As they sat for haircuts, the men talked trash and watched movies on the television.
It seemed just like any afternoon at the New Beginnings Unisex Barbershop in West Baltimore, but throughout the shop men — and a few women — got their blood pressure and weight checked, sat for flu shots, picked up medical literature and chatted with a doctor.
Under a program recently started by Kaiser Permanente of the Mid-Atlantic States, this barbershop is doubling as a health clinic of sorts as care providers seek to reach underserved populations by going where they go.
The program is part of a growing movement by insurers and others to address health disparities that make racial minorities more prone to certain illnesses. The health companies hope that by going to one of the most frequented and trusted institutions in the African-American community they can encourage residents to get preventive care that can help fend off fatal illnesses, such as colon cancer and cardiovascular disease.
"We were trying to figure out how we could get into the African-American community and reach people directly," said Dr. Bernadette Loftus, associate executive director of The Permanente Medical Group. "Barbershops are often the heart of the community."
Barbershops have long been stabilizers in African-American neighborhoods. Barbers have their ear to the streets so much that politicians have long sought them out during election season to learn the pulse of the community.
Customers often frequent the same barber for years and come to trust them like a close family member. While some black men may avoid the doctor, they can be found in the barbershop once or twice a month.
Insurers around the country hope the close bond barbers have with their clients can help promote better health. Health programs have been started in barbershops in Washington, D.C., Chicago, Colorado and Pennsylvania, among other places.
Kaiser launched its program in West Baltimore late last year to address the low number of African-Americans who get flu shots. The program also offers HIV tests, blood sugar screening, blood pressure tests and other services. Doctors, nurses and medical technicians screen people on Friday and Saturday, the two busiest days at barbershops.
They try to attract people with large signs outside the barbershop entrance and also send ambassadors out into the community with fliers.
The idea for the program came after Loftus was speaking to consultant Michael Cryor about the issue at an event at the new National Museum of African American History and Culture in Washington D.C. He suggested that Kaiser try doing outreach at New Beginnings near Hollins Market, where he has gotten his haircut for more than a decade.
Cryor, also chairman of the University of Maryland School of Medicine's Board of Visitors, liked the idea of barbershop outreach because he had seen the success of an initiative started by the late Dr. Elijah Saunders. A pioneer in treating heart disease in African-American men, Saunders started Hair, Heart and Health in 2006, which trained barbers and hairstylists to prescreen customers for hypertension and then make referrals for medical care.
"I thought there was the potential for a barbershop or a beauty shop to provide services beyond beautification," Loftus said.
Other barbershops are also diving into health advocacy.
The Cigna Foundation has funded a health program at barbershops in Prince George's County and Washington since 2014 aimed at getting more African-Americans to get screenings for colorectal cancer. The disease is preventable if caught early, but many African-Americans don't get screenings.
Colorectal cancer is the third most common cancer in both black men and women, according to the American Cancer Society. Colorectal cancer death rates are 52 percent higher in black men and 41 percent higher in black women than whites, and African-Americans are also more likely to die from the disease.
African-American men may be distrustful of the medical system and avoid the invasive colonoscopies that detect colon cancer or the polyps that lead to them. Cigna was stumped on how to reach the community.
"We needed to flex our communication style and identify who is the trusted person in the community," said Dr. Christina Stasiuk, Cigna's national medical director for health disparities. "Barbershops are really where everyone goes, from the grocery bagger at Safeway to the senator."
Stasiuk invested in barbershop outreach after attending a conference and hearing Stephen B. Thomas, director of the Maryland Center for Health Equity at the University of Maryland, College Park, talk about a program he was running at the time at two barbershops in Prince George's County.
After speaking with Thomas further, Stasiuk was so impressed she persuaded Cigna to pay for expanding it in Prince George's County. Today 10 barbershops participate. Thirty-six barbers have been trained under the program to be colon cancer ambassadors who talk to their clients about the disease and encourage screenings.
Thomas, who started a similar program in Pittsburgh and has studied these programs for more than a decade, said that not every barbershop program works. It's best if the owner works in the shop and is a barber himself. Absentee owners tend to have less of a connection to the community, he said.
Some programs train barbers to take blood pressure and perform other medical tasks. Thomas thinks such work should be left up to the professionals and barbers should be charged with being educators and ambassadors. He also doesn't think that drop-in, temporary programs are the best way to go either.
"We are there for the long haul," he said. "We are there to make these shops health information portals."
Michael Brown of The Shop Spa in Hyattsville is one of the barbers who received the training and also got screened for colon cancer. His dad died from pancreatic cancer that spread from his colon. But even he hadn't gotten screened for cancer before the program came to his barbershop.
Brown said health can be a sensitive topic among his clients and not everyone opens up immediately. He is not sure why some African-American men don't go to the doctor, but he likes the idea of using the barbershop to encourage more visits.
"A lot of us wait until our arm falls off until we go get it fixed," Brown said. "The arm has been telling us for years that something is wrong and to go get it looked at. But we wait until it falls off."
Kaiser has provided care or counseling to about 40 people since it started the program at New Beginnings in December.
One recent Friday afternoon, a phlebotomist — a specialist at drawing blood — set up a table at the front of the shop to take blood to test glucose levels and other screenings. A doctor set up a table in the middle of the shop, in front of two barber chairs and the television, to take people's blood pressure and weight and ask other questions about their health.
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Owner Troy Staton cut a client's hair while two men and young boy waited their turn. He said having Kaiser come was an extension of other community work the shop already does. Staton frequently pushes his customers to get the test.
"We are here to help the community and the health of the community is not as good as it should be," Staton said.
Since the health screenings have started, the dialogue has changed at the shop, too. Chattering about people's medical conditions mixed in with talk about the latest Ravens game and the presidency of Donald Trump. One man dressed in black sweatpants and shirt lamented proudly about getting his prostate checked at the doctor's office earlier that day.
Harry Wilson, 53, said he got his screenings a couple of weeks ago only because Staton told him to. Wilson's tests came back normal.
"Even though nothing was wrong, it was good to know," he said. "People need to know more about their health."
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