum laws are more propaganda than they are substance,” Siska said. “They’re there to make people think that policymakers are doing something about gun violence.”
However, Siska is still skeptical of the public health approach to preventing gun violence on the streets. “It’s not a horrible strategy, but it’s more of a band-aid,” Siska said. “I am for much more restrictive gun laws, but the long term is all based on economics. It’s about jobs, education, opportunity.”
Much of this is lacking in the South Side areas that would be served by U of C – which is based in well-off Hyde Park but surrounded by areas not only deserted by trauma care but also banks, grocery stores and other anchors that make up sustainable local economies.
The health community, including the World Health Organization and the Centers for Disease Control and Prevention, has already recognized that gun violence is a transmittable disease, yet policymakers continue to insist on punitive methods of curbing the use of violence.
Just this year, for example, the City Council approved a ban of concealed weapons in all bars and restaurants that sell packaged liquor, beefed-up the sentence for gun crimes committed along “Safe Passage” routes for school children and broadened the ban on assault weapons.
“Punishment is not the main driver of behavior,” Slutkin said. “The main formers of behavior have to do with what you observe and the social pressures around you.”
Not only are these punitive efforts ineffective, Slutkin says, but they also worsen the problem.
“It’s salt in the wound,” he said. “It’s been demonstrated that when you put people around other people who are violent, you create more violence. It’s counterproductive, not just un-productive.”
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