Almost all pediatric gun injuries and deaths occur in low-opportunity neighborhoods

Last year, the surgeon general declared that gun violence is a public health crisis, noting firearms are the leading cause of death in children and teens. Gun deaths of children and teens in our city are not random; almost all of them occur in low-child-opportunity neighborhoods.

It’s the difference between four pediatric gun injuries in Society Hill and 163 injuries in Strawberry Mansion — just five miles away — during the same eight-year time frame.

In my recent study, I analyzed pediatric firearm injury data for children and teens aged 0-19 years in Philadelphia, from 2015 to 2023. I found that children and teens who lived in a low-opportunity neighborhood were two and a half times more likely to sustain a gun injury, and were more likely to die from their injury.

In my study, I used the Child Opportunity Index — a composite index of indicators across health, education, physical environment, and socioeconomic status based on where children and teens live. While I expected many injuries would occur in low-opportunity neighborhoods, I was shocked to find almost all these injuries and deaths occurred in low-opportunity neighborhoods. We also found stark racial disparities: 97% of pediatric firearm injuries (and 96% of deaths) in Philadelphia were among Black and Hispanic children and teens.

Many narratives of the gun violence epidemic focus on mental health and mass shootings, which overshadow the everyday violence that is a symptom of structural inequity and missed opportunity.

Most often we refer to economic opportunity — or the possibility of upward mobility — as the American dream. The connection between economic opportunity and adult health is clear: With more opportunity, we see less mortality and lower rates of obesity, hypertension, and diabetes. For children and teens, opportunity includes access to everything from high-quality schools to healthy food, clean air, and safe housing.

Part of improving lives for kids — indeed, of saving kids’ lives — is to invest in child opportunity. Interventions such as increasing green space and walkability and abandoned house remediation have been shown to effectively decrease violence. Increased funding to schools and investments in evidence-based early childhood programs and systems are also paramount. More economic development would also bring better jobs and help create the stable neighborhoods children and teens need to thrive.

Our city and state leaders have the potential, and I’d say the responsibility, to increase opportunity for our children and teens. I welcome Philadelphia Mayor Cherelle L. Parker’s renewed urgency to decrease violence, with the declaration of a public safety emergency, and her other initiatives to clean the city, focusing on economic opportunity and increasing school funding. Pennsylvania Gov. Josh Shapiro’s budget also has a strong focus on investments in children and teens.

All of these efforts should improve child opportunity, yet we must do more.

It’s no accident that nearly all the gun injuries and deaths in Philadelphia were among Black and Hispanic children and teens. This is a reflection of the systematic deprivation of opportunity for racial minorities in our city, an unacceptable reality that should be changed with intention and urgency. There is a moral imperative to target investment in neighborhoods that have been historically underresourced due to the legacy of redlining and continued structural racism, particularly in North and West Philadelphia. Neighborhoods including Nicetown-Tioga, Hunting Park-Fairhill, Strawberry Mansion, and Haddington-Overbrook have lost over 150 children and teens each since 2015.

While decreasing pediatric gun deaths requires multiple levels of intervention, from implementing child access prevention laws to hospital-based programs, there is no denying the role of neighborhood opportunity. In addition to greening and housing remediation, there is emerging literature that economic interventions, such as increasing the minimum wage or state expansion of the Supplemental Nutrition Assistance Program (SNAP), are associated with decreased firearm deaths.

These approaches are just the beginning, and there remains a critical need for community-informed and evidence-based interventions to decrease pediatric gun deaths.

To preserve the lives of children and teens in our community, urgent investment in child opportunity is the path forward. Every day that we delay, more children and teens could die. Our leaders, and our society, need to act in concert now to increase opportunity and prevent the deaths we know will keep coming.

Anireddy Reddy is a pediatric critical care physician at Children’s Hospital of Philadelphia (CHOP PolicyLab; CHOP Center for Violence Prevention) and a senior fellow with the Leonard Davis Institute of Health Economics at the University of Pennsylvania.