Editor's Note: This article is part of a series in partnership with the All of Us Research Program, which collects and studies health data to help scientists identify health trends. More than 80% of participants are from groups that have been historically underrepresented in research.

 

Shortly after Andrew Suggs 32, launched his barbershop booking app Live Chair, his father's health started to decline from congestive heart failure. It led Suggs to research heart disease. That's how he learned that African American people, like his father and himself, were more likely than Americans of any other large racial or ethnic group to die of heart disease.

"My business partner and I had an epiphany," Suggs says. "We knew African American men didn't trust the health system for a number of historical reasons, but they are going to the barbershop every 2 weeks, so why couldn't we be the bridge between the barbershop and African American men's health?"

Suggs went to work and created Live Chair Health, an app that doubles as a barbershop booking app and a platform to help African American barbers provide preventive health screenings for their clients. While their clients are in the chair, barbers offer them blood pressure checks and BMI screenings for obesity. The app makes recommendations and referrals based on the client's results.

Suggs' app chips away at a larger public health problem that's been going on for decades: Racial minorities don't get preventive health screenings at the same rates that white people do.

Preventive screenings include tests for breast, cervical, colon, and prostate cancer. Annual checks of blood pressure, cholesterol, and weight are preventive screenings too.

The lower screening rates among minorities have an impact on health. African American people are more likely to die of cancer than any other group. A person of color is also more likely to have diabetes, and African American, Hispanic, and Native American people are more likely to die from it, too. High blood pressure -- a risk factor for heart disease, diabetes, and stroke -- also hits African American people harder than other groups.

"In minority communities, any visits to a physician are happening at a lower rate," says Dominic Mack, MD, director of the National Center for Primary Care at Morehouse School of Medicine in Atlanta. "If you're not visiting the health system, you're not getting your routine preventive screenings."

Seeking Solutions

The lower screening rates among people of color have many causes, so there's no single solution.

In 2010, the Affordable Care Act increased the number of Americans with health insurance and allowed everyone with a health plan to get free preventive screenings.

The impact of the law on screening rates is mixed. People who didn't have insurance before the Affordable Care Act and then gained it under the new law did seem to take advantage of screenings more. But for people who were already insured, their screening habits didn't change much. Blood pressure and cholesterol checks rose, but cancer screenings didn't.    

Poverty and lack of insurance are more common in minority communities and are barriers to health care. But insurance and free services alone don't bring down that barrier.

"Whether or not you have health insurance, it may simply be that you can't afford to take time off work or that you don't have transportation to doctor's appointments," says Melva Thompson-Robinson, DrPH, director of the Center for Health Disparities Research at the University of Nevada, Las Vegas.

Mobile medical units can help with some transportation problems. The trucks or vans, outfitted with medical equipment, travel to minority and underserved communities, where they offer primary care, preventive screenings, mammograms and, in some cases, specialty care.

More than half the people who use mobile medical units are people of color. About 40% are Hispanic. Some programs, such as the REACH Project in New Mexico and Colorado, provide transportation to screenings for minority groups. REACH provides transportation for Navajo women to get mammograms.

But it's not only a question of access. A long and complicated history of institutional racism in the American medical system has led to distrust in minority communities of the health care system. A lack of diversity in the medical profession has also caused some people of color to avoid health care.

"When an African American, Native American, or Hispanic person walks into a health care facility, they probably aren't seeing a doctor that looks like them. And that brings the comfort level down," Thompson-Robinson says.

Mobile units can help address distrust and lack of diversity by bringing care onto people's neighborhoods. Federally qualified health centers -- government-funded free or low-cost neighborhood clinics -- help gain community trust as well. While health facilities in general didn't record an increase in cancer screenings after the Affordable Care Act became law, these health centers did, particularly among minority patients. About 60% of health center patients belong to racial and ethnic minority groups. The centers emphasize what's called culturally competent care, which recognizes and adapts to the unique needs of people of various racial, ethnic, and cultural backgrounds.

Barbershops are among several community hubs where minority groups can get health screenings in a comfortable, trusted setting. Health promotion programs based in churches and other religious organizations that serve racial and ethnic minorities have also had success in increasing screening rates among the populations they serve.

"If we didn't have these programs, I think we'd be a lot worse off," Mack says. "These programs educate people and inspire them to take care of their own health. And if they save one life, they make a contribution."

It was a barbershop health screening that saved the life of Greg Pratt, a barber at Nile Style in Baltimore, MD. While training late last year to start offering blood pressure and BMI screenings to his clients, Pratt got his own blood pressure checked for the first time in as long as he could remember. At the time, Pratt, 34, weighed 215 pounds. He was surprised to learn that his blood pressure was dangerously high, at 170/120, putting him at risk of a stroke. The Live Chair app advised Pratt to see a doctor right away.

"I would have never known how unhealthy I was," Pratt says. "I don't know where I'd be if I hadn't found out."

Pratt started blood pressure medication right away, but after two doses, he was unhappy with the side effects. He asked the doctor if there was anything he could do instead of taking medicine.

The doctor's answer? Quit smoking, change your diet, lose weight, and exercise. So, that's what Pratt did. He took up new eating habits and joined a gym.

"I'm down to 175 pounds. I'm in the gym, and I love it," Pratt says. "It's therapeutic." At his next doctor visit, Pratt's blood pressure was back in the normal range.

Pratt's clients noticed the change and many asked him how he did it. Some have followed his lead and taken up healthier lifestyles themselves.

"At the barbershop," Suggs says, "men expose some of their weaknesses to their barbers because they trust them."

Health, he adds, is among the top five topics of conversation in African American barbershops, along with politics, religion, sports, and community news. And African American men, Suggs says, take health advice from their barbers.

"We've had more than a dozen guys whose blood pressure readings were higher than 180/120," Suggs says. "They hadn't been to a doctor, and we were able to tell them they needed to get to an ER." 

Barbershop health screenings are not new. But, Suggs notes, other formats may involve researchers from nearby universities who have a grant to come over and check blood pressures for a few months and then publish a paper about it. After the paper is published, the screenings end.

"Then, the health disparities are still here," Suggs says. "So someone else comes into the barbershops and starts the initiative again, and the cycle repeats. What we are doing, including the community barbers and reimbursing them for screenings, is sustainable. And we're doing this for our legacy."

One organization trying to change the way that clinical research is done is the All of Us Research Program. It's a large, diverse organization that helps researchers find answers to pressing health issues. To do that, they're asking 1 million or more people to share their health data. The program aims to reflect the diversity of the U.S. and to include participants from groups underrepresented in health research in the past.

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