The islands of Barbados, Trinidad and Jamaica typically conjure up images of a tropical paradise. But the Caribbean can be a dangerous place in which to grow up. Jamaica has one of the highest murder rates in the world, and alongside AIDS, road traffic accidents and substance abuse, injury from violence is a leading cause of death for 15- to 25-year-olds in the English-speaking Caribbean.

Now, with funding from the Wellcome Trust’s Health Consequences of Population Change Programme, experts in these three island nations will for the first time be able to quantify the growing problems of domestic violence, gang culture and other forms of aggression between people. They will also study links between violence and other factors, such as the region’s high levels of migration and knock-on effects on family life and the community. With such information at hand, local policy makers will be much better placed to tackle the alarming upsurge in violence.

A public health issue

Injury from violence, particularly among young people, is a growing (and potentially preventable) public health problem worldwide, and it is therefore crucial that we develop a better understanding of its causes.

Speaking at an international conference on violence prevention held in Jamaica in October last year, Dr Mirta Roses, Director of the Pan-American Health Organization (PAHO), said, “Violence is a public health problem because it produces a heavy burden of avoidable death and morbidity, especially among children, women, and young people. [Violence necessitates] major financial outlays to provide medical care to victims [and] produces negative economic, social and psychological impacts, immediately and long term.”

In 1993 the PAHO reported that the Americas, including the Caribbean, were one of the world’s most violent regions, declaring that: “Violence in all its manifestations is a public health priority that threatens the development of peoples, undermines their quality of life, and erodes the social fabric.”

Despite this, hard data on the problem in the Caribbean, its underlying causes, and possible solutions are still lacking. The new £750 000 Wellcome Trust-funded project, which began in January 2004, will help fill this information void. “This will be one of the first detailed studies to look at domestic and other types of violence on a population-based scale,” says Professor Elsie Le Franc, a sociologist and lead researcher behind the new project based at the University of the West Indies in Bridgetown, Barbados.

Although scant precise data exist on how many Caribbeans are affected by violence, there is evidence that the problem is widespread, serious and growing. The few (mostly focus group-based) studies that do exist, and the huge number of violence-related hospital admissions, frighteningly hint at the severity and scale of the problem – injury from violence has become one of the leading causes for admission to a hospital or clinic in Jamaica.

Shockingly, points out Dr Le Franc, one study estimated that up to two-thirds of women in the region had been beaten by their husbands on one or more occasions. Another found that at least one in three Barbadian women had been beaten as adults. In Jamaica, research suggested that incidences of rape, incest and domestic violence had increased by 114 per cent between 1980 and 1998.

Mobile society

The project team – a multidisciplinary group of six researchers from all three nations, including sociologists, a criminologist and an epidemiologist – will focus not only on the problem of violence, but also on the region’s high levels of migration.

Economic migration is another social trend that pervades Caribbean society, and has been suggested as one of a raft of reasons, alongside grinding inner-city poverty, for sky-rocketing violent crime rates.

“It’s only in recent years that we’ve started to recognise the public health effects of migration... and the impacts it can have on a kid’s welfare, development and behaviour,” says Dr Le Franc.

Migration and disruptions to home life are a central feature of some Caribbean societies. In fact, migration in Jamaica is so commonplace today that the children affected have their own moniker – the ‘barrel children’. The name derives from the time that mothers or fathers who had gone on ahead to seek prosperity in the UK or elsewhere shipped money, clothes, toys and other goodies back to their offspring in barrels.

There is a long history of migration in the Caribbean region. Early inhabitants were migrants themselves, many abducted and shipped as slaves from Africa under colonial rule. During the 19th and 20th centuries, migration was common within the Caribbean region, with young men (and sometimes their whole families) following work in Cuba’s sugar plantations, Trinidad’s oil and asphalt industries, and Central America during the construction of the Panama Canal, completed in 1914.

Reaching a peak in the 1950s and 1960s, waves of Jamaicans, Trinidadians and other islanders relocated to the UK to fill a gap left in the labour force left by World War II. “Today it’s more typical for young people to seek a new life in Canada or the USA,” says Dr Le Franc.

Historically, men were more likely to migrate than women were, but since the mid-twentieth century, it has been quite common for entire families to move in tune with economic opportunity. However, notes Dr Le Franc, women often go first and send for the rest of the family over time.

Therefore, Jamaican, Barbadian and other children frequently grow up in shifting home environments made up of grandparents, aunts, uncles and other relatives rather than more conventional two-parent households.

Under these circumstances, it can be difficult to maintain a consistent approach to parenting. “Children have to make multiple adjustments to new homes and the different parenting strategies they have,” notes co-researcher and epidemiologist Maureen Samms-Vaughan of the University of the West Indies Child Health Section in Mona, Jamaica, who heads the Jamaican side of the new project. “Forming stable emotional attachments [to mother and father figures] early on is important for emotional stability.”

Migration and the disruption it can cause to households can inflict stress upon family life and the community, adds Dr Le Franc, but few studies have yet systematically examined how population movements might contribute to violence in the community. Researchers have argued that, by dividing families, migration might have negative effects on child development and adolescent behaviour – and perhaps encourages gang allegiance and aggression.

Negative effects

To explore the relationships between violent crime, family structure, migration and other factors, Dr Le Franc’s team hopes to interview more than 6000 15- to 30-year-olds from Trinidad, Barbados and Jamaica. The researchers will collect data on the frequency of participation in violence – as victim or perpetrator – any history of migration in the family, and data on other variables including socio-economic status, ethnic identity, education as well as other factors that might have an impact on violent behaviour.

The three nations differ in terms of wealth, development, degree of inequality, rates of migration and crime, and proportion of nonconventionally structured families, says Dr Le Franc. Trinidad for example, was a net importer of migrants for many years. Furthermore, studying the incidence of violence and aggression in Trinidad’s large East Indian community will help test claims that the nature of the problem of violence could be distinct from that in African communities.

The team plans to share findings with governments, social policy makers and law enforcement agencies. The results could be used to provide information for the design of more effective youth-targeted violence prevention programmes and conflict management strategies, says Dr Le Franc, and perhaps also to inform early parenting practices and schooling.

The Caribbean is by no means the only region affected by violence. The project represents a rare attempt to document systematically its public health impact and to identify rigorously where its roots might lie. The results could thus be of more general relevance. Indeed, says Dr Le Franc, it may in the future be possible to “extend the gaze to ethnic communities [of Caribbean descent] in the UK who suffer from many of the same problems. The understanding of the problems there could perhaps benefit from information generated here.”