Yesterday I started reading Paul Farmer’s remarkable book, Pathologies of Power, and it occurred to me that while he doesn’t address the issue of gun violence, the way he approaches health and poverty (or better said, poverty and the lack of health) might be considered an exemplar for understanding or at least addressing the most pronounced disparity in the issue of who is affected by assaults committed with guns.

              We are used to thinking about gun violence as a pathology which overwhelmingly involves minorities and the poor. Most gun assaults occur in the inner cities; most of the individuals charged with gun assaults are minority males. Other than suicide, most victims of intentional gun assaults are also non-White males.

              So how come most intentional gun assaults in this country only occur in communities where the disparity between those who have and those who don’t have is the greatest of all? How come only 7% of the individuals who commit aggravated assault each year use a gun?

              The most penetrating aspect of Paul Farmer’s approach to medicine is his insistence that we need to go beyond simple numbers to not only understand why certain groups (viz., the ‘poor’) have worse health outcomes than the rest of us, but how and why the specific conditions of poverty result in poor health outcomes. He talks about this issue in terms of understanding poverty biographically, i.e., knowing life histories of individuals who make choices because they are poor which then lead to disparities in health.

              Farmer’s work was performed primarily in Haiti where he paid attention primarily to AIDS and sexual assault. His book contains biographies of women who died of AIDS even though they performed consensual sex with male partners who were carriers of the disease. Given a choice between starvation and risky sexual activity, many women chose the latter hoping that they might avoid becoming AIDS-infected because that was less of a risk than not being able to eat.

              As for contracting AIDS from earning money through sexual activity, women in impoverished Haitian communities had far less employment opportunities than men, either be cause they had young children whose welfare kept them at home, or they were just not able to secure employment outside of certain job categories (ex. domestic help) which often then resulted in sexual assaults.

              Farmer insists, and he’s absolutely correct in this respect, that if we are going to respond to health disparities in some positive and mitigating way, we not only need to know the numbers of poor people who live shorter and more desperate lives, we also need to understand and share their pain.  In other words, if we are going to do anything substantive about closing the health gap between people on the bottom of the social hierarchy and everyone else, we need to give poverty a ‘human face.’

              I could say exactly the same thing about how we discuss and try to understand gun violence which occurs at least 300 fatal and non-fatal times every day. When the issue is described on a personal basis, the description invariably comes from a family member or friend of someone who has been a gun-violence victim, usually a dead victim at that.

              Lucy McBath represents Georgia’s 6^th District in Congress. She gave up a 30-year career as a Delta flight attendant and went to work for Everytown after her son, Jordan Davis, was gunned down while listening to music in a car.

              The shooter in this case, Michael Dunn, harbored all kinds of hateful and abusive thoughts about Blacks before this event occurred. You can get a good idea about what was going through his head by reading some of the letters that he wrote from jail. But as angry and vicious as these letters appear to be, Dunn had never been arrested for any violent act before the fateful night when he blasted ten rounds into an SUV.

              What made Dunn suddenly lose control to the point that he pulled out a gun and started shooting at three kids who refused to turn down the music that was blaring from their car? For that matter, why couldn’t the kids in that SUV just drive off instead of first getting into an argument with someone who was obviously pissed off and maybe a little bit drunk?

              These are the kinds of questions that are never asked when gun violence is discussed only in numerical terms. I just regret that someone like the late and sainted Paul Farmer has yet to focus our attention on what he called ‘bearing witness’ to the deaths and injuries caused by guns.