Black barbershops offer
health care in US cities
By Tony Favro, USA Editor

2 January 2012: In cities across the United States, African-American barbers are receiving accolades, not for cutting hair, but for improving health outcomes for African-American men. Their barbershops are functioning as informal health clinics and challenging American notions about how health care is delivered.

Successful barbershops in the United States cater to masculine tastes and needs. They are places where men feel comfortable, enjoy camaraderie and entertaining conversation, and receive great grooming services. In urban African-American communities, a growing number of barbers are being trained to check their customers’ blood pressure and provide accurate information about diabetes, prostate cancer, colon cancer, and other medical ailments that disproportionately affect African-American males. Research by the American Medical Association and others shows that the barbershop-based health interventions are effective in raising awareness and, more important, getting men to pursue check-ups and treatment with primary medical providers.  

The issue
African-American males have the highest disability and death rates from high blood pressure, cardiovascular disease, diabetes, and prostate cancer of any racial or ethnic group in the United States. Part of the reason is economic. African-Americans are disproportionately employed in occupations which don’t provide health insurance. They are generally poorer than whites, and cost is a barrier to obtaining health care, especially preventative care. Cultural differences are also at work. Traditional medical outreach practices frequently are not culturally appropriate for African-American males, contributing to their distrust of the medical establishment.

Why barber shops?
Black-owned barbershops have a special status in the African-American community. Historically, barbering was one of the few professions open to African-Americans who desired self-employment. In the pre-civil rights era, barbershops became forums for debate, discussion, and relaxation among peers - essentially men’s clubs - when such institutions were closed to blacks.

Laws and attitudes may have changed, but barbershops remain cultural beacons in the African-American community. It’s almost obligatory for candidates running for mayor in American cities to campaign in barbershops if they are serious about earning minority support. President Obama’s grassroots initiative to mobilize African-American voters for the 2012 election is called “Barbershop and Beauty Salon”. National Public Radio has a regular feature called the Barbershop, in which minority commentators discuss current affairs.

For decades, health care workers have visited inner city neighborhoods with mobile health clinics to reach low-income African-Americans. Men, however, tend to patronize the service in lesser numbers than women; it often is not acceptable for men in inner city neighborhoods to display vulnerability. Black churches have been sites of medical screenings and outreach for many years, but fewer black men are regular churchgoers than women. Health care workers also have tried to provide medical services during sporting events, with limited success. The atmosphere is sometimes too hurried or charged for frank conversation and opportunities to meet with people before and after the events are constrained.

Black-owned barbershops have a large and loyal clientele that visits once a month on average. Barbershop conversations among influential friends and acquaintances may range from politics to food to family to sex to just about anything else. Barbers with health care training use their frequent contact and easy rapport with customers to ask them medically-significant questions about their diets, habits, vices, and other behavior, and to offer accurate counseling. Barbers may monitor blood pressure, screen for diabetes, dispense condoms, and give advice on asthma, HIV, prostate cancer, proper nutrition, and other issues important to the health of African-American men. They also urge their clients to follow-up with physicians when necessary. Barbershops that function as informal health clinics typically display sex-specific and culturally-appropriate posters and make similar pamphlets available to their clients. 

Outlook
The health care training and outreach materials for barbers are funded primarily by university medical schools, civic organizations, businesses, and city governments. The National Institutes of Health is in the midst of a two year study that could lead to more federal funding and an expansion of barbershop-based health services.

The American Medical Association estimates that extending health care interventions to all of the approximately 18,000 black-owned barbershops in the United States could result in 800 fewer heart attacks, 550 fewer strokes, and 900 fewer deaths among African-American men in the first year alone.  

The need to reduce racial and ethnic disparities in health has been a priority concern of health care professionals and researchers for at least two decades, although positive outcomes for at-risk groups have often been elusive. The success of barbershop-based clinics suggests that the setting in which services are delivered may be just as important as the interventions themselves. People are more likely to embrace their health in places where they gather voluntarily and feel comfortable and with information they can understand and digest.

The successful delivery of health care to all groups is particularly important for cities, the homes of many who receive less than adequate health care for economic, cultural, or language reasons.  

Selected Resource: Ronald Victor, et. al., Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men, American Medical Association, 2010.

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