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Non-Communicable diseases (NCDs) as defined by the World Health Organization (WHO) (2008a) are cancers, chronic respiratory diseases, cardiovascular diseases and diabetes. NCDs diseases are chronic and non-infectious. Combined, these four killers cause an estimated 35 billion deaths annually (WHO, 2008b). According to WHO (2005, 2008b), 60% of the 35 billion represents all deaths globally. Moreover, the WHO (2005, 2008b) reports that with all the deaths that occur in low and middle-income countries, 80% of those deaths will be a result of NCDs. According to Magnusson (2010), NCDs present a huge threat to public health. The prevalence of NCDs is simply not an individual or a national problem. It is one that deserves global attention, because it affects all people regardless of age, race or geographic location. Its prevalence arises, at least in part, from global economic practices and the global distribution of wealth (Beaglehole & Yach, 2003). NCDs account for most deaths in individuals 15-59 years of age in all regions of the world except South Asia and Sub-Saharan Africa (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). NCDs are highly prevalent in low and middle-income countries, where historically people were once more affected by infectious or communicable diseases. There are a number of disease conditions that are highly prevalent in persons of African descent, and diabetes mellitus (type II diabetes) is one of them (Solomon, 2003; Ali et al, 2015). However, it is not only the prevalence of NCDs that is of concern, but also the increasing disparity between developing and developed nations of this rapidly growing disease (WHO, 2008b; Wild et al., 2004). Developing countries like the countries of Latin America and the Caribbean have one of the highest burdens of diabetes globally (Yisahak, Beagley, Hambleton & Narayan, 2014). For example, diabetes mortality in CARICOM countries is one of the leading causes of death, along with chronic respiratory diseases, cancers, and cardiovascular diseases (PAHO, 2007). Research by Guariguata et al. (2014) demonstrates that the global estimates of diabetes are much higher than initially projected by many professionals of this work, including the renowned World Health Organization (WHO). In addition, researchers have also pointed that the top ten countries with the highest per capita health expenditure on diabetes are all from developed countries (Zhang et al., 2010). King et al. (1998) makes a clear note of the stark difference in the predicted prevalence of diabetes in developing countries as opposed to developed countries. That is, the proportional increase in diabetes will be greater in developing countries, where the increase in prevalence will be 48%, in contrast to just a 27% increase in developed Volume 9 Issue 1 (2020) Review Article ISSN: 2167-1907 www.JOFSR.org 1 countries. In fact, many public health officials predict approximately 75% of all cases of type II diabetes worldwide will be in developing countries by the year 2025. Type II diabetes as a growing burden on the Caribbean community Chronic conditions such as heart disease, stroke, diabetes and cancers are unfortunately causing disease and disability for people regardless of age, race, gender or socioeconomic status. Yet, those same characteristics and social determinants of health can increase the prevalence of these conditions in many people throughout the world. Particularly, our neighbors in the Caribbean are experiencing complications and death due to chronic conditions and comorbidities that leave many communities puzzled about how to address health concerns like high blood, high cholesterol and diabetes. Historically, many Caribbean islands did not experience the impact of NCDs until the most recent decades. Researchers must look broadly and deeply to assess the changing factors specifically in AfroCaribbean communities that speak to the increased incidence and prevalence rates of type II diabetes. It is necessary to explore the ways in which geography, ethnicity, socioeconomic status, age, access to food, and opportunities for adequate healthcare. Diabetes is a major risk factor for cardiovascular disease, kidney disease and blindness (Bloom et al., 2011). Historically, individuals living throughout the Caribbean had significant lower rates of being overweight, being obese, having type II diabetes and other chronic conditions (Figueroa, 2001). This is not to suggest Caribbean people have not faced non-communicable diseases in the past; rather, the prevalence rates are higher now than they have been decades ago. For example, the top leading causes of death in Jamaica in 1945 were tuberculosis, heart disease, nephritis, syphilis, pneumonia and influenza (Wilks et al., 1998). Ferguson et al. (2011) then illustrated that in 2004, the leading causes of death in Jamaica were cerebrovascular disease, diabetes mellitus, ischemic heart disease, hypertensive diseases and other heart diseases. A review of the literature reveals some insight into the topic of health disparities and type II diabetes among people of African descent in the Caribbean. Boyne’s (2008) extensive review of the literature revealed that the Caribbean is undergoing “a rapid epidemiological and nutritional transition” (p. 95), where communicable diseases accounted for about 5% 10% of all mortality rates and chronic, non-communicable diseases have assumed prominence. In contrast, half a century ago, the most common causes of mortality in the Caribbean at the time were infections. However, the literature is very dated and limiting in going beyond the surface to further the discourse of lifestyle factors that is commonly presented as contributing factors to the increasingly higher prevalence of type II diabetes among people of African descent presently living in the Caribbean. Research shows that the rate of type II diabetes is increasing at an alarming rate and it is especially more pronounced in developing countries like the Caribbean, where a majority of the deaths from non-communicable diseases, like type II diabetes will occur. The risk factors associated with NCDs are well-known and extensively researched. These universal risk factors include lifestyle factors such as, tobacco use, a poor diet, physical inactivity and the harmful consumption of alcohol (WHO, 2008b, 2011). However, this paper aims to go beyond these lifestyle risk factors to assess broadly and deeply those social determinants of health that are specific to Afro-Caribbean families that affect their current state of health and the increased incidence and prevalence rate of NCDs, specifically type II diabetes. Volume 9 Issue 1 (2020) Review Article ISSN: 2167-1907 www.JOFSR.org 2 Developing lowand middle-income countries of the Caribbean are extremely diverse. The people who make up this diversity are multi-lingual, multi-cultural and multi-racial (Trouillot, 1992). Islanders, as sometimes they are referenced, could be from the same country but speak multiple dialects and have varying lived experiences. Political, economic, educational, and health are also diversified in the Caribbean and within a country from region to region. For this reason, this paper examines specifically the increased prevalence of type II diabetes among English speaking peoples of Afro-Caribbean descent living on the Caribbean islands of Dominica, St. Lucia, Jamaica and Barbados. Individuals from these four countries were identified because they share particular characteristics that would make it easier to explore NCDs such as diabetes in their communities. For instance, all four islands are former British colonies, whose large African population is as a result of the slave trade. The population of people who are identified as being of African descent in Dominica, St. Lucia, Jamaica and Barbados are 86.6%, 85.3%, 92.1% and 92.4% respectively (CIA Factbook, 2018). These four countries are relatively small countries, with Jamaica being the largest in terms of population size and land mass. These four countries are relatively in close proximity to each other geographically with Jamaica being the farthest away. In addition, these four Caribbean countries have similar developing economies, which rely heavily on tourism and agriculture as main sources of income (Punnett, Dicke-Forde & Robinson, 2006). Perspectives on Health in the Caribbean There has been a tremendous change in health conditions over the last few decades in the Caribbean. Although people are living much longer, they are doing so with NCDs, such as cancers, diabetes, and cardiovascular diseases. Although these countries proportionally experience the majority of deaths from NCDs, it does not mean that they no longer experience communicable (infectious) diseases and their concomitant mortality. They simply struggle with both. However, evidence points to a global epidemiological shift, where the majority of deaths from NCDs are now largely due to chronic diseases and no longer just infectious ones (Miranda, Kinra, Casas, Smith & Ebrahim, 2008). For instance, Ali and colleagues (2015) compiled mortality data for males and females ages 0 85 years for cardiovascular diseases, diabetes, chronic respiratory diseases and cancers in countries with suitable data since 198

Exploring Global Health Disparities: Afro-Caribbeans’ Perceptions of the Prevalence of Type II Diabetes in Their Communities