In the wake of a violent death, a victim’s family is often left wondering: What could we have done differently to save this life?

As the number of people dying from gunshot wounds in the United States is on the rise, this question is being asked not only by those in mourning. Despite heavy restrictions on funding for gun-related research in this country, many medical and public health organizations believe a public health approach is the best path toward better understanding the root causes of violence.

Part of that understanding is identifying who is at risk to be a victim.

In 2017 in Alabama, 1,100 people died from complications of gunshot wounds—573 suicides, 506 homicides, and 21 accidental discharges, according to the Alabama Department of Public Health (ADPH).

Each of those deaths contributed to the Center for Disease Control naming Alabama second deadliest in the nation for firearm fatalities.

Alabama’s troubling trends are part of a national public health crisis: 40,000 Americans died from gunshot wounds in 2018, the highest number of victims in 50 years. In the U.S., homicide is the leading cause of death for young black boys and men. Suicide is the 10th leading cause of death nationally, and the second leading cause of death for young people, ages 10 to 24. The National Institute of Mental Health reports nearly half of suicides were carried out by firearm in 2017.

In Alabama in 2016, 70 percent of suicides were by firearm. Many studies show that states with higher rates of firearm ownership also have higher rates of suicide, and a 2013 survey suggests nearly half of Alabamians own a gun.

ADPH reports 84 percent of homicides are carried out by firearm.

Alabama second in the nation behind Alaska for rate of death from firearms.

While there is no singular portrait of the dead, demographics from the most recent ADPH data reveal troubling patterns: In 2016, of the 1,034 people who died of gunshots wounds, 82 percent were men. Alabama’s suicide victims were 90 percent white men (72 percent used a firearm as a weapon), while 60 percent of gun-related homicide victims in the state are African American men.

Why are men more likely to die from gunshot wounds?

“Multiple studies have reported that males are more likely to use violent methods when attempting suicide (e.g., firearm, hanging) while women tend to use non-violent methods (e.g., drug overdose, drowning). The violent methods are far more fatal than the non-violent methods,” said Dr. Russell Griffin, an assistant professor in the Department of Epidemiology at UAB.

But men and women are equally as likely to have suicidal thoughts, Griffin said. “So, the difference we see is largely due in part to the difference in method.”

Research shows girls, especially ages 10-20, are increasingly using firearms in suicide attempts, so the gender divide might change in coming years.

Dr. Lonnie Hannon, associate professor of sociology at Tuskegee University, said men are socialized to be violent. “For most of human history, the primary mechanism for obtaining power was through violence,” he said. “So power, violence, economic strength, and manhood are all bound together. Society instructs us that violence is an acceptable means to an end. Young men apply this socialization to their own lives.”

Hannon said for many men, including himself, what's ultimately at stake is self-worth, dignity, and respect.

“Men use violence as a default mechanism for achieving power over someone else's life, or in the case of suicide, power over their own life,” Hannon said.

Why is there such a stark racial split between homicide and suicide?

Griffin said the racial split isn’t present across all age groups, especially when it comes to suicide and children. It’s difficult to tease out all the risk factors, but the noticeable divide might be related to where people are living and what their socioeconomic status is.

“If we look at suicide data from the CDC using their WONDER tool, we see no difference in suicide rates for African-Americans for urban versus rural areas while rates increase for Caucasians as the areas become more rural. If we look at homicides in the same data, we see opposite trends. In particular, for African-Americans, the homicide rate from 1999-2016 goes from 26.4 per 100,000 large central metros to 13.1 per 100,000 in rural areas.”

Public health research, Griffin said, shows violent crime is associated with lower socio-economic status, higher unemployment rates, and low education levels.

The risk for Black men to die of homicide doubles in urban environments because of the trauma associated with poverty, said Hannon.

“Economic depravity is a strong predictor of whether a young man will commit a gun crime.”

How are homicide and suicide risks factors related—or not?

“Even though both suicide and homicide are violent deaths that commonly use firearms as the method of death, the situations that lead up to the deaths are different,” Griffin said. “Not all homicides are due to the person's actions—there are a good number of homicides each year that are persons who were bystanders caught in the crossfire—and the person who commits the homicide may not necessarily be hopeless as homicide can be a crime of emotion or passion.”

Hannon said describing homicide and suicide as “two sides of the same coin” might be correct when examining hopelessness, but there’s more nuance to the risk factors for each.

This story is part of a series examining gun violence a public health issue. You can read the first story about the people working to reduce homicide by firearm here.