Regardless of how an individual may perceive harm, structural inequality – the macro-level conditions such as residential segregation that limit opportunities, resources, and the well-being of underserved groups – can contribute heavily to such harm.(1–3) Structural inequality is frequently measured by daily or major events; for example, being unfairly fired from a job, being unfairly prevented from moving into a neighborhood because a landlord or realtor refused to rent or sell, or being unfairly denied a bank loan.(4, 5) Unequal treatment is a fairly common occurrence: 31% of adults in the United States report at least one major discriminatory occurrence in their lifetime and 63% report discrimination daily.(2) Unequal treatment in various forms affects various population groups, including racial/ethnic minorities, and discrimination based on race (commonly referred to as racism) has been linked to disparities in health outcomes for racial/ethnic minorities, including trust in physicians, medication adherence, receipt of health care, and birth weight deliveries.(6–8) Residential segregation is a major contributor to health disparities between African Americans and whites because it affects not only the social and economic resources of individuals and families but also the resources of communities.(9)
Residential segregation is a major source of health inequity and impacts socioeconomic resources, and low-income or highly segregated neighborhoods are more likely to experience violent crime than high-income or less segregated neighborhoods.(9, 10) How people experience different kinds of violence according to the communities they live in is a significant public health issue. People can be exposed to violence in a variety of ways, including directly, witnessing violence or property crimes in their community, or hearing about crime or violence inside or across their communities.(11) Survivors of violent crime experience physical pain and suffering, as well as mental distress and a lower quality of life, and repeated exposure to violence has been linked to an increase in negative health and social outcomes such as depressive symptoms, anxiety, over-arousal, aggression, delinquent behaviors, academic failure, cost-of-illness and injury compensation, and substance abuse.(12–14) People who fear crime in their communities may engage in less physical activity, resulting in poorer self-rated physical and mental health.(15, 16)
One of the most common types of violent crime is gun violence or firearm fatalities. Firearm fatalities, defined as the number of deaths caused by firearms in a county per 100,000 population in a given period, are a major cause of premature death in the United States, but they are a preventable public health concern.(17, 18) The United States is unique among advanced nations in terms of the level of everyday violence, particularly the number of civilians killed by gunfire.(19) Homicides (33%) and suicides (63%), respectively, account for the vast majority of firearm fatalities in the United States, and firearm-related homicide and suicide rates are 25.2 and 8.0 times higher in the United States than in other high-income countries in the Organization for Economic Co-operation and Development (OECD).(20, 21) Every year, gun violence claims the lives of 40,000 people in the United States.(22) A more recent nationwide cross-sectional study conducted in the United States between 2009 and 2017 discovered an annual average of 85,694 emergency department visits for nonfatal firearm injury and 34,538 deaths from a firearm injury, with suicide accounting for 61% and self-harm accounting for only 3% of nonfatal injuries, assaults accounting for 35% of deaths and 41% of nonfatal injuries, and unintentional injuries accounting for 35% of deaths and 4% of nonfatal injuries.(23) As a result, there is an urgent need in the United States to reduce firearm fatalities, particularly in low-income or highly segregated neighborhoods.
To design effective interventions for reducing firearm fatalities, it is critical to understand the various factors linked to higher rates of firearm fatalities in the United States. Previous research has found a strong link between state-level gun ownership rates and total homicide rates, as well as lethal suicidal behavior.(24, 25) The rich-poor divide, citizens' trust in institutions, economic opportunity, and high government welfare spending are all linked to firearm homicide rates in the US.(26, 27) Surely the relationship between firearm homicides and these radically different measurements and outcomes must be complex. Geographic firearm incident data was compared to the social determinant of health indicators, finding that firearm violence has significant statistical links to several factors. These links include the socioeconomic divide (a wider divide exhibits more firearm violence) and government welfare spending (states, where more money was spent on education, unemployment compensation, and so on, were associated with lower rates of firearm violence).(24, 25)
A link also exists between racial segregation and firearm violence. A cross-sectional study of 51 US Metropolitan Statistical Areas (MSAs) from 2013 to 2017, using data from the Brooking Institute's black-white segregation index, discovered that firearm homicide disproportionately affects black residents; multiple measures of structural racism and racial disparity, including the white-black segregation index, poverty rate, unemployment rate, percent black population, single-parent household, and crime rates are linked to firearm homicide.(28) Segregation disproportionately impacts firearm homicide, and there is an ongoing need for innovative research methods, improved instrumentation, and new approaches for identifying all types of inequality.(7) Additional research on the relationship between structural inequity and the likelihood of firearm fatalities is needed to build the evidence base describing discrimination’s effects on health disparities. While significant differences in firearm mortality show black residents are disproportionately affected,(29) there is little evidence showing how one's location can pose social and physical risks. It is also unclear how macro-level factors such as residential segregation affect the likelihood of firearm fatalities.
To address this knowledge gap, we investigated the relationship between residential segregation and the likelihood of firearm fatalities in Wisconsin, while controlling for potential confounders such as income inequality and community resilience. Exposure to gun violence in one's community has serious short- and long-term health consequences and addressing exposure to gun violence as a public health issue may help prevent and reduce harm to individual and community health and well-being. This study contributes to the body of evidence regarding residential segregation’s effect on firearm fatality disparities. The evidence presented in this study would aid public health efforts to address gun violence as a social determinant of health.