BUILDING A HEALTHIER PITTSBURGH: Rethinking the way we pay for care

Barbershop conversations turn to clients' health care


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In the waiting area of Bat's Barber Shop in East Liberty, next to a diagram of hairstyles, there's a sign that reads, "We serve the mind, the body and the hair."

Kevin "Bat" Andrews, the shop's owner, pointed to the sign as evidence of his commitment to improve the health of his clientele in the largely black East Liberty neighborhood. Hair is his livelihood, but he also considers it his duty to help customers find solutions to health problems. That's why there are signs on his walls from health organizations offering help with pregnancy and heart disease.

Sometimes Mr. Andrews gives customers tips for handling diabetes, which he suffers from. Usually he tells them to talk to a doctor, but many of his clients don't trust doctors.

"Doctors and patients don't talk enough," he said. "But they open up to me because I'm their barber."

The University of Pittsburgh's Center for Health Equity takes advantage of health-conscious barbers like Mr. Andrews. It has an annual event, Take a Professional to the People Day, in which doctors, nurses and pharmacists go to Bat's and four other Pittsburgh barbershops to reach people who don't have regular access to health care.

For four hours, the experts hand out pamphlets, answer questions, and perform blood pressure and asthma screenings. They encourage residents to find a "medical home," a clinic where they can get to know and trust the doctors and nurses.

The event is one of several local programs intended to improve health care access in low-income and minority neighborhoods, where many residents don't see a doctor often. The lack of routine visits can increase their risk of medical catastrophes like heart attacks and strokes, and puts a strain on the health care system, doctors say.

"This is a huge problem," said Brian Primack, associate professor of medicine and pediatrics at the University of Pittsburgh. "There's obviously a number of minorities who are disadvantaged and not getting routine health care."

Blacks and, especially, Hispanics are more likely than whites to be without health insurance, a chronic disparity that means those same communities are more likely to have trouble paying medical bills when they arise. They are also more likely to get health coverage through a subsidized government program rather than through work: While about half of whites are covered through an employer-sponsored health plan, that number drops to 38 percent for blacks and 28 percent for Hispanics.

The lack of insurance coverage, the lack of top-notch medical care for those who do have coverage and the lack of education about chronic issues can lead to major disparities in health outcomes -- which leads to major health costs.

One study, by the Joint Center for Political and Economic Studies, said that about 30 percent of "direct medical care expenditures for African Americans, Asians, and Hispanics [in the U.S.] were excess costs due to health inequalities."

Another study, published in January and carried out by researchers at the Johns Hopkins Bloomberg School of Public Health, says "African-American men incurred $341.8 billion in excess medical costs due to health inequalities between 2006 and 2009, and Hispanic men incurred an additional $115 billion over the four-year period."

Those costs, and chronic issues and mortality rates that drive them, are why spreading the word about health issues is paramount in minority communities.

Barbershops are a good place to start, because of their importance in communities, said Lora Ann Bray, manager of community partnerships, education and training at the Center for Health Equity. They're places of conversation, where people learn about what's going on in the neighborhood. Also, people have faith in their barbers.

"You don't just go to any barbershop, right? You have a place you go to. There's a relationship and a level of trust you have with the people there," Ms. Bray said.

Other programs at the Center for Health Equity are focused on Pittsburgh's Latino population. Patricia Documet, an assistant professor, helps put together group cancer screenings for Hispanic women. The women arrive at the doctor's office in large groups, then go into the examination room one-by-one.

By coming with their friends and family, they feel less intimidated about undressing in front of the doctor and running into a language barrier.

In addition to language, concern about cost often keeps patients from visiting a doctor. Another barrier is a lack of education about health, which makes it harder for many to identify problems that need treatment.

For some low-income people, just getting to health clinics can be difficult. When Dr. Primack worked in the Hill District, he knew patients who had to take three buses to visit their doctors. If one of the buses was late, they missed their appointment.

"One bus is late, and all of a sudden you're late," he said. "There's a rule that if you're 10 minutes late they won't see you, so how likely are you to come back?"

Patients without access to regular care can miss out on important preventive treatments, he said.

The lack of care has financial impacts on patients, hospitals and health insurance companies. Sometimes, patients can't pay for a hospital visit after a medical catastrophe that regular check-ups might have prevented. Those emergency room trips put a strain on the entire health care system, Dr. Primack said, and have played a part in rising costs.

On top of the local efforts to make care more accessible, the federal government has made a giant push to improve health insurance accessibility via the Affordable Care Act. Passed in 2010, it requires most Americans to buy health insurance and subsidizes a portion of the cost, depending on a person's income.

The law required Americans who lack health coverage, and who didn't qualify for other government health plans, to buy private insurance by March 31. The six-month open enrollment window caused a scramble to enroll as many of the uninsured as possible -- in the Pittsburgh area, the Allegheny Intermediate Unit dispatched six "navigators" to places frequented by low- and middle-income people who make too much to qualify for Medicaid, such as churches and Salvation Army buildings.

But insurance coverage must be complemented with ongoing health education. Years ago, the Center for Health Equity educated barbers in health topics such as cancer screenings, healthy eating habits and local treatment resources so they could spread the knowledge to their customers. Mr. Andrews learned CPR this way (but, luckily, he hasn't had to use it).

It's been tough to keep up that part of the program, though, Ms. Bray said. The barbershops disappear and their employees leave. It can be difficult to get new barbers to come in for training on their day off.

Ms. Bray wants to strengthen the barbershops' roles in local health; she imagines putting an automated defibrillator in each one. She also wants to recruit more barbershops in the effort. Most of the barbershops in the program now are from the city's East Side, but she wants them to be all over the city.

That will be difficult, though. The center is smaller now than it was before its grant from the National Institutes of Health ran out several years ago, leading to layoffs.


Richard Webner: rwebner@post-gazette.com or 412-263-4903.

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