Amidst the squeak of sneakers against the parquet floor and the low whine of hair clippers at Harlem Masters Barbershop, a group of medical researchers compared notes. "And the surgery," one researcher said. "You barely see any blood. It’s just so clean."
Heat waves radiated off the blacktop on Lenox Avenue, but it was cool inside the shop as Polo Greene, who has owned and operated Harlem Masters for 14 years, threaded his way among customers, cracking jokes and giving out handshakes. NBA summer league played on a TV overhead as the researchers assembled their tools: a blood-pressure cuff, health pamphlets and an iPad loaded with information about organ donation.
Greene relocated his shop earlier this year, to a bigger, brighter space, which still bares a few hints of its past life as a women's clothing boutique. Chandeliers hang from the ceiling, and beneath a framed collage of Los Angeles Lakers players, the wall is painted a dusty pink.
On this particular Friday, Greene was joined by a New York University doctor, Joseph Ravenell, who arrived with a small NYU team in tow and set up an ad-hoc blood-pressure screening station in the back of Greene's shop. As a kid, Dr. Ravenell tagged along behind his father -- a minister -- on his biweekly barbershop visits.
"They would talk about everything under the sun," Dr. Ravenell said. "Including health. The barbershop just seemed like a natural place to reach black men and to promote health."
For Greene, whose roster of clients includes men who have been loyal to him for more than 25 years, customers are family. "Not only do I cut the father's hair, I cut the son's hair," he said. "If the son has any children, I cut the son's son's hair. I'm going on three generations of families."
Now Dr. Ravenell, an assistant professor of population health and medicine at NYU Langone Medical Center, is leveraging the trust black men have in their local barber in an effort to improve public health. His Men's Health Initiative program, funded by the National Institutes of Health, was rolled out in 69 barbershops across New York City between 2009 and 2014.
While men wait to get their hair cut -- "Often there is a wait for the barber, particularly for the really good barbers," Dr. Ravenell said, the NYU team moves in, offering free blood-pressure screenings, coupled with medical advice.
"For a whole host of reasons, black men tend to underutilize private health-care services," Dr. Ravenell said, citing a lack of access to health care and insurance, as well as a culture of mistrust between black patients and health-care providers, as contributing problems.
"Once they sit down in the chair to get their blood pressure measured, it's a perfect entree to talk about not only cardiovascular disease, but also colon cancer and now organ donation," Dr. Ravenell added.
During the five years the grant lasted, Dr. Ravenell and his team screened 10,000 barbershop customers and offered those with high blood pressure the opportunity to enroll in a six-month study. As part of the study, a patient navigator provided nutrition, exercise and smoking cessation advice, over the phone and in person, to lower participants' blood pressure over the course of the next six months.
Among the study's 731 participants, blood pressure dropped by 5 points on average, over the six-month period. "If the entire population were to achieve that kind of blood-pressure drop, we would reduce stroke risk by about 30 percent," Dr. Ravenell said. "We're talking about a potentially major public health impact."
The health-disparity gap between blacks and whites is stark. One of the key risk factors for heart disease is high blood pressure, a fully manageable condition that can be addressed in a primary-care doctor's office, and one that disproportionally impacts African Americans, according to the Centers for Disease Control and Prevention. Forty-three percent of African-American men and nearly 46 percent of African-American women have high blood pressure, compared with 33 percent of white men and 31 percent of white women with the condition.
But even if every barbershop had its own Dr. Ravenell, societal inequities are notoriously difficult to upend. Critics of academic research cite what's known as the "seagull phenomenon," when an academic team swoops into a community, collects the information or research it needs, and then flies away.
"It just happens again and again and again," said Neelam Sharma, the executive director of the nonprofit Community Services Unlimited, which aims to reduce food disparities in South Central Los Angeles communities. "People get published and make their name, and yet it’s the same old situation in the community that they researched."
Sharma said she's frustrated by a lack of intentional thought and imagination that goes into academic research. Despite multiple studies on the lack of accessible, fresh food in South Central Los Angeles, for example, Sharma said there's been a net decrease in supermarkets since the 1992 L.A. Riots.
"It does make me angry," she said. "Is it not clear that there is a health problem in our communities? Is it not clear that that health problem is diet-related? Is it not clear that we need more outlets for fresh, affordable food? How much more research do we need to do?"
And indeed, like all grants, after five years of work in Harlem, Dr. Ravenell's $1.9 million from the NIH ran out in June 2014. He didn't seek a grant renewal, either. Instead, Dr. Ravenell and his team shifted gears, applying what they learned during their hypertension and colon-cancer studies to new projects, including an organ-donation survey that started in 2013 and a yet-to-be-written grant aimed at reducing the high smoking rate among barbershop patrons.
"It's something we're always thinking about," Dr. Ravenell said, referring to how his work stops when the money stops. But he noted that the team trained more than 200 lay-health educators to continue the blood-pressure screenings -- an initiative that's been more effective in Ravenell's church programs than in barbershop ones. There's also an advisory board of barbers, pastors and communities leaders tasked with sustaining the project's momentum. "Unfortunately, it's very tough to do things without funds," he said.
In Greene's opinion, things have changed. Conversations about health are a regular part of the barbershop banter since Dr. Ravenell showed up five years ago. His customers are more willing to open up about their health problems, too. For Ravenell's next health initiative, Greene's all in. "I'm following his move," Greene said.
"Whatever his next step is, whatever direction he wants me to go in, I will go in that direction and do my part."
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