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Barber shops provide a short cut to BP reduction

As well as a haircut, barbers can shave millimetres off men's blood pressure
The basics of preventive medicine are cut and dried: don't smoke, eat less, drink less, exercise more, and reduce your risk factors for life-limiting illnesses like cardiovascular disease, diabetes and cancer. If followed, this will deliver Jeremy Hunt's goal of keeping patients out of hospital and generally as far away from doctors as possible. Many people are happy to oblige, as shown by the rise in 'virtual GP' services like GP at Hand and Push Doctor, which allow busy people to pay for an online diagnosis and prescription without the inconvenience of seeing a GP.

The trouble is, many preventive health programmes fail to reach the patients who need them most. This creates a gap between well-informed, motivated patients who effectively self-manage their health, and less motivated people, often with lower educational attainment and socioeconomic status, who are destined for higher morbidity and lower life expectancy. Men are particularly reluctant to visit their doctor until they are at death's door, and their stance on disease prevention is often denial.

This is exemplified by black men in the United States, who have higher levels of hypertension than white men, but less contact with doctors. They therefore have lower rates of treatment, and more than 3 times the risk of dying due to hypertension. To tackle the problem, researchers have tried a novel way of reaching patients in a setting where they are receptive to intervention.

Barber shops are social hubs where men can bond, shoot the breeze and put the world to rights. They are also bastions of male culture, where boys can banter without female disapproval. In short, the barber shop is a man cave where they can find refuge and feel... unpressured. It isn't just men who feel this way. A recent survey found that 56% of women have used a men's barber shop in the past 2 years because they have a more relaxed and casual vibe, as well as being less expensive than a salon.(1)

Barber shops were therefore selected as 'community clinics' in a US initiative to measure and manage blood pressure in black men.(2) Customers who had raised BP when they came in for a haircut were given health and lifestyle advice by barbers. In the active intervention group, this was accompanied by antihypertensive medication delivered by clinical pharmacists, with permission from the men's doctors. This idea was the culmination of the Black Barbershop Health Outreach Program,(3) established in 2007 to address disparities in heart disease, diabetes and prostate cancer among African American men.

The study, published in the New England Journal of Medicine,(2) found that men receiving health advice trimmed 9.5 mmHg off their mean systolic BP, while men in the active treatment group cut their BP by 27 mmHg, with nearly two-thirds achieving a target of less than 130/80.

Using barber shops as hubs for healthcare delivery is nothing new. Centuries ago, as well as offering a shave and a haircut, barbers carried out high-tech medical procedures like bloodletting, application of leeches and removal of teeth. They also used their razors to perform minor surgery and even amputations. In 1540, the Fellowship of Surgeons (who, unlike Physicians, were not academically trained) merged with the Barbers' livery company in London to become the Company of Barber-Surgeons. The red and white poles we see outside traditional barber shops represent the blood and bandages that were the marks of their profession. Although British surgeons split from the Barbers in 1745, and require a doctorate to practice today, they still use the title "Mr" rather than "Dr" to distinguish themselves from mere physicians.

The barber shop is a logical starting point for medical outreach. If people won't visit the health service, the health service has to come to them. Cholesterol testing in pubs? BMI measurement in cafes? Blood glucose testing in supermarkets? Allergy testing in flower shops? Why not? All it requires is localised expertise, and a government that is keen to devolve the complexity and cost of healthcare, which the NHS is crying out for.

So we need more imaginative, patient-centred ways to engage the public and decentralise delivery of healthcare. Lots of effort has gone into encouraging men to take an interest in their prostates, but there is a long way to go, as evidenced by the fact that prostate cancer has leapfrogged breast cancer as the UK's third most deadly malignancy. A few years ago, a London garage owner who owed his life to a timely PSA test, started offering free car MOT tests to men who agreed to get their prostate examined (swapping one MOT for another, you might say).(4)

The critical difference with the barber shop trial is that it included medical intervention as well as diagnosis and advice. It didn't just nudge people into healthy habits, it moved the point of healthcare delivery to the community. The study showed that it is possible to make checking and treating blood pressure as normal as having a haircut. The barber shop model enabled patients to cut their hair, their blood pressure and the cost of healthcare, in one stroke.

© Life Healthcare Communications 2018

2. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018; 378:1291-1301.
3. The Black Barbershop Health Outreach Program.

1st May 2018



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