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Negro, Black, Black African, African Caribbean, African American Or 1014 J Epidemiol Community Health: first published as 10.1136/jech.2005.035964 on 14 November 2005. Downloaded from REVIEW Negro, Black, Black African, African Caribbean, African American or what? Labelling African origin populations in the health arena in the 21st century Charles Agyemang, Raj Bhopal, Marc Bruijnzeels ............................................................................................................................... J Epidemiol Community Health 2005;59:1014–1018. doi: 10.1136/jech.2005.035964 Broad terms such as Black, African, or Black African are race and ethnicity, these terms are often used interchangeably or as synonyms. The traditional entrenched in scientific writings although there is scientific concept of race refers to biological considerable diversity within African descent populations homogeneity as defined by a few phenotypical and such terms may be both offensive and inaccurate. This features.1 Buffon first introduced the concept of race into biological literature in 1749, which was paper outlines the heterogeneity within African explicitly regarded as an arbitrary classification, populations, and discusses the strengths and limitations of serving only as a convenient label and not a the term Black and related labels from epidemiological and definable scientific entity.5 In the USA the collection of data on race is well established public health perspectives in Europe and the USA. This and is used widely for epidemiological, clinical, paper calls for debate on appropriate terminologies for and planning purpose.6 However, the bulk of African descent populations and concludes with the genetic differences (90% to 95%) occur within populations, and not between continental group- proposals that (1) describing the population under ing, and the genes responsible for different consideration is of paramount importance (2) the word physical characteristics (such as skin colour and African origin or simply African is an appropriate and facial features) that underpin race are few and 7–9 necessary prefix for an ethnic label, for example, African rarely relate to either behaviour or disease. Current consensus is that race has comparatively copyright. Caribbean or African Kenyan or African Surinamese (3) little scientific value as there is more genetic documents should define the ethnic labels (4) the label variation within than between groups4 but that it is an important political and psychosocial con- Black should be phased out except when used in political cept.10 The consensus about race is however, contexts. being revised because of genetic epidemiology, ........................................................................... and particularly pharmacogenetics (so called ethno-pharmacology).11 The US Food and Drug Administration approval of BiDil, a new drug to esearch on race, ethnicity, and health is treat heart failure in only African-American growing in Western Europe, following the patients illustrate this point well. Many research- Rlonger tradition in North America. The ers and policy makers have long argued against terms and concepts of ethnicity need to be the use of race categories in medicine as they explicitly defined to permit better understanding reinforce existing social divisions in society or of research and to facilitate regional and inter- may lead to discriminatory practices.11 http://jech.bmj.com/ national comparisons.12 Despite much debate, Ethnicity is a multidimensional concept, broad terms such as Black, African, or Black which is being used frequently in medical African are still entrenched in scientific writings research.112 It is neither simple nor consistent. that may be both offensive and inaccurate. This It comprises one or more of the following: shared paper develops the debate called for by Bhopal in origins or social background; shared culture or the Journal of Epidemiology and Community Health tradition that are distinctive, maintained recently, and specifically tackles terminology in between generations, and lead to a sense of relation to African origin populations. This is also on October 1, 2021 by guest. Protected identity and group; and a common language or See end of article for a companion paper to Bhopal and Donaldson’s religious tradition.1 The characteristics that authors’ affiliations on the term White.3 Our general approach to ....................... define ethnicity are however, not fixed and terminology is described in the appendix. In this may change over time, which makes ethnicity Correspondence to: paper, we first briefly consider the concepts of difficult to measure and use in research.12 The Dr C Agyemang, race and ethnicity that underlie classifications Department of Health concept of ethnicity encapsulates cultural, beha- and terminology. Then we outline the hetero- Policy and Management, vioural, and environmental factors that increase geneity within African populations in Europe Erasmus Medical Center, the risk of disease; hence it is crucial in Burg Oudlaan 50, and the USA and then we discuss the terms used epidemiology and public health. In some parts L-gebouw, 3000 DR in medical and epidemiological research. Rotterdam, Netherlands; of Europe, race is being abandoned in favour of C.Agyemang@ ethnicity.913The USA is moving to the compound erasmusmc.nl RACE, ETHNICITY, AND HEALTH phrase race/ethnicity.14 Also, in the USA race has Accepted for publication RESEARCH been a proxy indicator for socioeconomic depri- 4 2 September 2005 Both race and ethnicity are difficult concepts. vation, which ignores for example, economically ....................... While there is a conceptual distinction between advantaged African Americans. Although social www.jech.com Labelling African origin populations in the health arena 1015 J Epidemiol Community Health: first published as 10.1136/jech.2005.035964 on 14 November 2005. Downloaded from economic status is crucial in exploring ethnic disparity in After publications pointing out that the term ‘‘Asian’’ was an health, it is inadequate to understand ethnic differences in obstacle to ethnicity and health research,119 several gains health.715 The migration of socially deprived Eastern have been made including the increasing division of South Europeans into Western Europe also shows that having Asians groups into Indian, Pakistanis, and Bangladeshi in the European ancestry is no longer a homogenous description of UK national census in 1999 and 2001. A few journal editors persons of similar socioeconomic status.3 have also set standards by publishing explicit guidelines for Self definition of ethnicity is currently gaining support. the use of race and ethnicity.2 20–22 Broader consensus is still However, one of the main drawbacks of this approach is that needed in classifying African descent populations in Europe people change their self assessment over time and with and the USA for epidemiological and public health research. context, although this fluidity also has strengths. The current Research on people originating from the African continent is groupings of African descent populations in the USA and the of great interest in both Europe and the USA. African descent UK such as Black, Black African, and African American hide populations in Europe, as in the USA, are diverse but research the huge heterogeneity within these groups, which weakens into their health has yet to capture and capitalise on this. the value of ethnic categorisation as a means of providing Ethnic classifications for African decent populations are often culturally appropriate health care, and in understanding the vaguely defined, and the concepts underlying them are poorly causes of ethnic differences in disease. Such broad terms may understood.8 Combining heterogeneous African populations not fit with self definition of ethnicity. under a single label such as Black creates practical problems Research on ethnicity and health has a scientific potential of comparability between places and times, and reinforces the in determining the causes of disease, explaining the interac- simplistic notion that being Black causes health disparity.23 tion between cultural factors and health, and ensuring that There is considerable diversity within and between the services and policies provide equitable access to health care. African descent populations in Europe and those in the USA. For example, why in comparison with the UK population as a The African descent populations in Europe came mainly from whole, is hypertension so common in African Caribbeans16 former colonies and from the West Indies in the 1950s and but coronary heart disease is less common?17 The paradoxes 1960s.18 24 In the USA African descent populations include behind many of the ethnic and racial differences in health are people from West Indies, Haiti, and various parts of Africa.25 not easily explained, and better definitions and terminology, These African descent groups are distinct in terms of beliefs, and greater attention to population heterogeneity are a behaviours, risk factors, and factors such as height and prerequisite for scientific progress. weight and disease experience.26 27 Several studies in the USA HETEROGENEITY OF AFRICAN DESCENT have shown considerable diversity in health status between POPULATIONS IN THE USA AND EUROPE different African populations.28–30 For example, Fang et al The heterogeneity of African descent populations,718 South studied the association between birthplace and mortality Asian,1 and White populations3 has long been pointed out. from cardiovascular
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