A Racial Divide

Todd Bowen, a 42-year-old father of seven, has been visiting the In the Cut barbershop in Inglewood, Calif., every two weeks for seven years. He likes to look good, but he never expected his tonsorial routine to save his life. In February, Bowen arrived at the shop to find not only his barbers, but also a doctor doing on-the-spot testing for hypertension and diabetes. Bowen, who is uninsured, had never been tested for either; that day he tested positive for both, with a blood-pressure reading of 160/89. "I was all shaken up when I saw where I was on the scale and where I was supposed to be," Bowen says. "I thought I was invincible, immune. If they wouldn't have been there, I wouldn't have gotten tested. I wouldn't have went out of my way. It was God's will for that to happen to me."

Undiagnosed and untreated, Bowen was at elevated risk of developing heart failure, which increasing numbers of African-American men and women are suffering at earlier and earlier ages. A study last month in The New England Journal of Medicine found that blacks under age 50 experience heart failure at 20 times the rate of whites. "To see this among people in their 30s and 40s was really quite striking to us," says Dr. Kirsten Bibbins-Domingo, codirector of the UCSF Center for Vulnerable Populations at San Francisco General Hospital, and the study's lead author. Because their weakened heart muscles can't pump enough blood, people with heart failure are often too weak to work. "It's a devastating illness whenever it happens. It comes with such a high degree of disability, it could be devastating to whole communities." Exactly why these rates are so skewed is unclear, but high rates of hypertension among young African-Americans is a major culprit. Genetics, higher sensitivity to salty diets and environmental factors are also believed to play a role.

"The finding, while absolutely breathtaking, is not surprising," says Dr. Joseph Ravenell, a hypertension specialist and professor of medicine at New York University. "The reason it's so criminal is that hypertension is very treatable, and easy to identify. However, in order to identify it and treat it requires that black men go to the doctor. Men go to the doctor less in general, but it's a particular problem among young men of color."

That's where organizations like the Black Barbershop Health Outreach Program come in. The California-based initiative, started in late 2007 by Dr. Bill Releford, has already screened more than 7,500 men around the country and plans to see another 25,000 this year alone. Last month in St. Louis, of some 550 men screened, seven had to be taken directly from the barbershop to the emergency room. And in New York's Harlem, another program, called Barbershop Quartet, is taking screening a step beyond, testing not just for hypertension and diabetes, but also for prostate and colon cancer in a mobile clinic parked in front of barbershops during the spring and summer months.

"The barbershop traditionally has been a place within the community where African-American men feel safe," explains Releford. "We can congregate, talk about politics, about our relationships. Now we're adding to the menu: we can talk about our health. Most black men, we're too cool to go to a health fair with balloons and things. It's just not going to happen." It's not just a matter of looking cool. For many, making the time to go to the doctor means a loss of wages. "When your primary concern is putting food on the table or keeping a roof over your head, you're not going to a doctor to get screened for anything," says Dr. Bert Petersen, founder of Barbershop Quartet. "Fundamentally, people have a desire to feel a sense of well-being. But if seeking health care is a problem, you'll put it off."

That was exactly the case for Bowen. "The neighborhoods I'm from in South-Central, it's rough," he says. "It's survival today instead of worrying about anything else." But since his diagnosis, Bowen has replaced soda with water, and hamburgers with salads. He's losing weight, his blood pressure is dropping and he says he no longer feels sluggish when he wakes up in the morning.

Bowen's diagnosis has turned his life around, but with childhood obesity rates on the rise, particularly in poor and minority communities, real change will require prevention, not just diagnosis. "Efforts to improve access to care and coverage are steps in the right direction," says Dr. David Williams, professor of public health and African-American studies at Harvard University. "However, those efforts alone are not going to be successful. Medical care as practiced in the United States is a repair shop. It takes care of us once we get sick. Addressing the problems we're talking about requires a new effort to prevent us from getting sick in the first place."

© 2009