Alfred Dawes | Let’s not blame slavery for all health issues
There is a video circulating of Professor Sir Hilary Beckles, vice-chancellor of The University of the West Indies, making a speech in which he places the blame for the high prevalence of chronic non-communicable diseases in the Caribbean squarely at the feet of slavery. In a demand for reparations, the professor claims that it is the stress of 300 years of slavery that has resulted in the Caribbean blacks being the unhealthiest group in the world when considering chronic diseases. I believe some clarifications are required lest the professor’s words counter the call by healthcare workers for personal responsibility in the prevention of chronic diseases and the mitigation of their sequelae.
The Caribbean does have an inordinately high rate of diabetes, hypertension, obesity and related chronic non-communicable diseases. Whereas the role of colonial exploitation cannot be ignored, the rapid rise in these lifestyle diseases mirrored the socio-economic development of the region over the last 30 years, and the accompanying change in diet and adoption of a more sedentary lifestyle. It is hard to claim causality between this sudden change in population health with events of 300 years ago. It is clear that it is a lifestyle change in recent times that has created this epidemic as previous generations closer to the stresses of slavery never had it this bad.
As the professor stated, some drugs treating hypertension don’t work well on Caribbean blacks. He, however, failed to identify to which drugs he was referring. Hypertensive drugs work in different ways. The ones the professor described work by acting on the heart to decrease the force of the blood pumped out each minute, or by widening blood vessels, thus causing the pressure within the vessels to fall. Others rid the body of excess salt, the diuretics or water tablets that pass out the salt and accompanying water in urine leading to lower blood pressures. What we know from clinical experience is that the Africans would react similarly to whites with the former types of hypertensive medications, but Caribbean blacks would not. However, if you are Afro-American or Afro-Caribbean you would react exceptionally well to diuretics, so it is unfair to say hypertensive medications do not work on us as well as Africans or European descendants. The remarkable effect of salt-lowering drugs gives us a clue as to why Western blacks are more likely to be hypertensive than any other ethnic group, and it is not because the plantations genetically modified us; it started from before we landed.
The Middle Passage was a cruel and inhumane feature of human history. Some estimates put the number of Africans dying en route to the New World at two million. Many died of dehydration and sickness. As any physician worth their salt knows, if you are not well hydrated your chances of combating diseases successfully are significantly diminished. One can easily infer then that the Africans who were more likely to survive the dehydration and diseases of the Middle Passage were the ones who were genetically predisposed to retain salt and water. This experiment in eugenics led to a super race that passed on these genes over subsequent generations. The descendants of these slaves will retain salt more than the descendants of the Africans who never made the journey, and when they change their diet to include more processed foods and salt, they will also develop hypertension at a higher rate. As this hypertension is primarily related to the retention of salt, Western blacks more than any other group will respond better to medications that rid the body of excess salt. The unnatural selection was done by the slave trade hundreds of years ago, but empowered with this knowledge, if we continue to consume processed foods and high-salt diets, it is our own doing why we suffer from hypertension.
In calling Jamaica and Barbados the amputation capitals of the world, there is some truth. However, this scratches only the surface. As a general surgeon working in hospitals in Jamaica and The Bahamas, I noted a common trend. On the female surgical wards, we would be amputating mostly toes. On the male surgical wards, the amputations were likely to be above or just below the knee. This observation drives home the point that personal responsibility has a significant impact on outcomes. Women are more likely to seek medical attention when something is amiss. They are also more likely to be compliant with medication. Men, on the other hand, wait until the horse has bolted the gate before they seek treatment and at that point the decision is life over limb, leading to higher amputation rates.
Another example is that of prostate cancer. Contrary to popular opinion, Jamaica does not have the highest rate of prostate cancer in the world. What we do have is an extraordinarily high death rate from prostate cancer. Why? Because men do not want to get screened for cancer, so when the disease presents clinically, it is at an advanced stage. We do not have plantation doctors any more, but well-trained urologists who beg, more than windscreen wiper boys, for men to get screened early. The men who don’t are shackled not by the relics of colonialism, but by machoism and their belief that it cannot happen to them.
It is not the stress of slavery over 300 years that is killing us. It is we who are killing ourselves with sugary drinks, snacks, processed foods and increased portion sizes of high-caloric foods that fed slaves. It is time we rid ourselves of the shackles of blaming everyone but ourselves for our problems and take responsibility for our health. Otherwise, any money we get as reparations will quickly be spent in the drive-through and on fat-loss teas. If you are living like a backra, stop eating as if you are burning off the calories working like a slave. Simple.
- Alfred Dawes is a general, laparoscopic, and weight-loss surgeon; Fellow of the American College of Surgeons; former senior medical officer of the Savanna-la-Mar Public General Hospital; former president of the Jamaica Medical Doctors Association. @dr_aldawes. Email feedback to email@example.com and firstname.lastname@example.org.