SAN DIEGO -- Seven barbershops in Southeast San Diego will participate in the Black Barbershop Health Outreach Program -- a health screening and education community outreach program -- as part of a California statewide initiative scheduled May 12.
In partnership with the San Diego Black Health Associates, the program will bring medical volunteers to African American-owned barbershops in Southeast San Diego, a community with the highest concentration of poverty and the largest percentage of ethnic minorities in the region. They will screen African American men for diabetes and high blood pressure, two diseases for which they are at higher risk than the general population.
The program also provides education about healthy lifestyle -- including diet and exercise habits -- and connects men with medical resources where they can follow up on their care with local clinics and doctors.
A Community Hub
Barbershops have long played an important role in African American culture. Prior to the era of Civil Rights, they were among the few businesses that black men could own, and in addition to churches, were one of the few places where they could safely gather and speak freely.
"Historically it's been the focal point where men feel safe and trust abounds," said Bill Releford, a Los Angeles podiatrist specializing in treating people with diabetes and creator of the Black Barbershop Health Outreach Program.
"We live in a racist society, and even during Civil Rights, barbershops and beauty shops and churches were where people could meet and be not [bothered] by racial issues. They are still today significant institutions [within the community]," Releford said.
Conducting screenings at barbershops is an attempt to meet men where they already are instead of trying to convince them to head to the physician office, Releford said.
"The value of this kind of program is that it brings health issues into the conversation in a place where men are comfortable, and that is the barbershop," said Lawrence Sanders, associate dean of clinical affairs at Morehouse School of Medicine in Atlanta, the first medical school established at a Historically Black College and University in the 20th century.
There's some evidence that health outreach programs based in African American-owned barbershops do the body good. In a study published in the Feb. 28, 2011, edition of the Archives of Internal Medicine, researchers found that hypertension control improved among black men patronizing barbershops when the barbers were given the tools to become health educators and promote screenings and follow-up care with physicians.
Although it has existed since 2007, the Black Barbershop Health Outreach Program will make its way to San Diego on Saturday, May 12, for the first time.
A Bright Idea
This program is Releford's brain child. Deeply disturbed by the enormous amputation rate he saw in the African American community, he set out in 2000 to effect change, first by establishing his own not-for-profit organization dedicated to the issue -- the Diabetic Amputation Prevention Foundation.
It was a Sunday afternoon years later while sitting in the barber's chair when the idea of the outreach program first hit Releford.
"I tell everyone I heard a voice say, 'What are you waiting for?'" Releford left his chair and went for a walk on Crenshaw Boulevard -- the hub of black-owned barbershops in Los Angeles -- and began to talk with men to determine their level of concern and interest about health issues most affecting African Americans.
In one barbershop, Releford said, he was surrounded by a crowd of people telling personal stories about the effect of diabetes and high blood pressure on their own lives or the life of a family member.
"You have a normal setting of men watching a basketball game or a baseball game at the barbershop and listening to music and talking trash and the subject [of diabetes and high blood pressure] comes up and everybody has something to contribute," he said.
That confirmed for Releford that the program would fill an unmet need within the African-American community.
"I put a stake in the ground, and we did our first program in December of 2007 [in Los Angeles]." Since that time, the Black Barbershop program has screened more than 35,000 men in 50 cities and almost 750 barbershops around the country.
Despite the fact that African American men are at a higher risk than the general population for diabetes and heart disease -- and the premature deaths and disability that accompany poorly managed illness -- they are the least likely to visit the doctor and receive preventive care, Releford said.
There are a host of reasons why African American men tend to avoid the doctor, according to experts. One major barrier is denial. "Culturally, men don't seek out health care because most men believe that they are not going to have any health problems," Sanders said.
A lack of health insurance also plays a role. According to the not-for-profit, San Diego-based Center on Policy Initiatives, African Americans in San Diego -- as is the case around the country -- are more likely to be uninsured than white and Asian residents.
According to Paul Simms, president of San Diego Black Health Associates, the first set of questions asked at a physician office often deal with the ability to pay.
"If you have marginal payment power, the whole system reacts differently. That process actually carries itself throughout the entire visit. By the time the physician gets to the patient, the interaction is contaminated by issues of trust," Simms said.
Trust -- or a lack thereof for the medical system -- is another significant and longstanding issue in the African-American community that dates back to the Tuskegee syphilis study, Releford said.
The study, conducted between 1932 and 1972 in Tuskegee, Ala., by the U.S. Public Health Service, observed the natural progression of untreated syphilis in low-income, rural black men. The men believed they were receiving free health care from the U.S. government and were unaware they were infected. It was known by 1942 that penicillin was an effective cure for the disease, yet the men were not treated.
"Those issues still resonate," Releford said.
In addition, said Carmella Gutierrez, president of Californians for Patient Care, many people feel more comfortable and trusting when their health care provider shares their culture. "When it comes to receiving health information, it's important that enough providers look like the community they are treating," Gutierrez said.
Although African-Americans represent 13% of the U.S. population, only 4% of physicians are black.
No One-Hit Wonder
Experts say outreach programs like the Black Barbershop program are useful when it comes to raising awareness, but just one interaction with medical professionals against a lifetime of avoidance does not make for a strong long-term plan.
"It's critical for people to establish a relationship that is long term to get appropriate preventive care and acute care, if needed," Gutierrez said. "A one-time deal will not see the outcomes we are hoping for."
Releford understands this and has designed the program for long-term impact. In addition to the May 12 screenings, the barbershops host a second phase of the program involving ongoing health education and screening, which takes place the first Saturday of each month. Health education materials are left behind with participating barbershops so men can continue to learn after the program is done.
With the help of San Diego Black Health Associates, the program has built relationships with local organizations where African Americans with diabetes, high blood pressure or other cardiovascular disease can go for follow-up care.
"We go to various cities and dig for those resources that are there and that may not be properly utilized to the fullest extent," Releford said. They leave behind a book of local resources called "The Real Black Book," which often facilitates referrals when the program is done, according to Releford.
Both Releford and Simms hope to screen as many as 200 men in San Diego barbershops on May 12 and to encourage African American men to take care of their health for many years to come.