A Shave, a Haircut, and a Blood-Pressure Test

An experimental program is using "barbershop intervention" to bring health education to African American men.

The barbershop has always been more than a place to get a trim and a shave for African American men. It’s a place to talk sports, debate politics, and swap stories. Now it may also be a site for early medical intervention for high blood pressure.

Dr. Ronald Victor, the director of Cedars-Sinai Center for Hypertension in Los Angeles, recently received an $8.5 million grant from the National Institutes of Health to test if early barbershop intervention can produce significantly better blood pressure control in African American men.

High blood pressure disproportionately affects African Americans, who develop it at younger ages than other groups in the U.S. and are more likely to develop related complications such as stroke and heart disease. African American men, in particular, suffer from a low rate of preventative care, and have a death rate from hypertension more than two times higher than that of their white counterparts.

The program will train barbers in traditionally African American communities to take their customers’ blood pressure and refer customers with elevated readings to doctors. “We have to leave the hallowed halls of medicine,” Victor explains. “Barbershops are the hub of a community.”

Victor is partnering with Dr. Anthony Reid, a cardiologist based in Inglewood, California, on the project. The study builds on an earlier one conducted in Dallas between 2006 and 2008 and published in the Archives of Internal Medicine in 2011.

The research looked at the effects of blood-pressure checks and health education promoted by barbers for 10 months in 17 barbershops on about 1,300 male patrons. In nine of the shops, barbers continually took blood-pressure checks of their patrons and referred them to physicians. In the other eight shops, patrons were given just the heart-health information, a standard pamphlet on blood pressure, without the barber-administered blood-pressure checks. The study found that while blood-pressure levels fell in both groups, the barber-assisted group showed greater improvement.

The new round of funding will allow for a larger study in Los Angeles, which is currently in the planning stages and scheduled to launch in the beginning of 2015. Victor and Reid plan to work with two dozen barbershops in LA, tracking patients for at least 18 months.

The study is partnered with healthcare providers like Kaiser Permanente and low-cost health clinics, which, along with Dr. Reid, will treat patients without insurance. According to Victor, one of the larger challenges in the Dallas study was coordinating patient care with the healthcare system. “If we had 100 regular customers with high blood pressure, they would have 99 different doctors,” he says.

The concept of the barbershop as a site for medical outreach isn’t entirely new. In the Middle Ages, barbers, rather than physicians, were expected to perform minor surgeries such as bloodletting, teeth extractions, and even give enemas. More recently, the barbershop has taken on special significance in the African American community. Prior to the pre-civil rights era, it was one of the few professions open to black men—a path to entrepreneurship and self-employment. The barbershop itself became a de facto men’s club when similar white institutions were closed to African Americans.

Even today, the barbershop remains a vital venue to the African American community as a gathering place to debate the issues of the day. “The barbershop is a forum for people to meet and discuss. They come here and say whatever they want to say. They’re free when they’re [here],” says barber Austin Wilfred at Headmaster Barber Shop in Los Angeles.

In both the 2008 and 2012 elections, barbershops played a crucial role in President Obama’s grassroots initiative to register black voters. Political operatives saw black barbers and beauticians serving the same role as black ministers outside the church, leading their “congregations” in electoral campaigns.

Reaching African Americans, particularly low-income men, has traditionally been a challenge for healthcare workers. Mobile clinics have been used for decades in inner city neighborhoods but are patronized in higher numbers by women, according to Victor. Similarly, black churches have developed programs for medical screening and outreach but women are also more likely to be regular churchgoers than men. Sporting events have had limited success as well, providing an inauspicious environment for a frank discussion about health.

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Marissa Gluck is a writer based in Los Angeles.

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