Cuyahoga County Gun Deaths Spiked in 2020, Public Health Approach May Help

Cuyahoga County saw a historically “eye-popping” rise in gun-related homicides in 2020, according to new analysis from the Medical Examiner’s office.

Data released by Dr. Thomas Gilson and Forensic Epidemiologist Manreet Bhullar compared gun-related homicides for four years, a decade apart. The county had 122 gunshot wound homicides in 1990, 53 in 2000, 67 in 2010, and last year — in the midst of the pandemic — 219.

“This is a terrible problem,” Gilson said. “These aren’t disposable people.”

Because the uptick in violent crime is being experienced during the pandemic, some observers are quick to connect the two.

“When businesses started to have a lot of people work from home, we saw an increase in violent crime,” said Cleveland Police Chief Calvin Williams in July 2020.

Gilson doesn’t think the pandemic is to blame.

“I think one of the concerns I have when I talk about this to people and say firearms violence is up, and they say, 'Oh it’s COVID,' and I’m sort of scratching my head, saying tell me why it’s COVID,” Gilson said. “They’ll say, 'Well people were spending more time together.' But the people who were being victimized by this violence, this isn’t domestic violence.”

Another striking part of this data analysis shows the sheer number of gunshot wounds has also sky-rocketed.

In 1990 there were three people who died with seven or more gunshot wounds. In 2020, that number was 38.

The average number of gunshot wounds per homicide victim last year was more than 3.5, more than double from 1990.

Gilson said he went through his training in the midst of the crack epidemic, but the recent violent crime trend in Cuyahoga County is eclipsing what was seen back then.

“A colleague and I were talking, and we trained in 1994 together, and we just said randomly, you know back when we trained, if someone was shot more than six or seven times, that was distinctly unusual. And it just felt like, talking back and forth amongst us in the group here, that was hardly unusual anymore,” Gilson said. “We just wanted to take a look at that and say is it really more violent? And I think the answer to that is yes.”

The analysis released to the public does not show geographic break-down, but Gilson said low-income communities and inner-ring suburbs are hardest hit.

“The demographic of the people who died has not changed over these 30 years. Far and away our most common victim of firearms homicide is a young African-American man, somewhere between 65 and 80% every year, year-over-year,” Gilson said.

Crime is a perennial issue, especially for larger cities. But before the pandemic, and also through it, communities of all sizes also faced the multi-pronged challenge of the opioid crisis.

Gilson agrees that communities are having to manage both violent crime and opioid addiction at the same time, and there are lessons to be drawn between them.

“The players who are responding to both of these crises are overlapping to a large degree, so in the Medical Examiner’s office I have the good fortune to interact with both my colleagues in public safety and law enforcement and public health,” Gilson said. “I’ll call it a firearms epidemic, I mean there’s no other way to look at this kind of data and not say this is eye-popping, outrageously above baseline.”

Gilson said communities built the framework for seeing better public health and public safety collaboration to deal with the opioid epidemic, and that framework can also help inform new approaches to violent crime data.

And in some ways that’s already happening.

Forensic Epidemiologist Manreet Bhullar joined the Medical Examiner's office to study the opioid epidemic during her studies for a master's in public health. Gilson said his office used some of the settlement money from the opioid settlement to put a public health professional on his team, as has been seen in places like New York City, Washington D.C. and the state of Maryland.

Gilson called Cleveland “cutting-edge” for including a public health perspective in this work, which can help communicate trends to other public health officials.

“One of the things that I noticed was having primary data. So we were looking at the number of gunshots each decedent had, or the number of gunshot homicides. So I think that really helps to inform any public health intervention you may want to look at is, what does the data say?” Bhullar said. “Is this a local problem? Is this national? Do we need to look at interventions that are more looking at what is happening in our community, or structural things like racism or other issues people may be facing?”

Gilson called this report and Bhullar’s work an opportunity to generate basic observations about what’s happening in our community. He recalled the so-called Dickey Amendment from 1996 which drastically reduced federal funding for gun research for about two decades.

“If you tell me out of the gate your funding or your employment is on the line potentially if you’re doing unpopular research — whatever that means — well, that’s a big problem because I’m trying to come up with policy in the absence of genuine data,” Gilson said. “I have to say, hats off to my county executive, I didn’t worry about my job generating this data. When we talked about it he said this is important information. It’s agnostic data. It’s information. It informs policy.”

Jay Dickey, the Republican Arkansas Congressman for whom the amendment was named, expressed regret for his role in the namesake funding provision, and Congress has since allowed for further gun research.

With that federal change, and local efforts, Gilson expressed optimism that new data and more open discussion may lead to better policy.

But Gilson also said he is concerned about “crisis fatigue” among the general population, especially at a time when some members of the public have their own concerns about guidelines from public health officials.

“[People might say] we’ve been in an opiate crisis, then we had the pandemic, now you’re telling me there’s a firearms crisis — well what’s really changing here? Well, things are changing here,” Gilson said. “This speaks to a very fundamentally different problem, and I hope we don’t get to that fatigue, or we feel polarized enough that we can say that this is same old, same old.”

“It is not,” he said. “By any measure.”