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And Take a Little Off the Systolic

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The best healthcare advice in the world won’t make a difference if it doesn’t reach its intended audience.  That’s why KUNC commentator Doctor Marc Ringel is a fan of programs that bring healthcare right into the heart of a community.


As my parents tell it, when I got my first haircut I sat on my dad’s lap in the barber chair and cried bloody murder.  But I soon came to love our neighborhood barbershop on Chicago’s North side. There were “Superman” comic books that I’d turn the pages of real slowly so people would think I could read. On the wall was a signed photo of Jay Silverheels, the actor who played Tonto on “The Lone Ranger” TV series. He’d gotten his ears lowered in that very same chair as I did.

As my kids would say, the shop was very chill.  There are movies, like “Barbershop,” that depict what chill places haircutting emporiums are in the African American community.  These small businesses often function as neighborhood social centers.  Sooner or later most everybody gets his hair cut.

Which is why public health types have used barbershops to reach black men, a group with a very high incidence of hypertension, much of it undiagnosed, untreated or not well regulated.  Since high blood pressure is an important risk factor for heart attack, stroke and kidney disease, getting a better handle on hypertension could save a lot of lives.

An article published in October in the Archives of Internal Medicine reported on a study called the Barber Assisted Reduction in Blood Pressure in Ethnic Residents (acronym, BARBER-1).  At the outset of the project the researchers offered free blood pressure screening to patrons of 17 black-owned barbershops in one Texas county.  1297 men, almost half of those who were screened, had hypertension.  But only 38% had their disease under control.

After the initial screening barbers at nine shops were trained to take blood pressures themselves.  The haircutters learned to interpret the numbers and to encourage their hypertensive clients to seek medical care.

Each of these shops was festooned with large posters featuring the stories of patrons who had taken care of their hypertension.  If a customer with elevated pressure had no regular source of care, there was a nurse available to make referrals to safety net clinics.

At the other eight shops men with high blood pressure got a pamphlet from the American Heart Association entitled “High Blood Pressure in African Americans.”  And that was all.  This was the control group that served as a comparison with the intervention group of customers who patronized shops with trained barbers and custom posters.

The results were astounding. After 10 months blood pressure control was improved in the intervention group by 9% when compared to controls.  The authors estimate that, if you extrapolate these numbers to the 18,000 black-owned barbershops in the United States, patronized by approximately 2.2 million African-American males with hypertension, heart attacks would be reduced by 800, strokes by 550, and deaths by 900 in the first year alone.

Participating barbers were paid $3 for every blood pressure they took, $10 for each referral to a nurse, and $50 for every completed referral to a physician.  Customers got a free haircut each time they saw a doctor about their blood pressure.

I don’t have the overall calculation of the bang of this program for the buck.  But I’m sure it was huge, especially when you compare it to the overall cost in terms of dollars and human suffering of heart attacks, strokes and kidney failure.  This is a great example of the power and efficiency of doing health care in the heart of the community.

Still, I have to say that as a kid I would have preferred not to have health care taken into my own beloved barbershop.  At that stage of my life “Superman” comics and autographed pictures of Tonto were way cooler than I could have imagined pamphlets from the American Heart Association and posters of old guys with high blood pressure would ever be.

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