Preventing Firearm Suicides Among Vulnerable Populations by Addressing the Root Cause
Thu, Sep 19, 2024 -
Comments (0) -
Posted by
Kim Byas, PhD
September is National Suicide Prevention month, a reminder to be watchful of and responsive to those around us who may be struggling or in crisis, to seek help if we ourselves are struggling, and to make use of the 988 Suicide & Crisis Lifeline if needed. It is also an opportunity to consider more closely how structural racism and poverty are linked with firearm suicide nationwide and right here in Cleveland, and to take action in order to save lives.
Firearm suicides are a significant public health issue. On the national level, over half of all suicides in the United States are from firearms and in Cleveland that rate is nearly 60% among the general population and over 70% among African American men under the age of 30.
While firearm suicides span all demographic groups, marginalized and economically vulnerable populations—particularly African Americans and young males under 30 in urban areas—are disproportionately affected. These vulnerable groups face unique challenges that are deeply rooted in structural racism such as historical redlining practices. Redlining is a well-documented and historical practice where banks, insurers, and other financial institutions refused or limited financial services to neighborhoods based primarily on racial or melanated populations. This practice led to long-term economic and social disadvantages for affected areas.
The vestiges of such national housing lending policies include neighborhoods with more than 50% of children living in poverty and whole census tracts where the median income was under $30,000 in 2023. These dire and hopeless conditions exacerbate the risk of firearm suicides.
This blog briefly explores the role of structural racism and poverty in driving firearm suicides and highlights data-driven interventions from The Center for Health Affairs Social Determinants of Health (SDoH) Innovation Hub.
Structural Racism as a Driver of Firearm Suicides
Structural racism refers to the institutional and systemic policies and practices that create and maintain racial inequality across various domains—including housing, education, employment, and healthcare. For marginalized populations, the consequences of structural racism are profound and long-lasting as manifested in health disparities.
The effects of structural racism are particularly evident in urban areas where many African American males reside. Decades of discriminatory policies such as redlining have concentrated poverty in specific neighborhoods leading to substandard housing, high crime rates, and limited access to quality education and healthcare. These conditions contribute to behavioral health stressors such as depression, anxiety, and post-traumatic stress disorder (PTSD)—all that increase the risk of suicide.
Firearm availability in these communities compounds the problem. Studies show that firearm suicides have a lethality rate of 90-95%, making access to guns particularly dangerous for individuals experiencing behavioral health crises. For young African American males, who are more likely to face economic hardship, violence, and inadequate access to behavioral healthcare services, the intersection of these challenges can be fatal.
The Intersection of Poverty and Suicide Risk
Poverty is a critical social determinant of health that significantly impacts mental well-being and suicide risk. Economic instability—often the result of structural racism—creates environments where individuals face high levels of stress and limited access to resources that could alleviate behavioral health crises. In marginalized communities, poverty is inextricably linked to the risk of firearm suicides.
Research demonstrates that individuals living in poverty are more likely to experience behavioral health conditions such as depression where self-medication with alcohol and other substances increase the likelihood of suicide. Additionally, poverty severely limits access to behavioral health services. Subsequently, individuals living at or below poverty guidelines often cannot afford care or live in areas where behavioral health resources are scarce. These barriers to care leave many individuals without the support they need to navigate behavioral health challenges and, therefore, increasing their vulnerability to suicide.
Firearm Suicides Among African American Males Under 30
Young African American males under 30 are particularly vulnerable to firearm suicides due to the compounded effects of structural racism, poverty, and firearm availability. In urban areas such as Cleveland, these young men face high rates of unemployment, lack of transportation, and housing instability. Data show that these social vulnerabilities contribute to poor mental health outcomes.
A study conducted in 2021 highlighted the alarming rise in suicide rates among young African American males—particularly those in their teens and 20s. While suicide rates have historically been higher among white males, recent data show a disturbing increase in suicides among African American males as well as among African American females. These trends underscore the urgent need for root cause solutions.
The prevalence of firearms in urban areas, combined with economic hardship and overwhelming sense of hopelessness and despair, create a perfect storm for firearm suicides. In these communities, firearms are readily accessible. Yet, behavioral health services are often limited or nonexistent. This disparity contributes to the high rates of firearm suicides among young African American males.
The Role of the SDoH Innovation Hub in Addressing Firearm Suicides
The Center for Health Affairs SDoH Innovation Hub is the leading force in addressing the root causes of firearm suicides among vulnerable populations. Launched in 2022 and powered by Amazon Web Services (AWS), the SDoH Hub uses data-driven solutions to tackle health disparities—including firearm suicides—by addressing the social determinants of health.
Through the analysis of over 500 sources of publicly available data, the SDoH Hub identified critical correlations between firearm suicides and social vulnerabilities, such as housing insecurity, unemployment, and lack of access to transportation. The SDoH Hub found that 58% of suicides in Northeast Ohio were attributable to firearms and nearly 70% of suicides among African Americans in Cuyahoga County are attributable to firearms—closely linked to these social determinants of health.
By focusing on these root causes, the SDoH Innovation Hub aims to reduce firearm suicides through targeted interventions that address the underlying social and economic factors driving these tragedies. For example, the Hub is working with local governments and organizations to improve access to housing and employment opportunities, two key factors that can alleviate the economic stressors contributing to suicide risk. Additionally, the SDoH Hub advocates for programs and policies that reduce firearm access in vulnerable communities.
Policy Solutions to Address Firearm Suicides
Reducing firearm suicides among vulnerable populations requires comprehensive policy changes that address structural racism, poverty, and firearm access. Several states have implemented successful policies that could serve as models for national efforts.
- Extreme Risk Protection Orders (ERPOs): ERPO laws, also known as "red flag" laws, allow family members and law enforcement to temporarily remove firearms from individuals at risk of suicide or violence. States like California and Connecticut have successfully implemented ERPO laws, which have been shown to reduce firearm suicides. Expanding these laws nationwide could help prevent suicides in communities where firearm access is prevalent.
- Improving Access to Mental Health Services: Medicaid expansion under the Affordable Care Act (ACA) has been instrumental in improving access to mental healthcare for low-income populations. States that expanded Medicaid, such as New York and Oregon, have seen improved mental health outcomes and reduced suicide rates among marginalized populations. Expanding Medicaid in all states would ensure that more individuals in poverty can access the mental healthcare they need.
- Culturally Competent Care: Increasing the availability of culturally competent mental health services is crucial for addressing the unique challenges faced by African American males. Programs that recruit and train mental health providers from underrepresented communities, like those implemented in North Carolina, have shown promise in improving mental health outcomes for marginalized populations.
- Economic Empowerment Programs: Addressing the economic disparities that contribute to suicide risk is essential for reducing firearm suicides. Job training and economic development programs, such as those implemented in Massachusetts, can help lift individuals out of poverty and provide them with the resources they need to thrive. Expanding these programs to other states could help reduce the economic pressures that drive suicide among marginalized populations.
The Way Forward: Solving Structural Racism and Poverty
Addressing firearm suicides requires a multifaceted approach that tackles the root causes of structural racism and poverty. The SDoH Innovation Hub offers a model for how data-driven solutions can help identify and address these root causes, reducing the risk of firearm suicides in vulnerable populations.
However, broader systemic changes are necessary to create lasting improvements. Policymakers must prioritize addressing the social determinants of health by investing in affordable housing, expanding access to mental healthcare, and implementing policies that reduce firearm access in communities at risk. Only by addressing the structural inequalities that drive suicide can we begin to reduce the devastating toll of firearm suicides among marginalized populations.
Conclusion
Firearm suicides disproportionately affect marginalized populations, particularly African American males under 30 living in urban areas. The intersection of structural racism, poverty, and firearm availability creates the conditions for these tragedies, which are preventable through targeted interventions. The SDoH Innovation Hub's work demonstrates the power of data-driven solutions to address the root causes of firearm suicides. By expanding access to mental healthcare, implementing ERPO laws, and addressing the social determinants of health, we can make meaningful strides in preventing firearm suicides and creating a more equitable society.
References
Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Sheftall, A. H., Greenhouse, J. B., Kelleher, K. J., & Campo, J. V. (2021). Age-related racial disparity in suicide rates among US youths from 2001 through 2015. JAMA Pediatrics, 172(7), 697-699.
Centers for Disease Control and Prevention. (2022). Suicide mortality in the United States, 2020. Retrieved from https://www.cdc.gov
Gifford, K., Weiner, J., & Squires, E. (2019). Medicaid moving forward. Kaiser Family Foundation.
Houle, J. N., & Light, M. T. (2017). The role of economic insecurity in suicide. Social Science & Medicine, 175, 127-135.
Kaplan, M. S., McFarland, B. H., Huguet, N., & Caetano, R. (2019). Firearm suicide in the United States: Epidemiology, prevention, and policy. American Journal of Public Health, 109(2), 244-251.
McLanahan, S., & Percheski, C. (2017). Family structure and the reproduction of inequalities. Annual Review of Sociology, 34(1), 257-276.
Rothstein, R. (2017). The color of law: A forgotten history of how our government segregated America. Liveright Publishing.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2018). Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press.
The Center for Health Affairs. (2022). An overview of the SDoH Innovation Hub on its impact on vulnerable populations.