The health and wellbeing of the African diaspora

Abstract

Throughout the years, the dispersion of African diaspora has led to large communities of people of African descent living in various countries and societies worldwide, with the majority settling in the Americas. From historical forced relocations during the slave trades to modern migration, this ever-growing population was proclaimed as the continent's sixth region by the African Union in 2012 and has had immeasurable impact on the societies and countries they have settled in. The UN International Decade for People of African Descent 2015–24 intends to highlight this unique community, and on Aug 31, 2022, they commemorate the second International day for People of African Descent. Although it is important to celebrate the numerous contributions of African diaspora, it is crucial to also acknowledge the history of racism, inequality, and discrimination that has negatively affected their health and wellbeing and continues to do so. Racial and ethnic disparities in health have long been apparent. In countries with large populations of people with African ancestry, Black and minority ethnic groups regularly experience lower life expectancies, increased risk for a multitude of health conditions, and worse health outcomes than White populations. In 2019, in the UK and the USA, the prevalence of diagnosed diabetes was higher in Black people than in non-Black individuals. These disparities could be driven by a combination of environmental factors and genetics. Adjustment for risk factors, such as poverty, educational attainment, and smoking and alcohol consumption, substantially reduces the gap in prevalence of type 2 diabetes between White and Black individuals. However, in Brazil, the country with the largest population of African diaspora, Black people with type 2 diabetes have higher rates of ischaemic heart disease, end-stage renal disease, and proliferative diabetic retinopathy compared with White Brazilians, which are not explained by differences in conventional risk factors. Nevertheless, evidence of people of African descent experiencing difficulties in accessing appropriate health care is unambiguous. Indeed, a landmark report by the NHS Race & Health Observatory found widespread ethnic inequalities related to health care. Within diabetes, these discrepancies can be when accessing routine diabetes care provision (eg, HbA1c, annual cholesterol testing, and retinal screening), or appropriate treatment and follow-up. Diabetes is a health condition reliant on the deployment and application of advanced technology, and inequalities in access can have detrimental health effects, especially in children and young adults. In the UK, despite Black children with type 1 diabetes being more likely to have higher HbA1c year after year than any other ethnic group, they have less access to insulin pumps or real-time continuous glucose monitoring systems than White children. Implicit racial and ethnic bias among health-care professionals cannot and must not be overlooked, and concrete recommendations for change must be put into place. To date, clinical research and discovery has overly focused on White populations. Data on ethnicity in clinical studies is often missing or is non-granular, grouping people of African descent into a single or an unhelpful non-White category, which results in medical guidelines not purposed for all. The initial type 2 diabetes genome-wide association studies have largely focused on European ancestry populations; however, there has been an emergence of genetic studies in people of African descent. Despite this, our understanding of the genetic architecture of diabetes across race and ethnicity is still in early stages. Pharmacogenetic studies in people with African ancestry and evidence of the inadequacy of HbA1c criteria in this population further amplify the existing disparities in access to the best and personalised care. People of African ancestry have long been neglected in medical practice and research. At the same time, mistrust in the health-care system and researchers, stemming from events such as Tuskegee, are barriers to engagement. As the endeavours to make research more inclusive of ethnically diverse populations are underway, it is essential that researchers make efforts to ensure that people of African descent are represented at study design and that their questions and fears are addressed to improve participation and engagement. To make meaningful steps towards health equity for people of African descent, both researchers and health-care service providers must focus on this neglected group and understand and respect the history and concerns of African diaspora.