Black men’s health—taking care of business

March 11, 2021

By Sandra Millon Underwood, RN, PhD, FAAN
Professor, UW-Milwaukee School of Nursing

Gaulien (Gee) Smith

New York Times editor Brent Staples reports that newspapers celebrating unsung Black heroes were for many years “religiously passed from home to home and read aloud in barbershops.” Today, barbershop owners are using their businesses as venues to raise awareness about chronic diseases affecting their customers, including hypertension, prostate cancer, and diabetes, which disproportionately affect Black men. Anecdotal evidence supports that the trend to ‘meet Black men where they are’ when it comes to dispensing health and wellness information and resources is working, and one of the best places to do that are Black barbershops.

Gaulien (Gee) Smith, owner of Gee’s Clippers and Beauty Salon on Dr. Martin Luther King Drive, understands the importance and historical significance of Black men gathering at barbershops. It’s one of the reasons why he decided to take things to the next level by opening a wellness clinic in his shop.

“I always look at barbershops in our community as the Black man’s country club. The barbershop definitely provides a safe haven for gentlemen to convene. Black barbershops provide a great venue for open and honest communication. In fact, most Black men have better relationships with their barber than they do with their doctor,” said Smith.

Gee’s Clippers is one of the larger and more trendy barbershops, located in Milwaukee’s Bronzeville district. In addition to providing an inviting atmosphere, it’s distinctive and popular because everyone from neighborhood residents to professional athletes come through the shop’s doors. Another unique aspect of Gee’s Clippers is that it also houses a wellness clinic. Through a 50/50 partnership with Gee’s MKE Wellness and Anthem Blue Cross the clinic provides services and screenings aimed at reducing health disparities, particularly among Black men. Recently, Froedtert/Medical College of Wisconsin has also come on board as a partner.

“The clinic is going extremely well. Our goal was to touch at least 30 individuals a day, but we’ve been consistently exceeding that— touching 50-60 people on Saturdays. To my knowledge, no other barbershop in Wisconsin is doing what we’re doing. We are literally performing health services in our clinic—from STD and HIV tests, prostate screenings, giving flu shots, checking blood glucose levels and everything in between. Before the pandemic we were open Thursdays through Fridays, but now we are only open on Saturdays—mostly by appointment. As more people get vaccinated, we are discussing reopening on Fridays as well,” said Smith.

Blacks are disproportionately affected by health disparities and oftentimes that disparity is even greater when it comes to our Black men’s health. There is a devastatingly low average life expectancy among Black men and a higher risk of them dying of heart disease, diabetes, cancer, and, lately, COVID-19. To put this in perspective, here are some of the disparities:

• Deaths from lung scarring—sarcoidosis—are 16 times more common among Blacks than among whites. This is the disease that killed former NFL star and Green Bay Packer Reggie White at age 43.

• Despite lower tobacco exposure, Black men are 50 percent more likely than white men to get lung cancer.

• Strokes kill 4 times more 35- to 54-year-old Black Americans than white Americans. Blacks have nearly twice the first-time stroke risk of whites.

• Blacks develop high blood pressure earlier in life — and with much higher blood pressure levels — than whites. Nearly 42 percent of Black men aged 20 and older have high blood pressure.

• Cancer treatment is equally successful for all races. Yet Black men have a 40 percent higher cancer death rate than white men.

• And Black men have the lowest life expectancy of any demographic group, living on average 4.5 fewer years than white men. (source: WebMD)

Preventive care can go a long way toward improving health outcomes. Some of the difference in life expectancy between white and Black men is attributed to chronic diseases that can be proactively treated. For example, by encouraging more preventive screenings, researchers have estimated that having more Black doctors deliver services to Black men could help reduce cardiovascular mortality by 16 deaths per 100,000 per year — resulting in a 19 percent reduction in the Black-white male gap in cardiovascular mortality and an 8 percent decline in the Black-white male life expectancy gap.

Some of the reasons Black men don’t access preventive care include a shortage of Black doctors, a lack of trust and communication of health care systems, lack of insurance, a shortage of mental health resources in Black communities, and the pervasive, systemic racism that devalues their health and wellness. Studies show that Black men are more likely to distrust the U.S. health care system than white men, and that this distrust leads to delayed preventive care and worse outcomes.

Moreover, studies show that men—especially Black men—tend to be reluctant to go to the doctor. To help better understand this, a group of Oakland researchers conducted a community-based study. They recruited more than 1,300 Black men from barbershops and flea markets in Oakland, California. The men received a coupon for free health screenings for blood pressure, BMI, cholesterol, and diabetes. They were given incentives to go to a clinic, as well as transportation, if they needed it. Fourteen male doctors were hired (eight non-Black and six Black) to provide these screenings. When participants arrived at the clinic, they were given a tablet showing a photo of their randomly assigned doctor, his name, and a list of the services they could select. Doctors could provide specific, highly recommended, cost-effective interventions — and were told to encourage patients to agree to all of them. During the consultation, patients could revise their selections and have the services done.

The researchers compared the services provided with the services the men chose before talking to the doctors, and the results were fascinating. Before meeting their doctors, participants selected the same number of preventive services, regardless of whether the doctor they saw on the tablet was Black. But after talking to their doctors, men who met with Black doctors elected to receive more preventive services than men who met with non- Black doctors.

The findings showed that:

• participants who saw a Black doctor were 20 percent more likely to agree to a diabetes screening,
• 26 percent more likely to accept a cholesterol screening than those who saw a non-Black doctor, and
• Ten percent more likely to agree to the flu shot if their doctor was Black.

Another study looked at how changing this ratio might improve health outcomes and save lives. Researchers randomly assigned Black male patients to Black or non-Black male doctors to see whether having a doctor of their race affected patients’ decisions about preventive care. They found that Black men seen by Black doctors agreed to more, and more invasive, preventive services than those seen by non-Black doctors. This effect seemed to be driven by better communication and more trust.

Barbershops like Gee’s Clippers may be on to something when it comes to closing the health disparity gaps among our Black men. Meeting them where they are, in an inviting venue, appears to be working. Moreover, other barbers are taking notice. Smith regularly receives invites to visit other cities and share information about his barbershop’s focus on wellness and health partnerships. “At Gee’s Clippers, we are trying to do our part to see to it that as many barbershops as possible have a health/ wellness component. We want to be part of the solution,” said Smith.

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The Healthy Eating and Active Living Milwaukee (HEAL) is a culturally-tailored program that aims to provide education, resources to secure healthy foods, and active living supports for adults atrisk for developing lifestyle-related diseases; and, to empower adults to make changes in their physical and social environment to improve nutrition and physical activity. ‘Like’ their Facebook page that’s full of videos of healthy recipes and low-cost, no-cost exercise.