Sunday, September 21, 2008

Barbershops become urban community health centers

Barbershops become urban community health centers
Thu Sep 18, 2008 3:10pm EDT
By Terri Coles
TORONTO (Reuters) - African-American communities in the shadows of the University of Pittsburgh's buildings are getting sick and dying sooner than their white counterparts, of preventable diseases -- and Dr. Stephen Thomas wants to change it.
An outreach initiative involving local barbershops and beauty salons is a step in that direction.
Epidemiological data shows that African-Americans suffer a higher burden of premature illness and death than Caucasians, said Thomas, director of the university's Center for Minority Health. They have higher rates of infant mortality, HIV/AIDS and mental illness. HIV is the leading cause of death among African-Americans 25 to 44, for example, and rates of death from cardiovascular disease are 30 percent higher in black adults than white adults, according to the American Medical Student Association. Diabetes is 70 percent more prevalent in blacks than whites, and prostate cancer hits African-American men 66 percent more frequently than Caucasian men, with twice the death rate.
Pittsburgh is not unique in this, Thomas pointed out - there are black communities around universities across the United States where residents have higher rates of diabetes, obesity and heart disease. "Simply because they are geographically close does not mean they benefit from the technology that's there," he said of the schools.
But although the disparity has been measured, we don't fully know why it exists, or how to remove it, Thomas said. Culturally appropriate strategies to address and attack the health disparities between blacks and whites are needed, he said.
To that end, the Center for Minority Health has created Take a Health Professional to the People Day, which falls on September 18 this year, its seventh. The program works to bridge the academic community and African-American neighborhoods in Pittsburgh by developing a health partnership that involves neighborhood barbershops and beauty salons and their staff and owners as lay health advocates, Thomas said.
The program works with ten barbershops and salons in the city, and 200 Pittsburgh health professionals have signed up to visit the shops on Take a Health Professional to the People Day to provide health screening to people in the surrounding neighborhoods. The screening goes from basic exams to cancer screening directly in the barbershops with blood tests and rectal digital exams, Thomas explained. Last year the participating health professionals were able to screen 700 people in one day; with more signed up this year, he expects they'll be able to see a higher number of patients this year.
Private insurers will also be on-site at the barbershops in order to take people through signing up for private insurance. Many people qualify for insurance, Thomas said, but have never had someone help them through the complicated process of applying.
The work goes beyond the one-day screening, however. Barbers are trained in CPR and the use of automatic defibrillators, for example, and serve as conduits for getting health information out to community members.
The outreach effort is focusing on barbershops because they serve as meeting places in African-American communities, where the conversation frequently strays from hair and the owners are seen as leaders in the community.
"No conversation goes without commentary," Thomas said, recalling one incident in a barbershop that underscored why they can be such a powerful tool. A man who had recently had a heart attack was getting his hair cut, and he, the barber and the shop patrons were discussing the new medication he had been prescribed. The barber pointed out that the pills might prevent him from keeping up his "obligations," referring to the possibility of erectile dysfunction as a side effect of the medication.
He could tell by the look on the man's face during the conversation that with that knowledge, he wasn't going to take the pills, Thomas said. "That's when we realized that a barber can have more credibility than a doctor."
A lack of trust of health professionals among African-Americans is part of what is keeping them at a disadvantage, Thomas said. Much of that mistrust stems from the infamous Tuskegee experiment in which poor black men with syphilis were left untreated for decades.
That notorious episode eventually led to increased protection for clinical trial participants, but the effects of it are still seen in black communities today, Thomas said. President Clinton formally apologized for the clinical trial in 1997, and that began a change, he said, but more still needs to be done to reach these communities through their mistrust. "We believe that it's time for atonement."
The program has partnered with the Mayo Clinic in Rochester, Minn., which offers a credit course studying health disparity that uses Take a Health Professional to the People Day as an urban immersion experience for its graduate students.
The field work involved in the trip to Pittsburgh for Take a Health Professional to the People Day helps health professionals understand the realities of health disparities and gain cultural confidence, said Dr. W. Charles Huskins, associate director for the Mayo Clinic Center for Translational Science Activities in Rochester, Minnesota. It also allows them to see first-hand some strategies for engaging the community in prevention initiatives.
The feedback has been incredible so far, Huskins said while in Pittsburgh. "They're seeing things that they would not necessarily have seen in Rochester," he said.
Increasing the diversity among health professional is an important step towards engaging communities in public health and their own care, said Dr. Eddie Greene, director of Health Disparities curriculum development and director of the Office of Diversity at Mayo Clinic Rochester. But it is also important to make sure that health professionals who are already working have that same sensitivity, he said, and initiatives like Take a Health Professional to the People Day and the Mayo Clinic's course help to achieve that cultural competence.
Thomas, Huskins and Greene hope the program in Pittsburgh can serve as a model for expansion to other parts of the country and other groups, such as Native Americans, Hispanics and rural Americans, who also experience health care disparities. With their programs and Take a Health Professional to the People, the University of Pittsburgh and the Mayo Clinic want to be a role model of cooperation for other institutions surrounded by minority communities dying from things they are experts in, Thomas said. "That is no longer acceptable morally, and it is no longer acceptable scientifically."
How do you think health disparities can be reduced? Let us know:
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Sunday, January 20, 2008

Question 5: Sustaining the Healthy Black Family Project

Q5: HBFP Franchising ? ?

The word franchise is defined as “…the right or license granted to an individual or group to market a company's goods or services in a particular territory”

Sustaining the Healthy Black Family Project is critical. I am working on several options including, but not limited to, creation of a “franchise.” Franchise is one of several options I am exploring to find the best way to sustain the Healthy Black Family Project. The cost of operating the HBFP is over one million dollars per year. As you know the program is “NO CHARGE” to the over 6,000 participants. We benefit from grants by local and national foundations and the NIH as well as donations. We are now in the middle of a one million dollar fund raising campaign (click below).

My aim is that before we reach the 2010 deadline we will have a viable sustainability plan to keep HBFP going on into the future and spreading across the nation. Franchise is only one idea. Other ideas include service contracts with Highmark, UPMC Health Plan, Gateway Health Plan and other insurance companies that would actually fund CMH to deliver HBFP to their members. Another idea is to produce health education content in the form of DVDs and TV shows that would generate income to support the HBFP.

There are many more ideas that we must consider and I am open to any and all ideas for how to sustain the program.

Question 4: Barbers & Stylists in Research Center of Excellence

Q4: How can we 'train' barbers and stylists to be integral parts of Research Center of Excellence in Minority Health Disparities (RCEMHD)

The CMH works in partnership with 10 barbershops/salons located in the Health Empowerment Zone. Over the past six years this innovative collaboration has evolved into our Health Advocates In-Reach (HAIR) intervention under the leadership of Mr. Mario Browne, CMH Project director. Click below to learn more about HAIR

Within the context of the RCEMHD, the shops serve as portals of entry for individuals into the Healthy Black Family Project. They are also sites for dissemination of evidence based health information including, but not limited to, mental wellness, obesity prevention, access to health insurance, environmental justice and other material. The barbers and stylist have received "mini-grants" to support their efforts. Importantly, the shops provide a venue for the annual Take A Health Professional to the People Day each September.

The barbershops /salons are in intregral part of the RCEMHD Community Research Engagement Core (Dr. Angela Ford, Core Dir.). Click below to learn more about the Community Research Engagement Core

Click below to learn more about the integration of barbershops/salons into the RCEMHD.

Question 3: More Help

Q3: Will the Center be bringing in more support (students or staff) to work with the various interventions?

1. Response:

The short answer is yes. The CMH will have two Kellogg Health Disparity Scholars in 2007 and we continue to identify new junior faculty to work with us on a variety of research projects. However, the key is “…more staff/student support…” that will help reduce work load stress. I am working with the Dean’s office to make a case for new staff support. The justification requires that we conduct a workload audit demonstrating how current staff are deployed and where the gaps are that must be filled. Keep in mind, we have experienced tremendous growth over the past seven years (15 to 20 new staff) and the vast majority of them are supported on “soft-money” …. (grants / contracts). We need enough staff and the right staff to successfully carry out the work in order to secure additional grants / contracts to keep everyone employed. It is a matter of balance and management to keep the CMH moving forward.

Question 2: Walk the Walk

Q: How can CMH better the health of its employees? Can each work day include some healthy activity or class? It definitely would help ensure we practice what we preach and help boost morale.

I am often reminded that when it comes to the CMH staff, we are the people we SERVE in the Healthy Black Family Project. In other words, many of the staff members were recruited and hired because they are part of the communities where health disparities exist. Strategies to “…better the health of …employees” include but are not limited to the following:

A. Join the HBFP, there is no charge. Most of the people engaged in HBFP have fulltime jobs … just like our staff. The HBFP classes are offered through the day, evenings and on Saturday.

B. If staff members do not want to participate in HBFP or cannot join for any reason, remember that all fulltime PITT staff have benefits from the UPMC Health Plan which also offers healthy lifestyle programs. The UPMC Health Plan services come as a benefit and at times with incentives for participation (see link below).

Recently Mr. Mario Brown, CMH Project Director, created a team (Thomas' Promises) in response to a UPMC Health Plan campaign to address obesity through increasing physical activity. I encourage all staff to join this effort and I commend Mario for demonstrating leadership on this matter. (click below for details)

As Center Director I cannot “mandate” that staff join any of these programs. However, the opportunity and encouragement for CMH staff to engage in healthy lifestyles are literally all around us. Just Do It !!

Question 1: Priority Population

Q: How can we better reach the entire minority population of Pittsburgh? Many of our interventions seem to be focused in the East End?

I made a strategic decision to focus on the African American population because it is the largest minority population and where the most significanct health disparities exist. In order to demonstrate effectiveness we must first begin where the problem is most obvious and that is in black neighborhoods in the city of Pittsburgh. For the purpose meeting the goals and objectives of our grants (NIH and Foundations) the "entire population" constitutes 10,000 African Americans. As of December 2007, our Healthy Black Family Project had enrolled approximately 6,000 African Americans (60% of our target goal!).

According to Pittsburgh’s Racial Demographics: Differences and Disparities (2007), a recent report by the Center for Race and Social Problems in the UPITT School of Social Work, presents data on the four racial/ethnic groups (Whites, African Americans, Asians, and Hispanics) and for four geographic areas (city of Pittsburgh, Allegheny County, Pittsburgh Metropolitan Statistical Area, and the U.S.). For the most part, Pittsburgh lacks racial/ethnic diversity compared to other cities and the nation. We are for the most part a Black / White town as illustrated in the table below.

Online Source:

Blacks make up approximately 12% of the population in Allegheny County and 27% of the population in the city of Pittsburgh. Hispanics and other minority groups are 1-2% of the population. Additionally, Whites and African Americans in the Pittsburgh region live largely in racially segregated communities. This is the reason CMH collaborated with the Allegheny County Health Department to create the Health Empowerment Zone (HEZ). Over 80% of African American live in the East End neighborhoods of Pittsburgh. With limited resources and a target date of 2010 to demonstrate results, we decided to beging our efforts where most African Americans live.

Thus, the Kingsley Association and Hosanna House is where we established our Healthy Black Family Project base of operation. In 2007, we received approval from The Pittsburgh Foundation to expand into the Hill District and the Northside. This expansion constitutes a citywide reach into black neighborhoods across the city.

Questions from My Staff

Over the past eight years the Center for Minority Health has experienced rapid growth from two fulltime staff to more than 20 today. The need for ongoing communication could not be more pressing. In order to be more responsive to staff needs Dr. Angela Ford instituted “question cards” staff used to write down their questions and for me to provide a response. The questions are listed below and the list will grow over time.

This blog is created as an efficient means not only to respond to questions from my staff, but also to highlight the challenge and opportunity Center Directors across the nation have in building the field of minority health and health disparity research.

Each Question and response will be listed as a separate posting to this blog

Dr. T