Most people don’t know the history of barbershops and health. A brief review of the literature uncovers centuries of evidence dating back to the humble origins of dentistry and surgery. Today, these prestigious specialists are far removed from their humble origins. In past centuries, barbershops were also a place for medical care. While I’m grateful that medicine evolved, there is value in remembering the connections between the two. Barbershops and salons are places of connection, conversation, and community. Barbers and stylists have the trust of the people in their neighborhoods. Important conversations of the day are often discussed, and debated, in barbershops. So, it makes sense that we think back to the original meaning of the red and blue barber pole and make barbershops and salons a place where health conversations and interventions can take place.
This is exactly what we did more than a decade ago. For many communities, trust is more important than science and credentials. A doctor may give great health advice, but they may not be aware that someone in the community with no degree but a lot of trust is “overriding” the doctor’s advice. It begs the question:
What if Our Neighborhood Barbers & Stylists Could Be Health Partners?
We leveraged our relationships with medical systems and local public health departments to deliver clinical services in Black barbershops and salons. Together, we trained a cadre of Black barbers and stylists. To accomplish this required simulation training of healthcare professionals and the barber/stylists. Our aim was to help more barbers and stylists complete state requirements to become Certified Community Health Workers (CHW). By embedding CHWs within Black barbershops and salons, we are more likely to have sustained engagement with medical and public health systems incorporating hyper-local services into their reimbursement models. We desired community health workers to maintain roots in their neighborhoods where they have established a deep fund of good will, trust, trustworthiness, and street credibility needed to help healthcare professionals navigate local cultural nuances. Our equity-framed approach to community engagement provided the fulcrum needed to advance the recognition and garner the support that CHWs demand to help improve care coordination in the community.
Neighborhood Voices Amplified As Credible Sources of Health Information
This health equity partnership amplified the voices of neighborhood influencers as credible sources of health information, adding value to our healthcare delivery system collaborators. Far too many Black people live in neighborhoods overshadowed and embedded in the catchments of local health departments, community hospitals, and academic health science centers, yet they live sicker and die younger due to being poorly served, underserved, and never-served by the systems responsible for health promotion and disease prevention. Our partnership flipped the script: We brought health services to the people in their neighborhood rather than herding people out of their neighborhoods to health services systems.
We are amazed with how well it all continues to work! Our initial success was focused on chronic disease management. For example, in one neighborhood, health professionals and our barbershop network screened more than 700 people for high blood pressure – in one day. Many people were identified as having stroke-level blood pressure. These people had no idea they were in the midst of a health crisis, but because of this partnership, were able to get needed help, potentially saving their lives. With miniaturized diagnostic tools, healthcare professionals no longer need to be tethered to a hospital or clinic in order to bring quality healthcare to communities of color. This critical lesson became self evident when COVID-19 hung in the air like smoke.
Shots at the Shop
Black communities continue to be hit hard by COVID-19, but there was often distrust in the health system. Scientists developed the vaccine in record time, but we were not having much success getting it in the arms of people in the community. So we pivoted to use our network for vaccination. “Shots at the Shop” has more than 1,000 barbershops and salons in the network. The hyper-local vaccination numbers do not compete with mass vaccination clinics, where 90% of people will go. But those with questions and concerns need a more personal touch. This is how we get to that last 10%. It’s harder than the mass vaccination approach, but it’s absolutely worth the effort. We are reaching people on the “Hell No Wall”—individuals who would never be vaccinated otherwise. We are committed to reaching that last mile because every life matters.
When I think of the success of our work over the years, I come away with four important truths:
- Misinformation is real and it’s a game changer. It is well organized and well funded, and our communities are “marinating” in it before we even reach them.
- The message is important, but the messenger matters too. We need to use messengers who already have the trust of their community.
- We need to learn from COVID-19 and codify a community-health system partnership. We need to focus on underlying conditions that impact health. It’s a hard truth that Black and brown people live sicker and die younger. But, we have an opportunity to create a new normal in which health is a state of complete physical, mental, and social well being and not merely the absence of disease. Health equity means that all communities have access to healthcare in a way that works for them.
- We need to remember that healthcare needs to address the who, what, and where in the daily lives of the most vulnerable members of our community. Equity is not a one-size-fits all, it’s a culturally tailored, hyper-local, community-based approach that takes into consideration the social determinants of health.
To expand the efforts of the Health Advocates In-Reach & Research, we partnered with National Minority Quality Forum (NMQF) and its Center for Sustainable Health Care Quality and Equity (SHC) to establish the HAIR Wellness Warriors Network. The Wellness Warriors campaign has 10 engaging barbers and stylists around the country to collaborate with medical and local public health teams to deliver flu vaccine education and vaccine clinics at their barbershops and salons. The barbers and stylists are enrolled in the Rapid Response Training on Influenza Mitigation provided by the Maryland Center for Health Equity. Our barbers and stylists are in the best position to listen to their clients about their flu vaccine concerns. Once trained, the barbers and stylists have an opportunity to become a CHW.
For communities and health systems looking to advance this equity framework, a great place to start is SHC’s DRIVE program. The DRIVE approach prioritizes the needs and wants of the community and health system in a simple, user-friendly way and makes the community an equal partner in delivering better health to its members. This is what true health equity looks like. We have the knowledge and the tools. We now need to ensure we take what we’ve learned to create a healthier future for everyone.
More information about the DRIVE approach and tools can be found at SHCDrive.org.