Part 4 of the TED Radio Hour episode Rethinking Medicine.
About Joseph Ravenell's TED Talk
Many black men trust their barber more than their primary care doctor, if they even have one. Physician Joseph Ravenell wants to turn barbershops into a place where men can access basic health care.
About Atul Gawande
Joseph Ravenell is an internist at NYU Langone Health. He also works with New York University's Men's Health Initiative, to study and implement community-based strategies to diagnose and treat hypertension and colorectal cancer.
These potentially deadly diseases are preventable and disproportionately affect African-American men. Ravenell hopes to change this by offering blood pressure readings and cancer screenings at barbershops and health education at churches and mosques.
GUY RAZ, HOST:
Long before Joseph Ravenell became a doctor, when he was just a kid in New Jersey, his interest in medicine actually started at a place you'd least expect.
JOSEPH RAVENELL: Some of the earliest memories that I have are of my father taking me to his barbershop.
RAZ: The barbershop where lots of men in his mainly African-American community would get together.
RAVENELL: The camaraderie that I saw, just the letting down of their guard, the banter back and forth, the laughter, the array of conversation they would have you can imagine for a 5 or a 6-year-old boy was just incredibly eye-opening and frankly entertaining (laughter).
RAZ: They would talk about politics, about sports and movies. But they would also talk about something much more personal.
RAVENELL: A common topic was health and, in particular, what the men were being told by their doctors. And it wasn't uncommon for me to hear, can you believe what my doctor told me to do (laughter) and conversations like that.
RAZ: Joseph picks up the story from the TED stage.
(SOUNDBITE OF TED TALK)
RAVENELL: 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.
RAVENELL: 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.
RAZ: Joseph would watch these men tell their barbers things they wouldn't even tell their own doctors. So when he got older and decided himself to become a doctor, one of the first research projects Joseph did at med school was to visit barbershops and find out why.
RAVENELL: So many of the men that we talked to had previous experiences with doctors who often did not look like them, who were not familiar with their experiences. So often the men felt like there was something that was being lost in translation. And there was this sentiment that the doctor was just trying to get through the visit as quickly as possible rather than actually hearing the men and their deepest concerns. So certainly the issue of trust comes into play. And if there is a topic that you perceive to be embarrassing...
RAVENELL: You know, if you don't trust your provider at the outset, there's almost no chance that you're going to volunteer to talk about those symptoms.
RAZ: But they would tell their barbers this stuff.
RAVENELL: Yeah. So, you know, this idea of there being kind of a sacred and confidential relationship between barbers and their customers in some ways mirrors the doctor-patient relationship. And sometimes a recommendation from a barber to get a health screening can potentially go much farther than a recommendation from a health care provider based largely on the trust that many men place in their barbers.
(SOUNDBITE OF TED TALK)
RAVENELL: 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 them 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. 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.
RAZ: This is probably, like, something that, you know, most people in the African-American community have known forever, that a barbershop is where, you know, you're really going to find out what's going on and what people are thinking. But when did it sort of become, you know, a way to really think about public health and improve public health?
RAVENELL: So barbershops have been an important institution in the African-American community going all the way back to slavery. Barbers have been key opinion leaders. And back in the Renaissance days, barbers were known as barber surgeons.
RAVENELL: And you would go to the barber shop not only for hair services, but also for certain surgeries. And so this legacy, we believe, is one of the reasons that at barber colleges today health is actually a very important part of the curriculum. And we also think it's why when we approached barbers with this idea of bringing health care into their barbershops, you know, it really was not a terribly radical idea for them.
RAZ: OK, so to clarify, you actually tried this out in real-life barbershops.
RAVENELL: Yes. So in a very rigorous randomized trial, we actually studied 18 barbershops. Half of them were randomly assigned to an intervention where we taught barbers how to measure blood pressure and how to counsel their customers to go to the doctor if their blood pressure was high. And we compared that to a group of shops who just got what we called usual care, which in a barbershop is basically educational pamphlets. And we followed all 18 shops for a period of one year.
And what we found was in the shops where the barbers were measuring blood pressure and counseling their customers, the proportion of people with high blood pressure who were actually controlled was significantly higher compared to the men who were in shops that were just getting the educational pamphlets. And so we actually do have statistically significant data that barbershops can be an effective avenue for addressing a very serious health concern in black men.
RAZ: I mean, you could imagine, like, if we're thinking about just radically different ways of treating patients or of thinking of medical care that, you know, one day you may have an integrated barbershop and medical center, like, in the same place or, like, a doctor on call.
RAVENELL: You know, one of my dreams is exactly what you said, to essentially have a clinic that can in some ways administer to the many needs that black men have. You know, if we just focus on health care, you know, that really is a small percentage of all the things that go into people's health. The majority of what goes into people's health - right? - is what happens the 99 percent that they're not in the doctor's office, right? It's when they're at home or when they're out in their communities. And so to the extent that we can figure out how we can align health with those other places, you know, we have a much better chance of really improving people's health in a holistic way.
RAZ: That's Dr. Joseph Ravenell. He's an associate professor at NYU School of Medicine. By the way, he also goes to dozens of barbershops where he does screenings for blood pressure and cancer. You can see his full talk at ted.com.
(SOUNDBITE OF SONG, "I FEEL BETTER")
GOTYE: (Singing) Call. Now I feel better, better, better than before. I feel better, better, now I'm not down anymore.
RAZ: Hey, thanks for listening to our show Rethinking Medicine this week. If you want to find out more about who was on it, go to ted.npr.org. To see hundreds more TED Talks, check out ted.com or the TED app. And you can listen to this show any time by subscribing to our podcast. You can do it now on Apple Podcasts or however you get your podcasts.
Our production staff at NPR includes Jeff Rogers, Sanaz Meshkinpour, Jinae West, Neva Grant, Rund Abdelfatah, Casey Herman and Rachel Faulkner, with help from Daniel Shukin. Our intern is Benjamin Klempay. Our partners at TED are Chris Anderson, Colin Helms, Anna Phelan and Janet Lee.
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(SOUNDBITE OF GOTYE SONG, "I FEEL BETTER") Transcript provided by NPR, Copyright NPR.