James Smith, a barber in Dallas, has spent four decades tending to the hair care needs, and more, of his African-American clientele. “In the black barbershop, we talk about the most important things in life—politics, religion, business. Now we’re adding health to the list,” he says.
Smith belongs to a pioneering team of barbers who have received training to perform blood pressure screenings. The goal of that training is to help reduce the epidemic rates of hypertension among African-American men. The condition is often silent; in its initial phase, it may be unaccompanied by pain or other noticeable symptoms. Left untreated, high blood pressure can lead to stroke or heart disease—and to early death. “We need to take this seriously,” says Smith.
African-American men “are more likely to have a barber than a doctor,” says Ronald Victor, director of the Cedars-Sinai Hypertension Center and associate director of the Cedars-Sinai Heart Institute in Los Angeles. Hypertension rates are high among both black men and black women, he notes, but “there’s a big gender difference when it comes to awareness and treatment of the condition. We guys are not very proactive about our health.”
Victor, a physician, is leading a push to use barbershops to raise awareness of hypertension. After conducting an initial study in Dallas, he is launching a multi-year, $8.5 million investigation in Los Angeles funded by the National Institutes of Health. Smith, who participated in the Dallas study, is an advisor to the new project. In late 2014, he traveled to Southern California to talk up the idea with barbers in that region. “It’s a natural role for us,” he says.
Barbers have a long history of serving as community health workers. During the middle ages, they acted as surgeons. “If they could pull teeth and put on leeches back in that time, then barbers today can certainly learn to use an automatic blood pressure machine,” Victor says.
As an environment for getting a reliable blood pressure reading, the barbershop outperforms the typical doctor’s office. “The barber chair is comfortable, with a straight back and armrests at heart level,” Victor explains. Then there’s the ambiance. “If you can’t relax in a barbershop, you’ve got a problem,” he says. “Compare that to a medical office, where you may be sitting on the edge of a gurney in a cold exam room. A doctor’s office is probably the worst place to get a good [reading of] blood pressure.” What’s more, barbershops tend to enjoy strong customer loyalty. “Men go to see their barber, on average, every two to four weeks,” Victor says. Smith, for instance, can trace some of his customers back three generations. “I’ve been part of their lives,” he says. “I’ve seen them grow up, go to college, and come back. That puts me in a good position to mentor them to eat right and get their blood pressure under control.”
When the new study ramps up in early 2015, an estimated two dozen Los Angeles barbershops will become hypertension screening and education sites. The goal is to track 500 African-American men with uncontrolled hypertension for a year. Investigators will match participants with clinical pharmacists and doctors who will help them manage their hypertension—in most cases by prescribing a combination of medication and lifestyle changes. A local barbershop will be their go-to spot for regular blood pressure checks. Participants who show up on schedule will receive coupons for free haircuts, and barbers will get an extra tip for each check that they perform.
In addition, for purposes of comparison, another group of barbers will serve as health educators. They won’t do blood pressure checks, but they will encourage patrons to see a doctor and will distribute educational pamphlets about hypertension.
The longer-term goal is for barbers to become “part of the health-care team” for certain patients, Victor says. By showing proof of concept for the community health model, he hopes to attract funding to continue the program after the research phase ends. “We want to have whopping positive results so this idea will be attractive to chain pharmacies, insurers, and HMOs,” he says. “We don’t have the business model worked out yet, but we hope to take the idea national.”
Read more stories by Suzie Boss.