Barbershops become urban community health centers
Thu Sep 18, 2008 3:10pm EDT
By Terri Coles
TORONTO (Reuters) - African-American communities in the shadows of the University of Pittsburgh's buildings are getting sick and dying sooner than their white counterparts, of preventable diseases -- and Dr. Stephen Thomas wants to change it.
An outreach initiative involving local barbershops and beauty salons is a step in that direction.
Epidemiological data shows that African-Americans suffer a higher burden of premature illness and death than Caucasians, said Thomas, director of the university's Center for Minority Health. They have higher rates of infant mortality, HIV/AIDS and mental illness. HIV is the leading cause of death among African-Americans 25 to 44, for example, and rates of death from cardiovascular disease are 30 percent higher in black adults than white adults, according to the American Medical Student Association. Diabetes is 70 percent more prevalent in blacks than whites, and prostate cancer hits African-American men 66 percent more frequently than Caucasian men, with twice the death rate.
Pittsburgh is not unique in this, Thomas pointed out - there are black communities around universities across the United States where residents have higher rates of diabetes, obesity and heart disease. "Simply because they are geographically close does not mean they benefit from the technology that's there," he said of the schools.
But although the disparity has been measured, we don't fully know why it exists, or how to remove it, Thomas said. Culturally appropriate strategies to address and attack the health disparities between blacks and whites are needed, he said.
To that end, the Center for Minority Health has created Take a Health Professional to the People Day, which falls on September 18 this year, its seventh. The program works to bridge the academic community and African-American neighborhoods in Pittsburgh by developing a health partnership that involves neighborhood barbershops and beauty salons and their staff and owners as lay health advocates, Thomas said.
The program works with ten barbershops and salons in the city, and 200 Pittsburgh health professionals have signed up to visit the shops on Take a Health Professional to the People Day to provide health screening to people in the surrounding neighborhoods. The screening goes from basic exams to cancer screening directly in the barbershops with blood tests and rectal digital exams, Thomas explained. Last year the participating health professionals were able to screen 700 people in one day; with more signed up this year, he expects they'll be able to see a higher number of patients this year.
Private insurers will also be on-site at the barbershops in order to take people through signing up for private insurance. Many people qualify for insurance, Thomas said, but have never had someone help them through the complicated process of applying.
The work goes beyond the one-day screening, however. Barbers are trained in CPR and the use of automatic defibrillators, for example, and serve as conduits for getting health information out to community members.
The outreach effort is focusing on barbershops because they serve as meeting places in African-American communities, where the conversation frequently strays from hair and the owners are seen as leaders in the community.
"No conversation goes without commentary," Thomas said, recalling one incident in a barbershop that underscored why they can be such a powerful tool. A man who had recently had a heart attack was getting his hair cut, and he, the barber and the shop patrons were discussing the new medication he had been prescribed. The barber pointed out that the pills might prevent him from keeping up his "obligations," referring to the possibility of erectile dysfunction as a side effect of the medication.
He could tell by the look on the man's face during the conversation that with that knowledge, he wasn't going to take the pills, Thomas said. "That's when we realized that a barber can have more credibility than a doctor."
A lack of trust of health professionals among African-Americans is part of what is keeping them at a disadvantage, Thomas said. Much of that mistrust stems from the infamous Tuskegee experiment in which poor black men with syphilis were left untreated for decades.
That notorious episode eventually led to increased protection for clinical trial participants, but the effects of it are still seen in black communities today, Thomas said. President Clinton formally apologized for the clinical trial in 1997, and that began a change, he said, but more still needs to be done to reach these communities through their mistrust. "We believe that it's time for atonement."
The program has partnered with the Mayo Clinic in Rochester, Minn., which offers a credit course studying health disparity that uses Take a Health Professional to the People Day as an urban immersion experience for its graduate students.
The field work involved in the trip to Pittsburgh for Take a Health Professional to the People Day helps health professionals understand the realities of health disparities and gain cultural confidence, said Dr. W. Charles Huskins, associate director for the Mayo Clinic Center for Translational Science Activities in Rochester, Minnesota. It also allows them to see first-hand some strategies for engaging the community in prevention initiatives.
The feedback has been incredible so far, Huskins said while in Pittsburgh. "They're seeing things that they would not necessarily have seen in Rochester," he said.
Increasing the diversity among health professional is an important step towards engaging communities in public health and their own care, said Dr. Eddie Greene, director of Health Disparities curriculum development and director of the Office of Diversity at Mayo Clinic Rochester. But it is also important to make sure that health professionals who are already working have that same sensitivity, he said, and initiatives like Take a Health Professional to the People Day and the Mayo Clinic's course help to achieve that cultural competence.
Thomas, Huskins and Greene hope the program in Pittsburgh can serve as a model for expansion to other parts of the country and other groups, such as Native Americans, Hispanics and rural Americans, who also experience health care disparities. With their programs and Take a Health Professional to the People, the University of Pittsburgh and the Mayo Clinic want to be a role model of cooperation for other institutions surrounded by minority communities dying from things they are experts in, Thomas said. "That is no longer acceptable morally, and it is no longer acceptable scientifically."
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