American barbershops often serve as local staples and places of cultural significance. For black men in particular, the barbershop is not simply a place for a haircut, but a safe haven of communal trust; a place where everyone can be themselves. Black men have known their barbers for an average of eight years and see them every two weeks, helping to solidify barbers’ roles as trusted confidants and leaders. Many serve as public advocates on behalf of their communities and encourage conversations and action about health, wellness, and social progress within the walls of their shops.
Perhaps it’s not surprising, then, that barbershops’ role as cultural centers could be harnessed productively as we continue to decentralize health care delivery. Black men have the lowest rate of primary care visits and the highest rate of high blood pressure–related death among any demographic group in the United States. But in a study published in the New England Journal of Medicine this month, black men with uncontrolled high blood pressure who were prescribed anti–high blood pressure medications by pharmacists in barbershops achieved larger reductions in blood pressure compared to those who received health promotion and education from their barbers alone. All men enrolled in the study had systolic blood-pressure measurements of 140 mmHg or higher, descriptive of high blood pressure. The study found that about 64 percent of the men who met with pharmacists each month at their barbershop achieved a blood pressure under 130/80 mmHg after six months, compared to about 12 percent of the men in the control group.
The stories of study participants are exemplary of the power of community in health and an important reminder that health care is fundamentally about relationships. The doctor’s office offers a sharp foil to the barbershop. Associated with illness, caution, and insecurity, the doctor is often just the person you visit when you feel unwell. Yet when you are at your most vulnerable and have waited anxiously for hours to be seen, the physician, dressed in a crisp white coat that subliminally conjures a wall of social status, will only give you, on average, seven minutes of their time.
Barbershops already have something of a history with health care delivery. During the Middle Ages, barbers wielded razors to both hair and limbs. Barber-surgeons, armed with knives, scalpels, razors, and other tools of the trade, were well equipped to operate. They performed limb amputations, bloodletting, dental extractions, and beard trims. By the mid-1700s, however, the professions of surgeons and barbers diverged as European royalty established countrywide institutions for the training and practice of surgery.
But perhaps they could be merged once again. In the study, pharmacists made medication management for high blood pressure convenient by bringing anti–high blood pressure drugs to local barbershops, a place that most of the men had been visiting every two weeks for more than a decade. The therapeutic intervention itself, often an area of skepticism, was tailored to the community and endorsed by the men’s barbers—their trusted confidants and loyal community leaders. As one participant wrote:
My doctor advised diet and exercise for my high blood pressure. I biked 5 days a week & lost 15 pounds. But my pressure crept up. Diet and exercise aren’t enough for me. Eric introduced me to the pharmacist working with him. He’s my barber 15 years so I trust him. Kathy prescribed medicine and my doctor is on board. I’m glad because I want to enjoy life at 70.
The men were happy to engage with the pharmacists at their barber’s recommendation. Accessibility and peer support were foundational in the effectiveness of this intervention and will likely serve as the backbone for the future of health care delivery to underserved populations.
Health care is now meeting people where they are to improve their health. This has been an ongoing trend: Basic health care services were first unbundled from expensive, centralized health systems to convenient retail clinics at local pharmacies and have now traveled even further upstream to places with more frequent touch points with patients. It’s worth considering which cultural centers—places of solidarity and solace—parallel barbershops in other demographic groups. Immigrant churches, outdoor markets, community playgrounds, town squares, and local YMCAs all serve as novel, decentralized places where groups congregate and share meaningful interactions. As our understanding of health progresses, more health care will happen outside of hospitals, and community centers of trust and social support will be the best place to both have necessary conversations about health and deploy the health care interventions that we already know work.