There are so many public health relevant things to write about this month, many of them unfortunately discouraging. Two of the latest include a recent proposal by the United States administration to eliminate inclusive language about transgender persons from UN documents with major implications for sexual rights and the health of the LGBTQ community. Just last week at our Jonathan Mann lecture, Sophia Gruskin, JD, MIA, spoke eloquently about the topic of sexual rights and the importance of language and international human rights law for public health.

And sadly, there is of course the latest instance of a gun violence infused hate crime right here in Pennsylvania. The Jewish community is the most recent victim, following previous attacks on the LGBTQ community, the African American community and even high school and elementary school children among so many others.

But today I am going to focus on something right here at home, something that happened here in Philadelphia not far from where I live. And although in this blog I often emphasize the population view that defines the public health approach, today I want to talk to you about a single case, a life story or actually two life stories that became tragically entwined.

Although the incident occurred near where I live, I first learned of the story from my niece who spent time with us as an exchange student shortly after we arrived in Philadelphia several years ago. She attended a public high school here in the city. While she was there, like any teenager, she had a crush on a slightly older boy maybe a senior, a rapper and a poet. At the time, she showed me his photo and one of his posts on social media. He was tall and handsome, but she knew he would never pay attention to her. Jokingly, whenever he saw her in the hallways he called out "Hello Italy," which made her smile. She spoke to me about him a few times, very briefly and cryptically, as teenagers do.

A few months ago, she texted me through Whatsapp as she does periodically. "Ana, have you seen this?" with a link to a news item about a stabbing by Rittenhouse Square. She was upset and shocked. A young black man working as a delivery man had stabbed a wealthy white developer after some sort of altercation regarding a vehicle blocking a street. A silly argument that got out of control fueled by various things including alcohol, frustration and overwork, and a knife carried for protection. The young black man was the boy she had had the crush on.

Just this week, the Philadelphia Inquirer published a longer story on the incident. The story describes the two lives involved, how they were in some senses similar but in other ways so different. They intersected in the Philadelphia neighborhood where the young man lived and where the developer apparently built his first house in an abandoned lot. And they intersected again fatefully that night on a Philadelphia side street right by diners sitting outside at a French bistro. It is a story of how circumstances and society and context worked together to create tragedy. One life lost and another in ruins.

I won't repeat the whole story and its tragic details, you can read it here. But briefly, the story involved a young black man from Philadelphia who was once on his way to a promising future after overcoming hardship and adversity. It's about how he came to stab a wealthy white man, a developer of Philadelphia neighborhoods, almost randomly in the street. It's a story about childhood trauma, about promise and great expectations thwarted by economic circumstances and violence. It's about how a man was tragically killed on a street right after a celebratory dinner with friends as a result of an argument with another motorist, and an encounter with a delivery man who just happened to bike by. It is about a fateful night, a random encounter, and sudden violence resulting in another life being tragically cut short.

Perhaps the most terrible thing about the story is how easily the tragedy could have been prevented at multiple points along the way. And yet somehow, and herein lies the greatest tragedy of all, the dramatic confrontation that happened on that street was in so many ways shaped, driven, even preordained by our history and our society.

I am telling you this particular story because it happened in our city. And of course because I found the story so moving and mobilizing, and because it made me think about what we do and what we should do to prevent these things from happening. But there are so many stories like this one: they make up our social history. They collectively generate our statistics.

We often speak in public health about the importance of life course processes and social context, about the social determinants of health. We show this powerfully with data. And as a strong believer in data, and in facts, I have advocated and will continue to advocate that we do this. But sometimes a simple story in all its specificity, in its terrible combination of chance and fate and history, in its logic and in its contradictions, can drive a point home so powerfully. 

This is how it happens: how life history, and context, a chain of fortuitous events, and then chance come together to generate one of many statistics: another death, another young man incarcerated. The things we talk about when we calculate homicide rates and incarceration rates for our neighborhoods and our city. This is how it happens.

May our data, our statistics and also our stories help us not only understand our world better but also motivate us to change it. This is after all what public health is fundamentally about.

Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished Professor, Epidemiology, Dornsife School of Public Health