Who survives a gunshot wound?

On the spatial inequality of trauma care.

You may have heard that gun violence is up, both in New York City and in most cities across the country.

This article is a little old, but Gothamist does a better job than most of putting the uptick in context than most other outlets:

In 2021 alone, 299 people have been shot, a 54% increase over the same time last year, and the most the city has seen since 2012.

Ninety-two people have been murdered, a 19.5% jump, according to the most recent NYPD data. In 2020, the city recorded 462 murders, an increase of 45% from 2019, even as most other major felonies declined. Shooting incidents overall exploded 97% last year.

New York is not unique. Murders across the United States rose an estimated 25% in 2020, according to preliminary data from the FBI, the largest increase since modern crime statistics have been compiled. Chicago, Houston, Philadelphia, and Los Angeles all had higher murder rates than New York City in 2020.

Reading about the increase in gun violence is an exercise in futility, because the politicians who are nominally responsbile for doing something about it have done nothing but blame totally unrelated stuff that they don’t like in an attempt to score political points. In this Gothamist article alone the police commissioner blames bail reform (lmao, let me tell you people are still being held on bail for gun crimes my dude), and the mayor points to the still somewhat covid-hampered court system.

That one actually irks me more than blaming bail reform because not only is the mayor trying to deflect, he’s showing that in the 15 months of the pandemic he has not once sought to learn about what the pandemic actually did to the court system. Far from just ignoring crime, covid has meant that people arrested for serious felonies have been arraigned with their lawyer’s head floating in a virtual box instead of meeting them in person, they’ve probably had bail set, and now they’re sitting at Rikers indefinitely because covid means almost no capacity for the courts to conduct hearings and trials. Covid doesn’t mean people don’t get arrested. It means they get arrested and never get their day in court.

Meanwhile, the idiots in charge have made no effort to deal with the actual problem that we have: violence is up and people are dying. Oh, I mean they’re talking about more cops, but more cops equal more violence, and I don’t really count that as a serious response to the problem. It’s the politically expedient one.

I hate that any conversation on gun violence immediately leads to talking about cops, because there’s so much more to the actual problem. Last week, I read this excellent 2019 analysis from the Trace about trauma centers in the city. I had no idea that Far Rockaway doesn’t have a trauma center. In fact, the southern-most parts of both Brooklyn and Queens are fatally far from any kind of hospital that would be capable of treating a gunshot wound. (Roughly speaking, a trauma center means that a hospital has the resources to treat acute, severe injuries 24 hours a day.)

According to the Trace: “When it comes to gunshots in New York City, our spatial analysis found that the fatality rate for incidents that occurred more than three miles away from a trauma center was 27 percent higher than that for shootings that occurred within a one-mile drive.”

Jamaica Hospital, which is chronically underfunded and seems always to be on the verge of closing, is the only trauma center in southern Queens. It has 8 beds. It’s also still pretty far north, and more than three miles away from a huge portion of Queens. You will be unsurprised to learn that this large portion of Queens that is in a “trauma desert” is largely poor, and black, and sees a fair amount of gun violence.

This spatial inequality mirrors what we saw during the height of the pandemic, where Covid patients admitted to understaffed and underfunded hospitals in the outer boroughs died as much higher rates than people who were admitted to the fancy hospitals in Manhattan.

It is infuriating to see “crime” so often framed as a government problem that requires a very specific type of expensive, ineffectual government solution (police), when the very worst-case result from that problem (death) so clearly could be mitigated through more spending on healthcare and hospitals. Yes, it’s very expensive, but I don’t really see how that argument holds any water when the NYPD budget is $6 billion.


Some quick housekeeping: Cruel and Usual now has its own discord channel! All of the newsletters under the Discontents umbrella teamed up with the excellent staff of Discourse Blog to combine into one mega discord server.

You can join the discord by being a paid subscriber to any of our newsletters, or to Discourse.

This poses a slight problem for this newsletter, as I do not have a paid tier and therefore cannot let people into the discord. I’ve thought a lot about creating a paid tier, but ultimately do not want to ask people to pay for something that I am not willing to put out consistently or on any sort of schedule. My day job is stressful, and if I didn’t feel like I could blow off writing this newsletter regularly I would just shut it down entirely.

However, I would encourage you to join me on discord by subscribing to any one of my colleagues’ newsletters, all of which are excellent, or Discourse itself. Here is the lineup:

  • Foreign Exchanges — a newsletter about progressive foreign policy, by Derek Davison.

  • Welcome to Hell World — Luke O’Neil’s interviews and essays on the society that we live in.

  • BORDER/LINES — immigration news and analysis by Gaby Del Valle and Felipe De La Hoz.

  • Trashberg — Ashley Feinberg’s singular work in its new home. 

  • Sick Note — Libby Watson grapples with the American healthcare system. 

  • The Flashpoint — original reporting and interviews on the cutting edge of progressive policy by Eoin Higgins. 

  • Perspectives — a look back at history through a leftist lens, by Patrick Wyman

  • Wars of Future Past — killer robot watchdog Kelsey Atherton tracks the modern day techno-violence-state. 

  • The Insurgents — Rob Rosseau and Jordan Uhl’s podcast on progressive issues and commentary. 

  • Air Gordon — Jeremy Gordon’s blog on pop culture, culture wars, and contemporary society. 

  • Habibti Please! — A podcast about underreported corners of the Muslim diaspora and the social movements it stands in solidarity with, by Nashwa Khan.

  • All Cops Are Posters — Katie Way’s reporting and reflection on the strange world of cop culture online. 

  • And Kim Kelly, roving correspondent on labor, justice, heavy metal, and strong tea. 

Loading more posts…