The movement fueling #ThisIsOurLane may fail Black Americans who endure a significant burden of gun violence. Responding to a tweet from the National Rifle Association (NRA) demanding we “stay in [our] lane” the medical community rose to the challenge. A new hashtag gained traction, thousands signed an open letter, and many shared graphic photos and stories from treating victims of gun violence.

While laudable in its medical unity, as an African-American trauma surgeon the celebrated response does not fully resonate with me. While healthcare professionals speed along the social media highway shouting at the NRA, will Black Americans remain stranded trying to hitch a ride? Not if we use our collective status to give voice to the deadly elephant in the room: racism.

The word “racism” has power. It makes some feel angry, while others get defensive. It evokes images of overt violence from an era relegated to vintage photos, videos, and oral histories. However, the legacy of racism is woven into the fabric of American society and persists in the form of structural violence. Its presence may be subtle and the impact difficult to comprehend, but the effects are devastating.

So what can we do?

First, confronting the NRA demands we acknowledge one of the core tenets of its success – the racism weaponized in its messaging to drive firearm sales. It is explicit in much of their video programming, and implicit in their silence after every shooting death of a “good guy with a gun” who does not conform to their accepted racial demographic.

Some lambasted as enemies of the NRA are President Obama, National Football League players, and #BlackLivesMatter. Beyond the optics of their skin color, I see a Nobel Peace Prize winner, non-violent protestors, and a movement of oppressed peoples demanding their humanity be recognized.

Did you know the NRA has a history of advocating for gun control? In the 1960s groups like the Black Panther Party promoted self-reliance and exercised their right to open-carry firearms. That was enough to mobilize the NRA to support the Mulford Act which repealed the California law allowing public-carry of loaded weapons. Signed in 1967, it validated cynics who proclaimed that if Black Americans purchased weapons en masse, Congress would quickly enact gun control measures.

Second, we must own our privilege as medical experts and discard our reticence to invoke the word racism in our discussions about healthcare inequities. In 1969, Johan Galtung introduced the term “structural violence” to describe static social systems functioning as barriers that prevent individuals from achieving their highest potential. It is a concept difficult for some to accept.

In contrast to direct violence, structural violence has no identifiable perpetrator. We fail to recognize its reality because it is “as natural as the air around us.”  However, it is no less harmful, and due to its unchanging nature, the adverse effects engulf entire communities for generations.

Medical professionals have the power to dismantle the framework of structural violence. To equip ourselves requires learning the unaltered history of racism, understanding how it shapes the narrative of healthcare disparities, and name it in our public health advocacy.

Even with surging interest in social determinants of health, the absence of the word “racism” in medical publications is telling. From 2005 to 2015 “racism” appeared in the New England Journal of Medicine 14 times despite more than 300 articles addressing healthcare disparities. The dearth of literature extends to my field of trauma surgery.  As medical experts, we have the credibility to lead the public discourse.

Third, we must acknowledge that the trauma community also profits from the successes of the NRA. Gun violence victims of color help keep our trauma centers in business, while trauma outcomes research is an avenue for career advancement. The profits manifest as academic capital earned through peer-reviewed manuscripts, expense-paid trips to lecture at conferences, and money in research grants.

I concede this is a worthy academic pursuit necessary to improve trauma outcomes. Generations of trauma surgeons, including myself, owe their success to operating on bullet-ridden Black men. Within 24 hours of you reading this column, there will be 30 gun homicides in the U.S., half of whom will be black men. Hundreds more will suffer non-lethal injuries that will bear lifelong physical and psychological scars. We cannot exploit a conveyor belt of disenfranchised patients for research yet remain silent on the structural violence that fills these research coffers.

Lastly, I challenge you to add structural violence to your lexicon. I challenge you to acknowledge the contributions of tens of thousands of African-American men who have involuntarily advanced trauma care. Moreover, if you choose to sit at the table with the NRA, I challenge you, in the name of public health, to make eradicating its racist agenda non-negotiable in the search for sustainable solutions

I know my stance may upset some of my friends, mentors, and colleagues who call for collaboration with the NRA. It may upset some who proclaim we are “anti-bullet holes, not anti-guns.” It may upset others extending an olive branch in hopes the NRA will reciprocate and work toward solutions.

However, we must protest their endless efforts to promote firearm sales by peddling a culture of racism, fear, and destruction to generate profit. Anything less is an abdication of our duty to ensure all Americans can be safe and healthy in their communities.

I am all in with this movement to end the scourge of gun violence. In doing so, we must speak for those whose voices are silenced. We must speak for those whose daily reality is ignored. We must speak for those who continue to remain a footnote in the national discussion about gun violence.

This is my lane too, and I will ride with you. I am hopeful of the destination but skeptical of who will join us at the finish line. Black folks have been here before, and I fear this time may be no different.

Brian H. Williams is a trauma surgeon who blogs at his self-titled site, Brian Williams, MD. He can be reached on Twitter @BHWilliamsMD.

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