A Gun Violence Expert Explains the Link Between Inequality and Gun Deaths

Support for gun safety laws is at an all-time high. Heading into Saturday’s March for Our Lives, more Americans than ever supported new laws to reduce gun violence—including nearly 70 percent of adults and half of all Republicans. But gun safety measures, while critical, are only the tip of the iceberg in addressing gun violence in the country.

In both the United States and globally, gun violence is strongly correlated with both poverty and inequality. A recent World Bank study found that inequality helped predict the difference in murder rates between states in the United States—as well as between countries. Suicides, which make up the majority of gun deaths in the country, skyrocket in times of economic distress. The Great Recession alone was linked to more than 10,000 suicides, according to one study.

At a time when the Trump administration is undertaking an all-out assault on health care, food assistance, and the broader safety net, I reached out to Mark S. Kaplan, a professor of social welfare at the University of California, Los Angeles, to discuss the link between inequality and gun violence.

Jeremy Slevin: It sounds like from your research, the primary way we can quickly address the gun violence epidemic in this country is through gun policy—reducing the amount of guns that are available in circulation. Is that fair to say?

Mark Kaplan: Limiting access to guns is a form of harm reduction. What guns do to a society that is inherently violent—and we are a violent society—is that it lethalizes the violence. So if we are able to tamp down that violence by reducing people’s access to guns, that might be a first good step in the direction we’re talking about.

JS: Could you talk a little bit about your research on how inequality correlates with levels of gun violence?

Gun deaths are only the tip of the iceberg

MK: For one, we know that the numerous studies that have looked at the intersectionality of race and class and gun violence have clearly shown that there is some relationship between issues of racial segregation and issues of deprivation—social and material deprivation. The reduction of guns is not going to alleviate those problems. But there is a very troubling and very strong association, and gun deaths are only the tip of the iceberg. Often we don’t talk about the other 90 percent of that iceberg—people who have to be hospitalized, the financial cost, members of those families, the pain, the post-traumatic stress associated with it. So it’s a much bigger problem than gun death.

JS: Is it fair to say that to address the gun violence issue, you need to tackle both the issue of guns, but also tackle the issues of poverty and inequality?

MK: There isn’t one epidemic of gun violence—there are multiple epidemics of gun violence. Suicide doesn’t come up as often, but that represents two-thirds of gun deaths in this country. And that’s a problem that is different from the interpersonal violence. But both are particularly sensitive to the issue of gun availability.

Let me give you an example. California is rated as an A+ by the Brady scorecard, which rates states by the number of gun laws they have on the books. Nationally, 51 percent of all suicides are gun-related. In some states, it runs even higher, all the way to 80, 90 percent. In California, it’s 30 percent, on average. So it means that with fewer guns, there’s a window of opportunity to intervene and possibly rescue people who are suicidal. But with the presence of a gun, the opportunities to intervene diminish dramatically.

JS: Has there been any research, either by you or other scholars, on how suicides are linked to economic factors?

MK: I did recently complete a project, funded by the NIH, looking at the impact of the Great Recession on suicides. And indeed, there is a relationship! There’s some evidence that with the Great Recession we saw a rise in unemployment, we saw a rise in foreclosure rates, we also saw a rise in the rate of poverty—which may have contributed even more than the other two measures in economic distress. That rise in poverty contributed to an uptick in the suicide rate.

There are data that seem to suggest, both coming from the United States and more so from Europe, that many European countries such as Greece went through a very hard time. The EU imposed very restrictive, draconian measures that were attached to the loans they got, and that caused a cutback in welfare and health care and all sorts of other things. And in countries that traditionally had lower suicide rates such as Greece and Italy during the Great Recession, rates of suicide went up. But we know in this country too that the long-term research looking at periods of unemployment and following up five years or more show that for each percentage-point rise in unemployment, there’s also a rise in the suicide rate.

JS: And of course, in the United States, it’s very easy to get a gun, which seems to be the most fatal form of suicide. Of all suicide attempts, those attempted with a firearm are unfortunately more likely to be fatal.

MK: Yes, that’s referred to as the “case fatality rate.” With the use of guns, it’s nearly 95 percent.

We’re dropping the safety net, meaning that people are going to get hurt.

JS: What would you recommend as policy solutions that get at both the firearm access and the social justice issues of gun violence?

MK: I think that we need to approach this in a more holistic way, a more comprehensive way. The gun issue is perhaps the first step. It’s how we tamp down the lethalization, which I brought up at the beginning. That’s something that researchers have looked at globally—the presence of guns. The first thing we need to do is lower the rate, the prevalence of gun availability, access to guns. California is a great example. Some of the most restrictive gun laws have produced very positive results, fewer gun deaths in the state. They say the winds blow from the west to the east, so hopefully that will happen.

And then we can begin to tackle some of these social inequities and inequalities, and some of the structures that promote inequality. Violence is a more difficult social problem to tackle. It represents more than just the loss of lives: The economic toll on society is huge. How do we redress the various measures of inequality? The distribution of wealth and income, the issue of racially segregated communities, the under-resourced and underfunded social welfare infrastructure that seems to be taking a hit in the current administration—those are issues that also need to be addressed. We are lowering the safety net right now. In other words, under the current government … we’re requiring work for health care, so we’re dropping the safety net, meaning that people are going to get hurt.

This interview has been lightly edited for length and clarity.




Tennessee Wants to Use Funding Meant for Poor Families to Kick People Off Medicaid

Nashville Public Radio reported over the weekend that the Tennessee legislature is finalizing legislation that would add work requirements So-called 'work requirements' function as strict time limits on public assistance for unemployed and underemployed individuals. Earlier this year, President Trump opened the door to work requirements in Medicaid by allowing states to take health insurance away from most working-age individuals who are not currently working or participating in qualifying 'work related activities' for a minimum number of hours, even though not having health insurance can make it harder to find and keep a job. to the state’s Medicaid program, kicking at least 3,700 Tennessee workers off their health care.

The state’s Republican leaders appear to have no qualms about taking health insurance away from Tennesseans who can’t find work or get enough hours at their job—even though taking away someone’s health insurance isn’t going to help them find work any faster, and can actually make it harder to find and keep a job. Instead, debate around the legislation has reportedly centered on how to pay for the new policy. Lawmakers’ own estimates put the price tag for enforcing the new work rules at $10,000 per person disenrolled from Medicaid—which advocates note could be more than the new policy saves.

This is where Tennessee’s proposal gets really evil. Unwilling to foot the bill for their new policy out of the state’s general budget, Republican lawmakers have decided to pay for it with funds from the state’s Temporary Assistance for Needy Families (TANF) program—which provides meager cash assistance to very poor families with children.

While news reports, such as the Nashville Public Radio story noted above, make it sound as though Tennessee’s TANF program is flush with unused cash due to a “booming economy and historically low unemployment,” the real story is much more dire.

Nearly one-quarter of Tennessee children live below the federal poverty line, making it one of the worst states in the nation when it comes to child poverty. But fewer than 1 in 4 poor Tennessee families with children get help from the state’s TANF program, which is one of the stingiest in the country. A Tennessee family of three lucky enough to get temporary assistance can expect to receive a maximum of $185 per month—or a little over $6 a day.

Fewer than 1 in 4 poor Tennessee families with children get help from TANF

Why is Tennessee failing so horrifically to help so many of its poorest children? In part, this failure is the legacy of 1996 “welfare reform,” which converted the nation’s main source of assistance for poor families—then called Aid to Families with Dependent Children—into TANF, a flat-funded block grant with very little accountability for how the money is spent.

Many states use TANF as a slush fund to close budget gaps, with just 1 in every 4 TANF dollars going to cash assistance for struggling families with kids. But Tennessee has made an Olympic sport out of diverting TANF funds away from poor families in need of help, squirreling away more than $400 million in unspent funds in recent years rather than using the money to help struggling families with kids avoid hunger and homelessness.

Now the state’s lawmakers want to use those unspent funds to bankroll the disenrollment of thousands of struggling Tennesseans from Medicaid.

The bill is expected to clear Tennessee’s conservative Senate in the coming days and has the support of Gov. Bill Haslam (R), who is expected to sign it into law. If passed, both the state’s proposed work rules and their proposed pay-for will require the approval of federal health officials. If the state’s scheme gets a thumbs up from the Trump administration, other states will likely follow suit. Kentucky, Indiana, and Arkansas have all received permission from the Trump administration to enact work requirements for Medicaid, following Trump’s widely criticized invitation to states earlier this year, and more than a dozen states are actively seeking similar approval. Many—if not all—of these states are looking for ways to pay for the costly bureaucracy required to implement this type of policy.

One would be hard-pressed to cook up a more twisted irony than taking money intended to help poor families with children avoid hunger and hardship and using it instead to take health insurance away from, in some cases, the very same struggling workers and families. But there’s a deeper rot at the core of Tennessee’s plan that cuts across conservative proposals to slash not just health care but food assistance, housing, and more—both in Congress and in the states. And that’s an ideology-fueled willingness to spend whatever it takes to take aid away from struggling workers and families—even when bureaucratic disentitlement costs more than it saves.



How Food Stamps Are Keeping Small Farms In Business

On a weekend morning, the farmers market stretches out like a long caterpillar. Customers mill about, pushing strollers and walking dogs. A band is playing something folksy. Vendors stand behind tables that are literally spilling over with winter greens and root vegetables. It’s a picture-perfect image that connotes abundance and community—if you have the cash for it.

The local food movement has been criticized for catering to middle- and upper-class Americans, and for leaving behind the low-income in all of the hype for Community Supported Agriculture (CSA) and “know your farmer” initiatives touted in glossy food magazines. But in the last decade, food justice activists have sought to correct this, connecting low-income consumers with cooking classes, gardening workshops, children’s programming, and locally grown and culturally appropriate foods.

Enter Double Up Food Bucks, a program that doubles Supplemental Nutrition Assistance Program (SNAP, commonly known as food stamps) benefits for recipients shopping at participating farmers markets or grocery stores, up to $20 per visit. Launched by the nonprofit Fair Food Network, Double Up Food Bucks began at five Detroit farmers markets in 2009. Today, 20 states have launched programs modeled after the original, including my home state of Arizona.

“Double Up is a win-win-win,” says Adrienne Udarbe, executive director of Pinnacle Prevention, the nonprofit that manages Arizona’s statewide Double Up initiative. “SNAP recipients have access to more fruits and vegetables, local farmers make more money, and more dollars stay in the local economy.“

In 2016, nationwide SNAP spending dropped to its lowest point since 2010

Pinnacle Prevention operates 23 Double Up sites across Arizona under the Fair Food Network national umbrella, including a mobile market with 80 stops on its route. Each of them has seen an uptick in SNAP spending, and Udarbe says local produce vendors have indicated an increase in sales since the program started.

Since Pinnacle Prevention’s Double Up program began in 2016, Udarbe says SNAP spending at participating farmers markets has increased by between 67 and 290 percent. Additionally, 84 percent of SNAP customers shopping at Pinnacle Prevention’s Double Up sites responded that they “buy and eat a greater variety of fruits and vegetables as a result of Double Up Food Bucks.” This increase in spending is significant, especially since in 2016, nationwide SNAP spending dropped to its lowest point since 2010.

The handful of Double Up programs in Arizona that are not managed by Pinnacle Prevention have also reported ballooning SNAP spending after their programs began. The Community Food Bank of Southern Arizona (CFBSA), one of Arizona’s earliest adapters of the Double Up concept, reported $9,000 in SNAP spending at its Tucson farmers markets in 2015. But in 2016, after receiving federal funding to implement Double Up, program manager Audra Christophel says SNAP spending at CFBSA markets increased to $37,000. And in 2017, the total SNAP spending exceeded $43,000—nearly half of which was spent on Arizona-grown fruits and vegetables.

*          *          *

In September 2018, the federal Farm Bill will expire. This means legislators are working now to craft a nearly $900 billion piece of legislation to steer food and agriculture programs over the next five years, including crop insurance, farmer loans, SNAP, and the Food Insecurity Nutrition Incentive (FINI) grants program that funds Pinnacle Prevention’s Double Up program. Udarbe says including FINI in the 2018 Farm Bill is important for the SNAP customers and farmers who count on similar produce incentive programs across the country.

But the recent unveiling of the USDA America’s Harvest Box, part of a theoretical overhaul to the SNAP program that would include deep cuts, shows that the Trump administration may have a different plan in mind. America’s Harvest Box—a Blue Apron-style box for SNAP recipients—would contain pre-determined rations of U.S.-produced breads, shelf-stable milk, pastas, and canned goods.

The box program was immediately met with widespread criticism from individuals and organizations working in the fields of nutrition and food security. In February, when a USDA official discussed the concept of America’s Harvest Box during a National Anti-Hunger Policy Conference, Politico reported that “boos and mocking laughter erupted” from a crowd of 1,200 anti-hunger advocates, and “at least 20 people walked out in protest.”

Udarbe says, “The Harvest Box idea contradicts everything we have been doing over the past decade to move in a direction that best supports food-insecure families and farmers.” Indeed, America’s Harvest Box would remove the element of choice and would not provide fresh fruits or vegetables. It would also cut back on the economic opportunities for local produce farmers across the United States, who have come to count on the Double Up program for sales.

Median farm income is projected to be negative $1,316 in 2018

The far-reaching benefits of Double Up, combined with increased pressure by the federal government for states to cough up funding for such programs, are at the foundation of SB 1245, a new bill introduced by State Sen. Kate Brophy McGee (R).

If passed, SB 1245 would allocate $400,000 from the Arizona state general fund to be used as a match for Double Up Food Bucks. Udarbe and Christophel each say that federal grant applications will be more competitive if they can show a match from the state. “While match requirements aren’t new to USDA grants,” says Udarbe, it helps if applicants can show “evidence of buy-in and support from local leaders.”

And though SB 1245 was introduced before the unveiling of America’s Harvest Box by the USDA, it’s hard not to contrast the two strategies—they’re literally at opposite ends of the continuum. “I passionately, passionately believe in this bill,” said McGee during public hearing for the bill. “If we are going to be spending food stamp dollars, this is where we need to be spending them.”

*          *          *

As a former vegetable farmer and SNAP recipient, I’ve been on both sides of the table—I actually qualified for SNAP when I was growing food for my community, a cruel irony replicated among the millions of food insecure food workers in America. Farmers are often low-income (in fact, median farm income is projected to be negative $1,316 in 2018), a fact that highlights the role of programs like Double Up in providing economic benefits for direct-market farmers.

“Funding for this program truly is the world to local farmers who sell directly at farmers markets in terms of being able to not only feed their families, but keep lights on and keep a roof over their heads,” says Udarbe.

This sentiment is echoed by Dave Brady, a vegetable producer from Pinal County in Arizona, who testified in support of SB 1245. “I was basically at the point where farmers markets just weren’t working for me,” he says. “But the one thing that made sense to me was Double Up SNAP program. It just makes it possible for me to get my volumes up to a level that’s practical, that I can actual make a decent living at it.”

Because of Double Up, Brady has started experimenting with a box program for seniors in his community who are SNAP recipients. A far cry from America’s Harvest Box, Brady’s boxes are comprised of fresh fruits and vegetables and customized to meet the needs of the seniors.

“When seniors participate in Double Up, I can help them stretch their food dollars and supply them with enough locally grown produce for an entire month,” he says.

In the months ahead, votes by federal and state lawmakers may determine the future of the Double Up program—and the lives of the consumers and farmers like Brady who depend on it.


First Person

Teacher Strikes Are About More Than Salaries. And They’re Not Over.

When I tell stories about the two years I spent as a public school teacher, I instinctively glance at my hands. I’ve learned to cover for it by stretching my arms out in front of me like I’m winding up to pitch, or sliding my hands into my pockets to strike my most casual conversational pose. What I’m actually doing is looking at the piece of graphite that’s still buried in my right palm.

Every teacher has at least one class that they need to watch at all times, and mine was fifth period English in 2011. They were the class that made substitutes cry, and that once knocked down the temporary wall separating my room from the one next door. One day, after I passed out pencils, I tried to put the extras down on the desk behind me without turning around. I missed and hit the edge of the desk, driving the freshly-sharpened tips straight into my own palm.

I laughed when it happened. There was a hunk of graphite driven a quarter inch into my hand and a jagged flap of skin that I would later cut off with eyebrow scissors, and there was absolutely nothing I could do for the next sixty minutes. I stared straight into the bloody mess and let loose a cackle while the look on my students’ faces shifted from shock to horror. Then I put my thumb over the wound to stop the bleeding, and kept teaching.

In between that class period and the next one, I had four minutes to run to the bathroom. I stared at the sign above the sink warning me not to drink the water, and wondered if getting toxic water in an open cut was dangerous. That’s when I began to wonder what, exactly, I was doing with my life.

I hadn’t planned to be a teacher. But when I went home for Thanksgiving my senior year of college and told my grandmother my master plan—to write freelance for a local arts website while I volunteered with advocacy groups—it knocked the wind out of her. Then, for the first and only time in my life, she gave me clear instructions on what she expected me to do next. I needed to go to graduate school, she said. I needed to get a masters’ degree, and a stable job doing something that could actually support me.

Teaching was the most stable career I could think of. I got that masters’ degree, and a job outside of Washington, D.C. My professors had warned me that the first year would be hard, but what they hadn’t told me was that my brand new career was essentially a pressure cooker.

During my first faculty meeting, I found out that my new colleagues had not received a raise in three years. The administration gave the union a choice when the recession hit: either lay off teachers, or give up their raises for the foreseeable future. The union voted for the latter, not knowing that their wages would be frozen for the better part of a decade. Our school—one of the only low-income schools in an otherwise affluent district—was failing, and if we didn’t raise test scores people were going to start losing their jobs anyway. But the new principal had some big ideas, she told us, and we were going to do this together.

Her first idea was ending all out-of-class discipline. Research shows that students of color and students with disabilities are punished too often and too harshly, so we were going to stop as much punishment as we could. Any behavioral issues were to be addressed in the classroom, no matter how severe.

The next was to use lunch periods as extra tutoring time. Administrators called names in the cafeteria of any student with outstanding work or low test scores, and sent them back up to their teachers. Our lunches were at the same time, so we ate with students while they worked through assignments.

By the end of the year I had students in my classroom for 12 hours a day

Then the school implemented a universal breakfast program. Most of our students already depended on school lunches, so offering breakfast doubled their chances to get something to eat. We didn’t have enough cafeteria staff to cover that, so breakfast happened in our classrooms too—our first-period students came in a half-hour earlier and ate in the rooms.

The new initiatives kept piling on: We added after-school tutoring, academic mentoring, and open office hours. Every single one of these ideas was good—every time we offered a new support, a few kids did a little bit better. But every single one of these ideas was also the sole responsibility of the teachers. By the end of the year I had students in my classroom for 12 hours a day, with no time to plan the next day’s lessons or grade papers until the last kid went home.

In theory, that type of schedule is exactly what a union is supposed to prevent. Our contract mandated breaks, planning periods, and additional staff in the classrooms to support students with disabilities. But our union was doing its best to keep its members employed in the face of a budget crunch—dealing with contract violations was a luxury. So our list of responsibilities kept growing until teachers buckled under the pressure.

The teacher across the hall from me didn’t even last through October. He quit in the middle of the week, and the rest of us took turns covering his schedule for two months while the district tried to find a replacement. That spring, the state was granted a waiver that exempted us from the punishments that we could have faced if the school didn’t make enough progress. Even so, a third of us didn’t come back the following year. Some, like me, switched careers. Others transferred schools, and some retired. The school administrators had the summer to scramble and fill all those open jobs—still for the same pay, because the salary freeze was entering its fourth year.

Seven years later, many teachers still haven’t gotten relief. Districts across the country are still struggling to recover from the housing crisis that wiped out their tax base. On top of this, federal spending for K-12 education has been cut by almost 20 percent since 2011, and states have struggled to make up the difference. Seven states—Arizona, Idaho, Kansas, Michigan, Mississippi, and Oklahoma—poured gas on the fire by enacting income tax cuts post-recession rather than restoring education funding. With the exception of Michigan, teacher salaries in these states are among the lowest in the nation.

Now, for the first time in a generation, schools are being closed with a series of wildcat strikes. Because of course they are. Teaching has always been difficult, but years of funding cuts are making it impossible. After pleading with lawmakers for support, striking is the only thing left that makes sense. That’s why West Virginia closed down every school in the state for 12 days, and it’s why Oklahoma might follow suit.

Given how normalized mass protests have become under the Trump administration, it’s worth remembering that this is genuinely radical: striking by public employees is forbidden by statute in 26 states. During the West Virginia strike, the state’s Attorney General made it clear that he believed the work stoppage was “unlawful,” though it seems superintendents have chosen not to punish participants.

That’s because superintendents know something lawmakers still haven’t grasped: Teachers make their living by getting people to pay attention. So when they say they can’t do their jobs anymore without more money and more support, and state legislators respond by jamming their fingers in their ears and passing yet another tax cut, teachers will do what it takes to be heard.



Martin Shkreli Is Going to Jail Because He Forgot There Are Consequences For Hurting the Rich

The frat boy of pharmaceuticals, Martin Shkreli, was sentenced to seven years in prison last Friday for securities fraud and conspiracy. After four years of earning millions by controlling the supply of certain medications, he was convicted of defrauding hedge fund investors in a Ponzi scheme.

In many ways Shkreli is a master of American capitalism, but he forgot its cardinal rule: Hurting people with less money than you is part of doing business, but ripping off other rich people is a line you do not cross.

Like most people, I first heard the name Martin Shkreli when he made news for hiking up the price of a drug called Daraprim. The medication is used to treat life-threatening infections that can strike people with compromised immune systems, particularly people with AIDS. After Daraprim was acquired by Shkreli’s company in 2015, the price of a single tablet skyrocketed by 5,000% overnight from $13.50 to $750. It was at least the second time he had used the tactic: A year earlier he encouraged a different company to inflate the price of a kidney stone medicine called Thiola, increasing the daily cost from $30 to $450.

To be fair, he isn’t the only one guilty of this offense. Hundreds of other drug company executives have committed similar deeds to rake in as much profit as possible. But few others have been so blatant about it, reveling with such glee in both the frustration of patients and the rewards of his gluttony. Shkreli seemed to delight in flaunting his wealth. He loved showing off all the pricey toys and trinkets he bought with his drug company profits, including an infamous (and now subject to forfeiture) one-of-a-kind Wu-Tang Clan album. It was the kind of entitled, spoiled-rich-kid behavior that earned him the nickname, “Pharma Bro.”

From all appearances, life was good for Pharma Bro in those glory days of making a lifesaving drug unaffordable to those who desperately needed it. He was universally loathed, but nothing he did was actually illegal.

I had always assumed that somewhere behind the scenes, someone was getting rich

I don’t currently have any family members who take Daraprim, as far as I know. However, my family and I rely on other expensive drugs to stay alive or maintain even just the bare minimum quality of life. My sister is on a host of drugs to treat advanced multiple sclerosis (MS), rheumatoid arthritis, lupus, and severe asthma. Or should I say, she is supposed to be on these drugs. She doesn’t have insurance, so she hasn’t taken any of them in more than a year. Just one of her MS drugs, Rebif, costs more than $5,000 a month. That’s $60,000 per year.

I would go to fill my child’s prescriptions, and then see the staggering price lists on the computer screen.  The clerk or pharmacist would call me over to the side for a private consult. Their expression was always one of either shock or pity, or a combination of both. In whispered tones, they would say something like, “Um, this is pretty expensive, so I just wanted to make sure you were aware of that.” If you were lucky enough to have insurance that would cover any portion of this—usually a relatively small amount—the insurance company would also often get involved at this point. Then you would face the additional experience of insurance companies playing doctor, attempting to make critical decisions about your lifesaving treatments.

Sometimes I’d try to bargain with the pharmacist by asking if they could dole out a one-week supply at a time, so I could pay in smaller increments. There were times when I had little or no money at all, and would break down in tears at the pharmacy counter. In the end, though, you usually would be left to face the inevitable: Come up with the money, or go without it.

Sometimes the prices are justified—the rarer the drug, the more costly the treatment—but a lot of the time it’s not. I had always assumed that somewhere behind the scenes, someone was getting rich off the proceeds of these meds, whose sky-high prices often sent me into an emotional panic. But I never realized how arbitrary it could be until I read the coverage of Shkreli and his Daraprim price hike a few years ago.

Shkreli was famous for his cocky smirk and glib attitude towards anyone who questions his methods, but he reportedly cried when his sentence was announced. He presumably never shed tears for the people who needed his companies’ medications so they wouldn’t die, or the many people like me who have sobbed at a pharmacy counter.

We are left to wonder why justice only appeared when the victims were rich.