African-Caribbean People Research Articles

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent revisited study (SABRE).

Atherosclerotic cardiovascular disease (ASCVD) risk differs by ethnicity. In comparison with Europeans (EA) South Asian (SA) people in UK experience higher risk of coronary heart disease (CHD) and stroke, while African Caribbean people have a lower risk of CHD but a higher risk of stroke. To compare carotid atherosclerosis in EA, SA, and AC participants in the Southall and Brent Revisited (SABRE) study and establish if any differences were explained by ASCVD risk factors. Cardiovascular risk factors were measured, and carotid ultrasound was performed in 985 individuals (438 EA, 325 SA, 228 AC). Carotid artery plaques and intima-media thickness (cIMT) were measured. Associations of carotid atherosclerosis with ethnicity were investigated using generalised linear models (GLMs), with and without adjustment for non-modifiable (age, sex) and modifiable risk factors (education, diabetes, hypertension, total cholesterol, HDL-C, alcohol consumption, current smoking). Prevalence of any plaque was similar in EA and SA, but lower in AC (16, 16, and 6%, respectively; p < 0.001). In those with plaque, total plaque area, numbers of plaques, plaque class, or greyscale median did not differ by ethnicity; adjustment for risk factors had minimal effects. cIMT was higher in AC than the other ethnic groups after adjustment for age and sex, adjustment for risk factors attenuated this difference. Prevalence of carotid artery atherosclerotic plaques varies by ethnicity, independent of risk factors. Lower plaque prevalence in in AC is consistent with their lower risk of CHD but not their higher risk of stroke. Higher cIMT in AC may be explained by risk factors. The similarity of plaque burden in SA and EA despite established differences in ASCVD risk casts some doubt on the utility of carotid ultrasound as a means of assessing risk across these ethnic groups.

African Caribbean Ethnicity Is an Independent Predictor of Significant Decline in Kidney Function in People With Type 1 Diabetes.

The aim of the study was to identify the demographic and clinical features in an urban cohort of people with type 1 diabetes who developed a ≥50% decline in estimated glomerular filtration rate (eGFR). We evaluated 5,261 people with type 1 diabetes (51% female, 13.4% African Caribbean) with baseline eGFR >45 mL/min/1.73 m2 between 2004 and 2018. The primary end point was an eGFR decline of ≥50% from baseline with a final eGFR <30 mL/min/1.73 m2. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Of the cohort, 263 (5%) reached the primary end point. These individuals were more likely to be of African Caribbean ethnicity, be older, have a longer duration of diabetes, have higher systolic blood pressure and HbA1c, have more prevalent retinopathy, and have higher albuminuria (all P < 0.05). In multivariable Cox regression models, African Caribbean ethnicity emerged as a significant risk factor for the primary end point (hazard ratio 1.57, 95% CI 1.19, 2.08) compared with other ethnicities and independent of established risk factors (P < 0.01). The incidence rate for the primary end point in African Caribbean people was double that in non-African Caribbean people (16 vs. 7.7 per 1000 patient-years, P < 0.001). A similar significant independent impact of African Caribbean ethnicity for secondary end points (≥40% and ≥30% fall in eGFR) was observed. We report a novel observation that African Caribbean ethnicity increased the risk of kidney function loss in people with type 1 diabetes, an effect that was independent of traditional risk factors. Further studies are needed to examine the associated pathophysiology that may explain this observation.

Chatoyer’s Punch Ladle: A Museum Artifact that Speaks to the Hidden History of the Garifuna, An African-Caribbean People

ABSTRACT This paper contextualizes the artifact “Punch Ladle, 1773” on display in the “London, Sugar & Slavery” exhibition at Museum of London Docklands (UK). A placard identifies the ladle as once belonging to “Chatoyer, Chief of the Caribs” and as on loan by the West India Committee. Through this artifact, the largely forgotten story of Chatoyer and the so-called Black Caribs (Garifuna) is highlighted, while complexities of the artifact’s provenance are analyzed through an object biography approach. The paper also considers the ethical and curatorial implications of the current non-repatriation of the artifact and its present location within the “Slave Owner” part of the exhibition. Finally, by arguing for the artifact’s global significance through its association with Chatoyer, a historic African-Caribbean figure of colonial resistance, this article contributes to current museum decolonization debates.

Antihypertensive Medication Use and Its Effects on Blood Pressure and Haemodynamics in a Tri-ethnic Population Cohort: Southall and Brent Revisited (SABRE).

Objectives:We characterised differences in BP control and use of antihypertensive medications in European (EA), South Asian (SA) and African-Caribbean (AC) people with hypertension and investigated the potential role of type 2 diabetes (T2DM), reduced arterial compliance (Ca), and antihypertensive medication use in any differences.Methods:Analysis was restricted to individuals with hypertension [age range 59–85 years; N = 852 (EA = 328, SA = 356, and AC =168)]. Questionnaires, anthropometry, BP measurements, echocardiography, and fasting blood assays were performed. BP control was classified according to UK guidelines operating at the time of the study. Data were analysed using generalised structural equation models, multivariable regression and treatment effect models.Results:SA and AC people were more likely to receive treatment for high BP and received a greater average number of antihypertensive agents, but despite this a smaller proportion of SA and AC achieved control of BP to target [age and sex adjusted odds ratio (95% confidence interval) = 0.52 (0.38, 0.72) and 0.64 (0.43, 0.96), respectively]. Differences in BP control were partially attenuated by controlling for the higher prevalence of T2DM and reduced Ca in SA and AC. There was little difference in choice of antihypertensive agent by ethnicity and no evidence that differences in efficacy of antihypertensive regimens contributed to ethnic differences in BP control.Conclusions:T2DM and more adverse arterial stiffness are important factors in the poorer BP control in SA and AC people. More effort is required to achieve better control of BP, particularly in UK ethnic minorities.

Low sex hormone binding globulin: a potential predictor of future glucose dysregulation in women.

Learning Points • Sex hormone binding globulin (SHBG) concentration associates with insulin-resistance. • We looked at the relation between baseline SHBG concentration and future glycaemic status over an up to 10-year period, for women who were normoglycaemic at baseline. • In multiple linear regression analysis, a lower SHBG was associated with a higher fasting glucose independent of age and index of multiple deprivation. • These findings suggest that a low SHBG level, at a relatively young age is a risk marker for future impaired glucose handling in women. Precis: In a laboratory study, we found that low sex hormone-binding globulin level is a risk marker for future relative dysglycaemia in women, with index of multiple deprivation also an independent predictor of future prediabetes/type 2 diabetes mellitus.Editor, Previous work has suggested that a low sex hormone-binding globulin (SHBG) concentration associates with insulin resistance [1]. We previously showed that a low circulating SHBG level (<30 nmol/L) is associated with the presence of the metabolic syndrome in a multiethnic population [2] with lower levels found in both men and women of Pakistan ethnic origin compared with Caucasian and African-Caribbean origin people. In that study SHBG correlated positively with insulin sensitivity as estimated by HOMA-S [3] and negatively with waist-hip ratio, BMI and DBP across all ethnic groups, whereas in multivariate logistic regression analysis a low SHBG increased the likelihood of the metabolic syndrome being present. Furthermore, SHBG levels are often lower in women with polycystic ovarian syndrome (PCOS) [4–6]. There is therefore the potential for SHBG, given its relative ease of measurement (commonly by automated immunoassay), not requiring fasting status or special processing to have utility in identifying people at increased risk or developing impaired glucose handling in the future. In the light of this, we looked at the predictive value of SHBG in relation to the future development of impaired glucose handling in women in a preliminary study in 115 women, over an up to 10-year period. The women were normoglycaemic at baseline. Outcome was either fasting glucose or glycosylated haemoglobin (HbA1c) [7], as measures of glycaemia. ‘As anonymised data were used for the analysis from a laboratory database and no patient was contacted in this study, approval was sought and obtained from the Research and Innovation team’. The mean age of the women at the start of follow-up was 26.8 years (SD, 9.0; range, 16–65). Over the up to 10-year follow-up period, 6% developed non-diabetic hyperglycaemia (defined as HbA1c 42–47 mmol/mol) to and 1% type 2 diabetes (T2DM, defined as HbA1c ≥48 mmol/mol). In multiple linear regression analysis, a lower SHBG was associated with higher fasting glucose [normalised beta (β) −0.22; P = 0.02] independent of age (β 0.28; P = 0.01) and index of multiple deprivation (IMD) (β −0.11; P = 0.06) and South Asian ethnicity (β −0.13; P = 0.04). In logistic regression, we found that age was predictive of subsequent development of prediabetes/T2DM [odds ratio 1.08 (95% CI, 1.02–1.15); P = 0.01] independent of IMD/SHBG/ethnicity. In the light of these results, we suggest that a low SHBG level may have value as a risk marker for the development of future glucose dysregulation in women, with age also an independent predictor of nondiabetic hyperglycaemia/T2DM. Where someone has been found to have a low SHBG, there is the potential for targeted lifestyle measures to be implemented to prevent or delay the onset of glucose dysregulation. In our study, a younger age profile of the group likely influenced the low cumulative incidence of T2DM over the 10-year follow-up period. Nevertheless, SHBG may prove to be a useful future marker for the impact of lifestyle change programmes to reduce metabolic risk those people found to have a low SHBG, including women with PCOS. We plan further work to improve our understanding of this and to continue to follow-up this cohort of women in the coming years. Acknowledgements Conflicts of interest There are no conflicts of interest.

African Caribbean Residents of Edinburgh in the Eighteenth and Nineteenth Centuries

Scotland is gradually coming to terms with its involvement in slavery and colonialism as part of the British Empire. This article places the spotlight on the lives of African Caribbean people who were residents of Edinburgh during the eighteenth and nineteenth centuries. I discuss their varied experiences and contributions: from runaways and men fighting for their freedom in the Scottish courts to women working as servants in city households or marrying into Edinburgh high society. The nineteenth century saw activism among political radicals from abolitionists to anticolonialists; some of these figures studied and taught at Edinburgh University. Their stories reflect the Scottish capital’s many direct connections with the Caribbean region.

Ethnicity and Arterial Stiffness.

Early vascular aging reflects increased arterial stiffness of central blood vessels at young chronological ages and powerfully predicts cardiovascular events and mortality, independent of routine brachial blood pressure and other risk factors. Since ethnic disparities exist in routine blood pressure, in hypertension and cardiovascular outcomes, this review evaluates major studies comparing arterial stiffness through the life course between different ethnic groups or races (which have no biological definition)-in children, adolescents, young, and middle-aged adults and the very elderly. Most report that compared with white European-origin samples, populations of black African descent have increased central arterial stiffness throughout different life stages, as well as a more rapid increase in arterial stiffness at young ages. Exceptions may include African Caribbean origin people in Europe. Differences in vascular structure and function are clearest, where obesity, socioeconomic, and psychosocial factors are most marked. Few studies evaluate a wider spectrum of ethnic groups or factors contributing to these ethnic disparities. Genetic effects are not obvious; maternal risk and intergenerational studies are scarce. Nevertheless, across all ethnic groups, for given levels of blood pressure and age, some people have stiffer central arteries than others. These individuals are most at risk of vascular events and mortality and, therefore, may benefit from early, as yet untested, preventive action and treatment.

Encountering the Metropole: Stuart Hall, Race, (Un)Belonging, and Identity in Canada: Exploring the African Caribbean Immigration Experience

ABSTRACT The period between 1965 and 2001 witnessed a dramatic population movement of Black people into lands currently called Canada. Over 500,000 Caribbean people arrived as “landed immigrants” during this period, bringing the total Black population to over one million by 2016. Motivated by economic and political upheavals, thousands of African Caribbean immigrants left their homes in search of a better life. This large inflow of Black immigrants altered the Canadian political and cultural landscapes and ultimately changed the face of Southwestern Ontario. Using data collected from our research project on African Caribbean people in Canada, we examine the lived experiences of this Black immigrant population. This paper utilizes Stuart Hall’s framing of race, representation, (un)belonging, and identity to explore the particularities of African Caribbean immigration experiences in Canada; we show that Blackness, Black identity, and belonging in Canada are not fixed in their meaning, but rather represent a contested terrain.

An Intolerance of Idleness

Abstract Despite the fact that disasters, usually induced by hurricanes, were a near-annual experience in the nineteenth-century British-controlled Caribbean, the immediate response of white elites (plantation owners and colonial officers) to these events has remained largely underexamined. This article fills that lacuna by examining the concerns that, across the long nineteenth century, informed British responses to some of the most devastating nature-induced disasters in this period. Though the damages wrought by these events always necessitated some form of humanitarian relief, across the period 1831–1907 the survival of labor regimes and the plantation economy always remained the paramount concern of British officials. White elites viewed their minority control over colonies in the region as contingent on their ability to make African-Caribbean people labor for them. Consequently, because disasters so often destroyed plantations and other sites of labor, colonial responses to disaster were primarily informed by a desire to coerce the African-Caribbean population back to work. Reflecting a preoccupation with “idleness” that was mirrored in domestic poor relief and disaster relief throughout the British Empire, white elites often attempted to withhold needed foodstuffs and materials for rebuilding from the African-Caribbean population until they re-engaged in labor for the colonial state. This article, through showing that a preoccupation with idleness remained central to colonial disaster response, reveals an underexamined continuity between the eras of slavery and emancipation.

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta-analysis.

To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta-analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). Thirty-two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to ESRD.

Co-production and evaluation of an e-learning resource to improve African-Caribbean families\u2019 knowledge about schizophrenia and engagement with services: a pilot randomised controlled trial protocol

BackgroundA higher proportion of African-Caribbean people in the UK are diagnosed with schizophrenia spectrum disorders than other ethnic groups. High levels of shame and stigma at individual and community levels contribute to delayed access to care, potentially increasing the duration of untreated psychosis and so worsening outcomes. Inferior access, more coercive care, and worse outcomes have created a ‘circle of fear’ of mental health services within African-Caribbean communities. This further discourages early engagement with statutory services and increases the burden of care for families living with schizophrenia.Providing tailored and relevant information about psychosis (psychoeducation) has the potential for improving outcomes for patients and families. However, there are no culturally appropriate psychoeducation programmes for African-Caribbeans in the UK. We aim to determine whether an e-learning resource, co-produced with African-Caribbean stakeholders to improve knowledge about psychoses, would be culturally acceptable and accessible to members of this population.MethodsA pilot randomised controlled trial of the feasibility of co-producing and testing a novel e-learning resource to improve knowledge about and attitudes towards schizophrenia in African-Caribbean families. We will seek to recruit 40 participants, aged ≥ 16 years, either to receive the intervention or as controls. They will self-refer or be referred via inpatient and wellbeing services, family and carers’ forums, statutory community mental health teams, and voluntary sector/non-governmental agencies (NGOs). Participants will complete the Ca-KAP, ASMI, and SF-12. Acceptability will be explored qualitatively via focus groups and individual semi-structured interviews.DiscussionThe proposed trial will demonstrate the feasibility of conducting a fully powered RCT to evaluate the efficacy of an e-learning resource about schizophrenia with African-Caribbean families. Qualitative work will explore the intervention’s accessibility and barriers/facilitators to participation, including attitudes to randomisation. These data will facilitate further refinement of the intervention.Trial registrationISRCTN11394005, retrospectively registered 20/03/2018.

Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability

BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.

Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK

The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a new Knowledge about Psychosis (KAP) self-report measure and a culturally-adapted version for African-Caribbean people (CaKAP). Content and face validity were achieved through consultations with experts in psychosis and a focus group with service users, carers, and community members. Eighty-seven predominantly White British participants and 79 African-Caribbean participants completed the knowledge questionnaires (KAP and CaKAP) and measures of help-seeking and stigma. Overall, the measures showed good internal consistency and test re-test reliability. Construct validity was evidenced via significant positive associations between knowledge about psychosis and help-seeking and significant negative associations between knowledge and stigma. These measures could improve the delivery of psychosocial interventions and outcome measurement in research trials.

African Caribbean Migration

This article seeks to examine the concept of the better life in the context of African Caribbean migration to Canada with the aim of contributing toward a more complicated and nuanced understanding of the intersection of transnational migration and decolonizing approaches in social work. Within this examination, I contend that migration by African Caribbeans is a form of resistance to the ongoing evisceration of their life chances and choices as a result of colonization. The movement of African Caribbean people is tied to a legacy of centuries of resistance to European exploitation, extortion, and extraction of resources enacted through regimes of slavery, colonization, and globalization. This article briefly explores the history of social work values in what is now known as Canada, as it relates to understanding how social work is positioned in relation to African Caribbean migration to Canada through a decolonizing lens and draws on recent findings from research with African Caribbean participants in the city of Toronto, Ontario, to critically deconstruct the concept of a better life. This deconstruction is necessary to supporting decolonizing understandings of the contemporary social conditions endured by African Caribbean peoples in Canada and to transforming relations between social work and African Caribbean peoples.

?We All Black Innit??: Analysing Relations between African and African-Caribbean Groups in Britain

‘We all Black innit?’ examines relationships between African and African-Caribbean communities in Britain. Historically, these groups have formed coalitions, especially in times of difficulty, for example in resistances against racism. Yet media coverage and academic research studies have highlighted ‘tensions’ between African and Caribbean migrants, especially those arriving from the latter stages of World War 2 and during the 1960s (Mwakigale 2007, Benson 1981). However, this research is limited and focuses specifically on the views and experiences of that particular generation. Very little, if any academic research considers the views and perceptions of second and third generation British born people of African and African-Caribbean descent, although plays, books and, more recently films have begun to explore this issue (see for example, Femi Oguns, Torn (2008) and Bola Agbaje's Gone Too Far (2013). Therefore, the following research draws on interviews with second and third generation British African and African Caribbean people to assess whether tensions still exist between the two groups, and if so, the potential causes, and if they replicate those of previous generations. Conversely it may be that there has been reconcilement between them, and establishment of new ‘race based coalitions’ (Rogers 2004). Again, the research considers the factors which may have contributed to this.

Support and its Impact on the Lived Experiences of African Caribbean Nurses as Students and Practitioners in the British National Health Service (NHS)

Current participation by the children of immigrants in UK nursing education is very low. There are implications for culturally sensitive care delivery and the increasing demographic shift towards an ageing population. Those who arrived during the HMS Windrush period immediately after World War 2 are now beginning to use NHS services more frequently. This paper will provide insights into Black British African Caribbean nurses’ perceptions of support as students and clinical practitioners. It draws on original research, which explored factors, that impact on participation of British African Caribbean people in careers in nursing. The paper is specifically concerned with support which was one of four key findings from the research. UK policy requires that all services, including health services, should reflect the diversity of the communities they serve. This presents opportunities and challenges that need to be explored and addressed, as the UK grapples with increased nursing shortages and low retention rates of qualified staff. The British National Health Service (NHS) has benefited from major contributions of African Caribbean communities who were specifically invited and recruited to help to rebuild the economy and the infrastructure. There is some evidence that Children of the post Windrush era, who were born here, may choose not to participate in nursing as a career because of the experiences of discrimination suffered by their parents and grandparents in the NHS. This paper explores the views of British African Caribbean nursing participants as students and workers, in their own voices. It specifically highlights the role of support in their experiences and its direct impact on their decision making and success with regards to career choices in nursing. It will consider the role that bespoke support can play in enabling successful participation, career building and the implications for nursing education.

Eucharistic Encounters: Towards an African Caribbean Diasporan Pastoral Theology. Healing Begins where the Wound was Made

This article focuses on developing a model of pastoral theology for African Caribbean Diasporan people. Such a theology is developed by reflecting on the history, dislocation and resettlement of a people throughout the world whose African origins were conceived, enacted and sustained by violence. Given the sustained epoch of violent dehumanization on the plantations in the Caribbean, the psychological and emotional remnants of such brutality continue to this day. Interpersonal conflict for African Caribbean people can take on a real and hostile reality. An African Caribbean pastoral theology begins with taking seriously and giving voice to the experience of enslavement. Given the depth and enduring legacy of such trauma, participation of the Eucharist is recognized as a possible means of healing in this present life.

Reproducing the British Caribbean: Sex, Gender, and Population Politics after Slavery

Reproducing the British Caribbean, by Juanita De Barros, maps the new concerns that emerged after slavery in the British Caribbean over control of the size of the population and focuses on the territories of Barbados, Jamaica, and Guiana. In the words of its author, “This book examines ideas about reproduction and the size and health of Caribbean populations in the British Caribbean from the early nineteenth century to the 1930s” (p. 14). This anxiety over the size of the population had profound effects on the development of policymaking, which governed the work of midwives as well as issues concerning health, hygiene, and sanitation and which also had implications for the building of infant welfare clinics in the region. It was in this sociohistorical context that colonial reproductive policies were formed. The primary apprehension of the postemancipation period revolved around “the effects of falling birthrates, rising rates of infant mortality, and population ‘degeneration’” (p. 8).The effects of emancipation on sugar production and profitability in the British Caribbean increasingly disillusioned the planter class there. Quite naturally, the blame for the region's economic decline had to be placed on the formerly enslaved. Blame was placed on their behavior and on the lifestyles of African-descended men and women. In this regard, De Barros makes a strong case for understanding the impact of the intersection of race, class, gender, and sexuality in the creation of colonial policymaking. This confluence of social factors is also germane to the colonial distinctions made between African Caribbean and Indo-Caribbean people. Though poverty was recognized as a serious problem for the social reproduction of these countries, it did not exculpate the formerly enslaved for their alleged ignorance of modern sanitation and hygiene (p. 8). “Poor women in particular,” as De Barros notes, “found themselves condemned as ignorant and indifferent mothers whose poor mothering skills were seen as contributing to infant mortality” (p. 8).Reproducing the British Caribbean is clear in its analysis of how the colonial authorities and the planter class viewed the sexual and domestic practices of the formerly enslaved, who were characterized as uncivilized and immoral and therefore in need of colonial tutelage in the form of the assistance of British women in the colonies. Indeed, the argument might have been strengthened in this regard if the author had pointed to the literature, travel accounts, and novels of the eighteenth- and nineteenth-century Caribbean that viewed the British Caribbean as a site of sexual profligacy. Nevertheless, the author notes that “in Britain's colonies, white British women were believed necessary to solve a range of social problems that were attributed to the behavior of colonial people, including infant mortality” (p. 12). De Barros described the work of these British women as “maternal imperialism,” an adjunct to the “imperial ideological and administrative system” (p. 12).Given the eighteenth- and nineteenth-century practice by British Caribbean women of home births, the contracting of traditional midwives for their services was not surprising. As is to be expected, therefore, the formally trained nurses were critical of the traditional midwives, most of whom were of African or Asian descent. It was the midwives who were blamed for infant deaths, because they were deemed prone to superstition and lacking in adequate training and medical knowledge. Given their sheer numbers and relationships with local women, the midwives could not be eliminated and had to be integrated “into the regulated world of colonial midwifery” (p. 93). Whereas the early nineteenth-century discourse in the British Caribbean revolved around population size, infant mortality, and the general health of the region according to De Barros, the early twentieth-century concern began to focus on overpopulation. Thus a new set of anxieties began to emerge with respect to British Caribbean labor.Reproducing the British Caribbean makes a useful contribution to an understanding of the social and historical factors that shaped the colonial policy of the early nineteenth-century Caribbean. However, it would have been useful to tie colonial policymaking more specifically to the control of labor in the postemancipation era beyond a focus on the labor unrest of the 1930s. Indeed, a stronger critique of the need to oppress labor in the interest of reproducing capitalism would have been quite welcome in this text. Social control over the labor process was not restricted to slavery but was crucial to reproducing the status quo, whether through the regulation of sexual reproduction, population size, or health status. A more specific focus on how these concerns related to the development of peripheral capitalism in the British Caribbean would have added another layer of complexity to this important project.

Money Pools in the Americas: The African Diaspora’s Legacy in the Social Economy

Money pools are ancient African traditions that speak to the functionality of getting things done by a historically oppressed group of people. The analysis for this study is based on 583 interviews in five Caribbean countries: Haiti, Grenada, Jamaica, Trinidad and Tobago, and Guyana. African traditions of collectives reveal that Black people have long had money pools that focused on helping people thrive in commerce, including during the hard times of slavery and colonization. This research argues that throughout the Caribbean indigenous banking systems—with localized names such as susu, partner, meeting-turn, box-hand and sol—are long-standing ancient traditions that historically and currently are taking a bold stand against exclusionary financial systems. African-Caribbean people have an important legacy on the social economy through money pools. The ways in which persons of African descent organize in the social economy is vital to unravelling the market fundamentalist view that there is only a singular way to do business in society.

Can we ever really tackle diabetes in ethnic minorities?

Can we ever really tackle diabetes in ethnic minorities?