Real outreach

May 24 2011 Published by under Medicine

It's no secret that doctors don't often look like their patients.  This simplistic observation hides a more complex set of effects: in addition to the economic problems faced by minorities seeking medical care, there is a quieter, dirtier history, one of forced sterilization, institutionalization, research abuse (and, one might argue, murder).  It should then be no surprise that when it comes to getting proper health care, minorities are often at a economic and cultural disadvantage, and have valid reasons not to trust the health care system.

For many minorities, the emergency department is the landing zone when preventable illness finally becomes impossible to ignore.  Internists like me see case after case of advanced heart disease, kidney failure, and stroke that could have been prevented with good primary care.

As a recent study has shown, when suffering signs of a catastrophic illness such as stroke, African Americans may reach out to friends before calling 911.  This is one of the many good reasons for looking into ways to bring prevention directly into trusted minority community institutions rather than waiting for minorities to seek out care that may be unavailable or alienating.

Hypertension is a potent risk for heart attack, stroke, and kidney failure, common ailments among African Americans. Investigators went to Dallas County, TX to see what effect if any outreach at black-owned barbershops might have on patrons' blood pressure.  Shops received one of two interventions: either standard pressure pamphlets, or an intervention group where patrons were screened with their haircuts and offered peer-based intervention, and encouraged to get medical follow up.

The results were both frightening and encouraging.  Forty-five percent of men screened had hypertension, and of those, only 38% had their disease under good control.  Both groups in the study had improved blood pressure control, with the more intensive intervention group experiencing a slightly greater increase in blood pressure control.

This study shows the great potential of community-based interventions for important health conditions, especially in communities with less access to standard health care.  It is important that programs like this continue to be studied for validity and strength of effect, and if widely implemented, that they remain science-based, and do not become a profit opportunity for more charlatans to prey on the poor and on minorities.



Hsia, A., Castle, A., Wing, J., Edwards, D., Brown, N., Higgins, T., Wallace, J., Koslosky, S., Gibbons, M., Sanchez, B., Fokar, A., Shara, N., Morgenstern, L., & Kidwell, C. (2011). Understanding Reasons for Delay in Seeking Acute Stroke Care in an Underserved Urban Population Stroke DOI: 10.1161/STROKEAHA.110.604736

Victor, R., Ravenell, J., Freeman, A., Leonard, D., Bhat, D., Shafiq, M., Knowles, P., Storm, J., Adhikari, E., Bibbins-Domingo, K., Coxson, P., Pletcher, M., Hannan, P., & Haley, R. (2010). Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men: The BARBER-1 Study: A Cluster Randomized Trial Archives of Internal Medicine, 171 (4), 342-350 DOI: 10.1001/archinternmed.2010.390

3 responses so far

  • Shay says:

    We've had some success by partnering with local African-American churches to sponsor health fairs spotlighting things like hypertension and breast cancer. Our biggest spike in African-American families coming to be vaccinated during the H1N1 response came after one of the pastors invited us to hold a clinic at his church. And then he and his wife were there for the entire clinic and a dozen members of the congregation volunteered to help out.

  • D. C. Sessions says:

    This study shows the great potential of community-based interventions for important health conditions, especially in communities with less access to standard health care.

    The relative contribution of access is not totally clear. I'm a little too close to the behavioral health problems on one Apache reservation, but it sure seems to me that the peer-based programs started and (literall) run by Apache activists are producing more in the way of results than the IHS programs do.

    Bottom line: neighbors are good. Be one.

  • genewitch says:

    as a person who reads the PDR and DSM for fun, lots of people ask me medical and psychological advice on a regular basis. My favorite thing to be able to say is "i really have no idea, you should see a doctor!" And it's true, they should. Luckily for me, i was able to find a PCP that only costs $40 for a visit, and he seems to care about my health. except for the "eat more fish and less omega-3 peanut butter" schtick 🙁