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Building A Turbulent Future

Professor John Keynote Address at
Launch of the Caribbean and African Health Network (CAHN)
Longford Park Manchester
27 October 2017.

Est. read time: 19 min

First, let me say how much I welcome the opportunity to join you as you add to the rich tapestry we continue to weave in British Social History through your crucial intervention in the matter of the health and wellbeing of people of African Descent in this city and region.
I congratulate you on taking this initiative, especially as it is the result of your individual efforts and financial contributions and has not been resourced by grants of any sort.
You do so at an important moment in the history of our turbulent relationship with this country and its institutions. And the turbulence is all around us, here in Britain and more particularly in the countries we left, not intending to, but eventually and inexorably settling in Britain and being part of the answer to the vexed question: who are ‘we the British’.
This important moment in history encompasses:
• The United Nations Declaration of the International Decade for People of African Descent (2015 – 2024) with its theme of: Recognition, Justice and Development
• Brexit and the challenges and threats facing people of African descent, as well as other global majority people, in a post-Brexit Britain that is anything but ‘post-racial’
• The David Lammy Report
• The government’s sudden awakening to the embedded racial disparities in all of its ministries and institutions of state; reports of the impact of the government’s austerity programme on poor and vulnerable groups for whom social exclusion and marginalisation are being compounded, with predictable consequences for health and wellbeing
• The galloping privatisation, marketisation and strangulation of the National Health Service
• Growing concerns about the incidence of mental illness and suicides among young people, especially those in custody
• More and more evidence of the police killing black people in their custody with impunity
• The Minister for Justice, David Lidington, contemplating giving powers of arrest to G4S and Serco as part of a police privatisation plan. That, in spite of Jimmy Mubenga’s death at the hands of G4S’ guards on a plane in 2010 as they tried to deport him to the Congo; in spite of them not being found guilty of manslaughter and in spite of the fact that the trial judge refused to let the jury hear of the racist messages exchanged by those guards prior to their involvement in restraining Mubenga. The state is therefore planning to let G4S and Serco loose on vulnerable groups. No doubt, both those companies could take comfort from the fact that despite the scores of people who met their death in police custody since David Oluwale was murdered by police in West Yorkshire in 1969, a case in which two police officers were found guilty only of grievous bodily harm, no police officer, or guard acting for the Border Agency, has been convicted for causing such deaths
• The relentless rise in the number of homicides, principally knife and gun-enabled, in which both victims and assailants are black males (and less frequently black females) aged between 14 and 30.
And internationally:
• Climate change and its impact upon the economies of already poor and dependent countries, particularly in the Caribbean, where the devastation and unprecedented loss of life caused by Hurricanes Irma and Maria recently is predicted to be ‘the new normal’

Clearly, that has a major and direct impact upon settled Caribbean communities here in Britain, given the number of dependents we have in our countries of origin and the interconnectedness of the populations of those countries. But it has an impact upon us in another critical respect. For, it is not enough and never will be enough for us to ship barrels of clothes and food, or hold concerts and dinner and dance events, to send relief to islands with their infrastructure devastated by hurricanes, their agriculture and livestock destroyed, their drinking water contaminated and their citizens buried beneath tons of rubble. Those islands have little capacity to sustain themselves in normal times, so much so that many have taken to selling passports to rich Europeans, Chinese, Russians, Arabs and North Americans (often described as ‘ultra high net worth individuals’) for as little as £50,000 pounds, in a hardly sustainable and highly problematic programme that they call ‘Citizenship by Investment’.

In Antigua and Barbuda (the latter now no longer inhabited as a result of being comprehensively wrecked by Irma and Maria), the Antiguan passport entitles the so-called ‘investor’ to visa-free travel to 132 countries and in order to maintain their citizenship, they simply have to show evidence of residing in the country for 5 days over 5 years. For those privileges, the ‘investor’ is required to contribute to the National Development Fund a minimum of USD 200,000.

A recent report noted that:
‘…the money generated from the Antigua program launched just three years ago is expected to account for 25% of the government’s annual revenues. For St Kitts & Nevis, the program is projected to generate 30% of the government’s revenue in 2015 — roughly EC$200 million (approximately US$74 million). A significant percentage of the millions generated by both programs are used to fund various development initiatives across a range of sectors…
However, these programs are not without their challenges and critics with regards to transparency and the due diligence process. The St Kitts & Nevis program came under scrutiny last year when several Iranian nationals who had acquired passports through their program were identified as sanctions evaders. Canada then imposed a visa restriction on St Kitts & Nevis for all 55,000 nationals. As this was less than ideal and created negative publicity, the government is now implementing new measures to safeguard the integrity of the program and revenue generated. Revenue that will no doubt go up as in addition to stricter background checks, the investment level is expected to increase.

4 Caribbean Citizenship By Investment Programs

The countries that operate that scheme are putting their ‘bona fide’ citizens at risk on a number of counts.

Despite whatever due diligence measures and security checks those countries might have in place, the fact remains that they are wide open to exploitation from money launderers, drug cartels, international criminals, paedophiles, ruthless employers and more. Worse yet, given how they do politics in most of those countries and given the manner in which politicians manipulate the population and waste human and financial resources by insisting upon the Westminster ‘first past the post’ electoral system, these ultra rich individuals would no doubt seize every opportunity to bribe, to field candidates of their choice, having already bribed them, to entice and disable in order to get the electoral result they desire, thereby exerting untold power over the local population.
Imagine, for example, a party in government making a manifesto pledge to keep casinos away from their country. Ultra high net worth individuals who would no doubt be in favour of such entities would clearly have the wealth and the privilege to buy votes, bribe politicians, coerce huge swathes of the population and secure the electoral result they want. All those countries would risk saying goodbye to any pretensions of democratic representation, having replaced the yoke of colonialism around their necks.

Our past is their amplified present. Their present could well be our inevitable future. We stand with them in an uncertain and predictably turbulent future. We have an imperative, therefore, to do our best by them as our families and fellow nationals, yes. But we also owe it to them to use all our energy and collective power here in Europe to demand reparatory justice. Justice, not only for the genocide and crimes against humanity that impacted twenty million of our Ancestors, while Britain and Europe prospered and continue to do so to this day, but on account of the fact that those islands whose contribution to green house gases and climate change is miniscule, continue to bear the brunt of the excessive and unregulated consumption of Britain, Europe and North America. They are predicted to suffer devastation continuously, from ever rising temperatures, rising sea levels, intermittent periods of drought and excessive rainfall, soil erosion, ecological degradation and more.
Their ‘quick fix’ solution called ‘citizenship by investment’ would no doubt represent a double whammie. While imposing upon themselves a new set of colonial overlords and slave masters who would no doubt be uninhibited in their racist treatment of ‘the natives’, both as ‘citizens’ and employers, thereby losing whatever pretence at national sovereignty they espouse, the rising tide of climate change would not pass them by simply because they have chosen that way of sticking their finger in the dyke.

It is for all of these reasons that we need to make the connection between global warming, climate change and reparatory justice.

David Cameron, addressing the Jamaican Parliament in September 2015 , had the gall to say to his hosts with unfettered British colonialist arrogance that slavery was an ‘abhorrent’ trade, but that while it was unfortunate, all that is in the past, so we the descendants of enslaved Africans should ‘get over it’…., as if it were some debilitating migraine. He whose forebears profited from the £20m that was paid on abolition as compensation to former plantation owners for the loss of ‘property’; he who to this day is enjoying the benefit of their compensation. In the same breath, he offered the Jamaican government £25m to build a new prison complex so that he could more readily repatriate Jamaican nationals who are costing ‘the British taxpayer’ in excess of £100, 000 per year each to keep them in the nation’s so-called ‘secure estate’.

But there has been another sort of repatriation going on for several decades, a voluntary repatriation, or ‘returning home’, on the part of a growing number of middle-aged and elderly Caribbean people. It is a repatriation for which Britain is no doubt deeply grateful, while not offering any support to its former colonies to accommodate returnees. Those returnees are typically at an age when they have predictable health needs. Indeed, many return expecting to enjoy a less stressful life and hoping that the combination of sun, sea and air quality would result in a healthier and longer life.

The reality for most, however, is that local health services prove incapable of meeting their needs, in many cases very complex needs. In time, they discover that despite their ability to pay for private health care, their ongoing health needs make the situation untenable. Consequently, having returned to the retirement homes they built in the expectation that they would spend the rest of their days in them, and having said good bye to Britain, many return here for no other reason than that they need to be able to access health services appropriate to their needs.

As early as 1984, while researching a film in Jamaica for Channel 4 television, I raised this issue with the Prime Minister Michael Manley and with the Opposition Leader Edward Seaga. Prime Minister Manley was adamant that the issue should be laid at the door of the British Government. His argument was that Britain received those returnees as adult workers, without having spent one dollar preparing them for employability, or compensating Jamaica and other countries in the region for their lack of development on account of the number of their nationals who emigrated to Britain. Those nationals spent most of their working life building up the British economy and contributing to its social and cultural development. The economic benefit Jamaica and other donor countries derived from remittances sent by those nationals when they were in the UK pales into insignificance when compared to their contribution to the British economy and society. Britain, therefore, owes a debt to the islands and should bear the responsibility for not just improving but expanding health services, both for the domestic population and for returnees from Britain.

Manley’s reasoning is not just persuasive, it is indisputable. And it is indisputable because Britain has a historical responsibility for the persistent infrastructural weaknesses and deficiencies in those islands, especially in the provision of health and social care. It is significant, therefore, that David Cameron was ready to provide millions of pounds to Jamaica to build a prison complex that could accommodate repatriated convicts, seemingly without a concern about that country’s capacity to provide health and social care for its many returning nationals who gave their best years to Britain, having been invited to come here all those years ago.

Despite all of that, however, shamefully and totally without compunction, the British government has declared that it has no intention of engaging with the UN Declaration on the Decade for People of African Descent and putting in place a programme of policies and actions consonant with the theme of Recognition, Justice and Development.

I could go on, but my purpose here is not to cause you to cut your wrists. Rather, it is to invite you to situate yourselves and your mission as a network in a much wider context than the existing and anticipated structures of the NHS and of access to health services in the community.

CAHN Greater Manchester states as its purpose: to empower, enable and equip faith and community organisations with the Infrastructure to deliver and shape health and wellbeing services.

I want to suggest that in the context of our health and well being as African people in this society, health is much more than the absence of illness or disease. In fact, health is always much more than the absence of illness or disease. It is indeed the presence and enjoyment of wellbeing, physical, emotional, spiritual and mental wellbeing. And in passing, let me remind us that faith/religion/belief is neither a necessary nor a sufficient condition for spiritual wellbeing.

There are many things that militate against our capacity to experience and enjoy wellbeing. What we leave we carry…. and African people, especially we the descendants of enslaved Africans are carrying a great deal. We endure our past like our bodies do a scab. Rub it against something sharp, caustic or abrasive and it begins to reveal the old wound that is attempting to use all the powers of our immune system to heal. The daily grind of racism, discrimination and marginalisation is for us the most caustic, toxic and abrasive trigger for those historical wounds, wounds that have not healed with the passing of time, or with the superimposition of white supremacy, the Christian faith, or any of the other trappings of imperialism and colonialism.

In this regard, let me add that I consider your frequent references to ‘faith’ to be somewhat ambiguous. I assume that in each case it refers to Christian faith, or perhaps Islam, given the growing number of African people of that faith in Greater Manchester. I would suggest, however, that we ignore African Spiritually at our peril and at the expense of children and entire families who have both ancestral and contemporary groundings in African Spirituality and its traditions and practices.
I have heard it said, for example, that the reason for the epidemic of murder and maiming of our children by other children is that they have not been brought up to know God and the redemptive grace of His son, Jesus. This may be a sincerely held belief. For some us, however, the cause of that scourge in our communities has much more to do with the structural, institutional and cultural framing of the condition of being young and black in British society over time, than with anything to do with the absence of God in the lives of young people.

I refuse to believe, for example, that those young people have a genetic propensity to murder and mayhem, or that they have a greater capacity to be instruments of satan than the rest of the population, black, white or pink.

As such, we need to see this scourge in our communities as a health and wellbeing problem much more than a law and order problem. The government throws any amount of money at it as a law and order problem. Our own communities perpetuate the anguish by accommodating a ‘don’t snitch’ policy, even when it is common knowledge who the young murderers are. In this sense, there is for far too many of us up and down the land an unforgiveable complicity in the murder of our young people because we insist upon harbouring vipers in our bosoms.

But, do commissioning groups fund preventive or interventive services for communities affected by gun and knife crime as a health and wellbeing issue?

I currently work in young offender institutions in Wales on improving offender management and rehabilitation. In some institutions there and across the country, over 50% of the inmates, or trainees as the prison service prefers to call them, are of African heritage and an increasing number of mixed heritage. How do we end up in Cardiff of all places with 50% of black young people from London in a maximum security prison? Practically all of those had been excluded from school permanently. Others had been through Pupil Referral Units or other alternative schooling provision, almost as the ante-chamber of the young offender institution. Does the government spend money on counselling and therapeutic services on young people with complex needs, including mental health needs, and those at risk of exclusion in schools? Would that not be more humane, less wasteful and destructive and more in keeping with Article 2 of the UN Conventions on the Rights of the Child, than locking up more and more young people, having committed their victims to the grave, when they are not left maimed for life?

The evidence I have on account of my work with victims of knife crime and with bereaved families who have lost loved ones as a result of gun and knife crime is that our communities are in need of much healing. The murder of every single young people directly affects at least fifty people, parents, siblings, other relatives, friends, members of peer groups, and more. If the young person is still at school, that number could increase by up to one hundred.

The community’s need for healing has an even longer history than the contemporary self immolation that has been pretty much normalised in urban centres with a significant African population. Throughout the 1960s up to about the 1980s, children who were sent for or brought to join biological parents and step parents, having been left behind in the Caribbean when the biological parents(s) first emigrated, suffered all forms of physical, sexual and emotional abuse. Such practices were so widespread that today, if one were to do a poll of every gathering of adults aged 40 and over, you would find at least ten per cent would have suffered some form of abuse, especially at the hands of step parents and siblings. Nevertheless, that remained such a taboo subject that it was rarely discussed openly or at all, leading to suppressed pain and hurt. Consequently, many people have had their life chances compromised and their lives ruined.

Yet, it is questionable how many of that generation, let alone relatives of victims of gun and knife crime, access any form of counselling or therapy, or have the opportunity to express their pain and anguish in a supportive environment, with or without the aid of health professionals.

There is in my view a correlation between attitudes to health and wellbeing within our communities and the importance of learning to actively take care of our own health; self organisation in our communities and epidemiology, the incidence and treatment of prevalent diseases affecting the Caribbean and African Communities. In relation to all of these, I see a role for CAHN both in encouraging our communities to do more for themselves and in holding Hospital Trusts and other health service providers to account.

History is on our side where this is concerned and there are people here today who have been involved in making that history. The pioneering work of the Sickle Cell Anaemia Society and the Organisation for Sickle Cell Anaemia Research has saved more unnecessary deaths over the last four decades than the NHS would like to quantify. Theirs has been a classic case of change from the bottom up and of communities demanding that health practitioners grow some humility, set aside arrogance and puffed up superiority and listen to those who know more about their condition than they do.
CAHN says:
‘The ultimate focus will be to facilitate capacity building in the Caribbean and African voluntary, community sector, ensuring they are commission ready to deliver evidence based, and culturally appropriate health and wellbeing services within a framework of governance’.

Hopefully, those culturally appropriate health and wellbeing services will include community based primary health education and awareness raising campaigns in relation to staples such as: prostate cancer, type 2 diabetes, hypertension, stroke, clinical depression and much more.

There clearly needs to be more discussion, education and awareness raising with respect to our interface with medical practitioners such as GPs, doctors in A & E, on wards and in out-patients. Some health practitioners come to us in those settings carrying a great deal of baggage, to the extent that they convince themselves that do not and cannot understand what we are saying, and they assume that because we speak Jamaican English, or Barbadian English, we must be stupid. What is worse, is that generally speaking there is a tendency to patronise working class people and assume that we cannot possibly know our bodies well enough to say what is actually happening to us.

In the last year, I have had cause to avail myself of health care in the NHS more often than I ever wished. What I found interesting but not at all surprising is that the moment doctors asked me what I ‘did for a living before retirement ‘ – as if anybody informed them I was retired – and I told them that I worked in two universities as a professor, their whole attitude changed. I did not even have to ask any questions about my condition, or about their treatment plan. They began to volunteer more information than I could digest. In one hospital, the consultant gave the ward sister strict instructions to make sure and take good care of me because I was one of them, i.e, a professor from UCL as they were.

And just as I suspected, their attitude towards and way of speaking to other patients in that ward was much more patronising and sometimes simply condescending.

Hopefully, CAHN will encourage the ‘patient voice’ and hold practitioners to account for the way some of them deal with African people, both patients and relatives. In this respect, CAHN should aim to secure funding to run an advocacy and representation service and guide and assist patients to hold health service providers to account.

Finally, let me say that it is clearly not my business to rewrite or reset your aims, objectives and priorities. I trust, however, that you will feel able to give due consideration to the issues I addressed in this presentation as you define the contours of your relationship with care commissioners, strategic health authorities, health practitioners and voluntary sector organisations.

Hearty congratulations once again and I wish you well!

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