Joseph Ravenell
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What do you see? Most of you see a barbershop, but I see an opportunity: an opportunity for health, an opportunity for health equity.

For black men, the barbershop is not just a place where you get your hair cut or your beard trimmed. No, it's much more than that. Historically, the barbershop has been a safe haven for black men. It's a place where we go for friendship, solidarity and solace. It's a place where we go to get away from the stress of the grind of work and sometimes home life. It's a place where we don't have to worry about how we're being perceived by the outside world. It's a place where we don't feel threatened, or threatening. It's a place of loyalty and trust. For that reason, it's one of the few places where we can fearlessly be ourselves and just ... talk. The talk, the shop talk, the conversation, that is the essence of the black barbershop.

I can remember going to the barbershop with my dad as a kid. We went to Mr. Mike's barbershop every other Saturday. And like clockwork, the same group of men would be there every time we went, either waiting on their favorite barber or just soaking up the atmosphere.

I can remember the jovial greeting that warmly welcomed us every time we went.

"Hey Rev," they would say to my dad. He's a local pastor, and they treated him like a celebrity.

"Hey young fella, how you doing?" they would say to me, making me feel just as special.

I remember the range of the conversations was immense. The men would talk about politics and sports and music and world news, national news, neighborhood news. There was some talk about women and what it was like to be a black man in America. But many times they also talked about health. The conversations about health were lengthy and deep. The men often recounted their doctor's recommendations to cut salt in their diet or to eat less fried foods or to stop smoking or to reduce stress. They talked about the different ways you could reduce stress, like simplifying one's love life —


all ways to treat high blood pressure.

There's a lot of talk about high blood pressure in the barbershop. That's because almost 40 percent of black men have it. That means that almost every single black man either has high blood pressure or knows a black man who has it.

Sometimes, those conversations in the barbershop would be about what happens when high blood pressure is not adequately addressed.

"Say, did you hear about Jimmy? He had a stroke."

"Did you hear about Eddie? He died last week. Massive heart attack. He was 50."

More black men die from high blood pressure than from anything else, even though decades of medical wisdom and science have demonstrated that death from high blood pressure can be prevented with timely diagnosis and appropriate treatment.

So why is high blood pressure so differentially deadly for black men? Because too often, high blood pressure is either untreated or under-treated in black men, in part because of our lower engagement with the primary healthcare system. Black men, in particular those with high blood pressure, are less likely to have a primary care doctor than other groups.

But why? Some of our earliest research on black men's health revealed that for many, the doctor's office is associated with fear, mistrust, disrespect, and unnecessary unpleasantness. The doctor's office is only a place that you go when you don't feel well. And when you do go, you might wait for hours only to get the run-around and to be evaluated by a stoic figure in a white coat who only has 10 minutes to give you and who doesn't value the talk. So it's no wonder that some men don't want to be bothered and skip going to the doctor altogether, especially if they feel fine.

But herein lies the problem. You can feel just fine while high blood pressure ravages your most vital organs.

This is Denny Moe, owner of Denny Moe's Superstar Barbershop in Harlem. I've been lucky enough to have Denny as my barber for the last eight years.

He said to me once, "Hey Doc, you know, lots of black men trust their barbers more than they trust their doctors."

This was stunning to me, at first, but not so much when you think about it. Black men have been with their current barbers on average as long as I've been with Denny, about eight years. And black men see their barbers about every two weeks. Not only do you trust your barber with your look and with your style, but you also trust him with your secrets and sometimes your life. Denny, like many barbers, is more than just an artist, a businessman and confidant. He's a leader and a passionate advocate for the well-being of his community. The very first time I walked into Denny Moe's shop, he wasn't just cutting hair. He was also orchestrating a voter registration drive to give a voice to his customers and his community.

With this kind of activism, and community investment that typifies the black barbershop, of course the barbershop is a perfect place to talk about high blood pressure and other health concerns in the community.

First, the barbershop is not a medical setting, and so it doesn't have all the negative psychological baggage that comes along with that. When you're in a barbershop, you're in your territory, and you're among friends who share your history, your struggle and your health risks.

Second, because the barbershop is a place of connection, loyalty and trust, it's a place where you're more open to have a conversation about health and especially about high blood pressure. After all, conversations about high blood pressure have all the elements of great shop talk: stress and high blood pressure, food and high blood pressure, relationships and high blood pressure, and yes, what it's like to be a black man in America and high blood pressure.

But you can do more than just talk about high blood pressure in the barbershop. You can concretely take action. Here we have an opportunity to partner with the Denny Moe's of the world and empower communities to address the health inequities that uniquely affect it. When high blood pressure screening expanded from clinics and hospitals to communities in the 1960s and '70s, black physicians like Dr. Eli Saunders in Baltimore and Dr. Keith Ferdinand in New Orleans were at the forefront of bringing health promotion to community hubs in urban black neighborhoods.

These pioneers paved the way for my professional journey with barbershops and health, which began in Chicago in medical school.

The very first research project that I worked on as a medical student was to help design healthcare interventions that would appeal to black men. We conducted about a dozen focus groups with a broad cross-section of black men, and we learned that for them, being healthy was as much about being perceived as healthy as it was about feeling healthy, and that feeling good went hand in hand with looking good. This work led to the development of Project Brotherhood, a community clinic founded by Dr. Eric Whitaker that provided tailored healthcare to black men. Part of this tailored care involved having a barber on the premises to reward the men who came for needed healthcare with a free haircut, to let the men know that we, too, valued how they looked as well as how they felt, and that what was important to them was also important to us.

But while there's only one Project Brotherhood, there are thousands of black barbershops where the intersection of health and haircuts can be cultivated. The next stop on my journey was Dallas, Texas, where we learned that barbers were not only willing but fully able to roll up their sleeves and participate in delivering needed health services to improve the health of their customers and their community. We teamed up with an amazing cadre of black barbers and taught them how to measure blood pressure and how to counsel their customers and refer them to doctors to help manage high blood pressure. The barbers were not only willing to do it but they were damn good at it. Over a three-year period, the barbers measured thousands of blood pressures resulting in hundreds of black men being referred to doctors for medical care of their high blood pressure. These barber-doctor partnerships resulted in a 20 percent increase in the number of men who were able to achieve target blood pressure levels and a three-point drop, on average, in the blood pressure of each participant. If we were to extrapolate that three point drop to every single black man with high blood pressure in America, we would prevent 800 heart attacks, 500 strokes and 900 deaths from high blood pressure in just one year.

And our experience with barbershops has been no different in New York City, where my journey has currently led me. With an incredible team of diverse research assistants, community health workers and volunteers, we've been able to partner with over 200 barbershops and other trusted community venues to reach over 7,000 older black men. And we've offered high blood pressure screening and counseling to each and every one of them. Thanks to Denny Moe and the myriad other barbers and community leaders who shared the vision of opportunity and empowerment to make a difference in their communities, we've been able to not only lower blood pressure in our participants, but we've also been able to impact other health indicators.

So what do you see? What is your barbershop? Where is that place for you where people who are affected by a unique problem can meet a unique solution? When you find that place, see the opportunity.

Thank you.