Joyce Balls-Berry, PhD, MPE
Mayo Clinic, Rochester, Minnesota, United States
Lea C. Dacy, BA
Mayo Clinic, Rochester, Minnesota, United States
James Balls, MSPH
St. Louis, Missouri, United States
Barbering is an ancient profession and early records indicate that barbers played a role as community leaders. Elevated almost to the role of priests or medicine men, they typically offered bloodletting, tooth extraction, cauterization, and tonsorial surgery as well as grooming.1 As medicine advanced, they did not continue the role of the “barber-surgeon-dentist” but maintained their identities as community leaders. The role of the black barbershop is well documented in the history of the civil rights movement as a gathering place for planning strategy and promoting unity. As a lesser-known story, epidemiologists and public health officials have used the barbershop in recent decades to educate black men about disease prevention.
In the antebellum south, barbering (i.e., hair-cutting and shaving) was a necessary skill for black slaves serving as valets to white masters. In the free northern states, owning a barbershop was one of the few businesses open to black entrepreneurs because cutting hair was perceived as too menial an occupation for whites. However, these black-owned barbershops only served white patrons.2 Meanwhile black men received haircuts in the kitchen or on somebody’s back porch.3 This trend continued until the post-civil war years, when German and Italian immigrants began to arrive in large numbers. These workers saw no stigma in barbering and entered the profession in large numbers. In the northern states these new barbers lobbied in favor of strict barbershop-licensing laws. The Journeyman Barbers’ International Union of America pursued legislation to exclude blacks from the trade.2 In the post-Reconstruction South of the 1890s, upscale black-owned barbershops with a white clientele were often targets of vandalism and arson by resentful poor white mobs.2,3
At this point, black barbers began opening shops in the black community specifically to serve black men. These barbershops quickly became a gathering place where black men could gather to socialize, play chess and checkers, and discuss politics. The rise of Jim Crow laws limited spaces where blacks could gather, and the barbershop filled this void, similar to black churches but on a smaller scale. Many politically active barbers handpicked the reading materials, and the barbershop provided an opportunity for men to read black newspapers and magazines.4 Barbers also conducted voter-registration campaigns. The civil rights activist Stokely Carmichael (aka Kwame Toure) attributed his early political education to his weekly visits to a barbershop in Harlem.4 (Ironically, during the Civil Rights movement, sit-ins in the south were held in black-owned barbershops that continued to serve only white patrons.3)
Black barbershops continue to thrive in the present day as a meeting place for black men from all socioeconomic backgrounds.5 Affluent blacks, including business executives, professional athletes and politicians, will still return to inner-city neighborhoods for a haircut in a black-owned barbershop, and these barbershops often are major revenue-generating centers in economically depressed neighborhoods. Quincy T. Mills, a history professor at Vassar College and author of Cutting Along the Color Line, describes the black barbershop as “private spaces in the public sphere for Black men.”3 “The barbershop is where black men can come to reconnect, to be themselves, and enjoy each other’s company,” said Sean Thompson, owner of Sean’s House of Masters Barbershop. “It’s been called the black men’s country club. It doesn’t matter how much you make, what your title is, we’re all on the same level when we enter the barbershop. We laugh, we debate, we talk sports, and current events.”5
In recent decades, recognizing that African-American men died disproportionately from preventable diseases, health researchers looked to the barbershop as a culturally safe site in which to promote health through screening and education among a vulnerable population that distrusted conventional healthcare systems and providers.6 Given its role as a forum for frank discussion, the black barbershop has served as a successful, non-traditional venue to inform the community on ways to prevent potential chronic diseases. Successful barbershop outreaches have addressed diseases such as prostate cancer, hypertension, diabetes, HIV, and other STDs in heterosexual males.7
James Balls, an author of the present paper, worked in the public health field in Chicago, St. Louis, and East St. Louis from 1969 to 2007. His initial exposure to barbershop-for-health outreaches came from benchmarking trips to Roxbury, Massachusetts, and Johns Hopkins University in Baltimore in the early 1970s; each of these sites piloted barbershop hypertension- and diabetes-screening projects.8 In the early 1990s, he helped to set up similar programs in East St. Louis, Illinois, and St. Louis City and County. Controlling hypertension in the black male population was one of the initial goals. Balls and colleagues from the Metropolitan Heart Association recruited and trained eleven barbers in the St. Louis metro area to measure blood pressures and to refer clients to healthcare facilities. To counter budget cuts and a decline in city- and county-funded health services, the barbershop outreaches also highlighted needs in the community:
We had four comprehensive primary care clinics in St. Louis, and their walls were bursting with patients all the time. In addition, we saw a need in the hospital emergency rooms, people coming with just hypertension problems and diabetes without any primary care provided to them. So we said, “Well, if we can identify more, we can also make an appeal to [government] to open up other satellite clinics in the south and the north [of St. Louis]”. . . It did show that there was a need for more facilities that provided primary health care and a need to increase awareness and educate the public, not only about hypertension and diabetes but about other diseases prevalent in poor neighborhoods and also about preventive health care and where you can get it.8
Barbers recruited in the St. Louis/East St. Louis program became “true believers” in preventive care. Two of those that Balls recruited and trained subsequently returned to school to train as nurse practitioners.8
While black churches also established health-screening and prevention programs, barbershops had access to a wider swath of the population. Churches served their congregations and reached primarily women and children, but the barbershop was successful in reaching men including those reluctant to enter a church.3,8 (Similar initiatives in black-owned beauty salons have addressed health issues such as heart disease, cancer and stroke that disproportionately affect African-American women.9) While the barbershop is a place of business, it is also a community resource, a place for men who have moved away from urban centers to reconnect with the black community, and a place to discuss current events and job opportunities.7,10,11 Because it also functions as a forum for frank discussion in a primarily male domain, it lends itself to some of the more sensitive health issues like prostate cancer screening and HIV prevention.7,12,13 A more recent study by Balls-Berry and colleagues demonstrated that black barbershops could reach beyond the African-American population to Somali, Sudanese, and other recently arrived immigrant populations.14
Barbershop health-prevention outreach has some inherent limitations. Barbers enjoy positions of respect and trust in the black community,7,11,15 but men can still be uncomfortable discussing confidential health issues. In the St. Louis project, barbers sometimes grew discouraged by the reluctance of clients to participate in health screening. The very public environment in the barber chairs and waiting areas could inhibit a patron from having a hypertension screening along with his haircut and shave: “well, these guys are all watching me.” “I don’t want to have my blood pressure checked.” “Well, you don’t have to. We’re just asking if you want to.” Because barbers could not discuss findings with the patrons, only refer them to a health facility for further screening, confrontations sometimes occurred when the patron demanded his results.8 And while barbershops served as an educational forum for HIV prevention for heterosexual males,13 the overtly macho environment could be unwelcoming to black males with same-sex partners. Indeed, some of this population expressed fear of entering the domain even for purposes of grooming.16
Still, the black barbershop has enjoyed an ongoing role in the community, initially in the civil rights movement and more recently in the sphere of health education and disease prevention. Black barbers enjoy a high degree of trust and respect and have served as role models for entrepreneurship and community participation. (In both the 2008 and 2012 campaigns, President Barack Obama included barbershops in his campaign itineraries.) As a force to address health disparities in the black community, the barbershop will help to lead the charge.
- Wazir MS, Mehmood S, Ahmed A, Jadoon HR. Awareness among barbers about health hazards associated with their profession. J Ayub Med Coll Abbottabad. Apr-Jun 2008;20(2):35-38.
- Bristol D. From Outposts to Enclaves: A Social History of Black Barbers from 1750 to 1915. The Business History Conference 2004. Vol 5. Le Creusot, France: Enterprise & Society; 2004:594-606.
- Mills QT. Cutting along the color line: black barbers and barber shops in America. Philadelphia, PA: University of Pennsylvania Press; 2013.
- Oatman-Stanford H. Straight Razors and Social Justice: The Empowering Evolution of Black Barbershops. Collectors Weekly. 2014. http://www.collectorsweekly.com/articles/the-empowering-evolution-of-black-barbershops/.
- Sapong E. Black barbershops draw customers back with a blend of camaraderie, culture. The Buffalo News 2014.
- Releford BJ, Frencher SK, Jr., Yancey AK. Health promotion in barbershops: balancing outreach and research in African American communities. Ethn Dis. Spring 2010;20(2):185-188.
- Luque JS, Ross L, Gwede CK. Qualitative systematic review of barber-administered health education, promotion, screening and outreach programs in African-American communities. J Community Health. Feb 2014;39(1):181-190.
- Balls J, Balls-Berry J, Dacy L. James Balls discusses his career in public health: 1971-2007. Rochester, MN: Mayo Clinic 2015.
- Linnan LA, Ferguson YO. Beauty salons: a promising health promotion setting for reaching and promoting health among African American women. Health Educ Behav. Jun 2007;34(3):517-530.
- Ferdinand KC. The Healthy Heart Community Prevention Project: a model for primary cardiovascular risk reduction in the African-American population. J Natl Med Assoc. Aug 1995;87(8 Suppl):638-641.
- Grant CG, Davis JL, Rivers BM, et al. The men's health forum: an initiative to address health disparities in the community. J Community Health. Aug 2012;37(4):773-780.
- Luque JS, Roy S, Tarasenko YN, Ross L, Johnson J, Gwede CK. Feasibility Study of Engaging Barbershops for Prostate Cancer Education in Rural African-American Communities. J Cancer Educ. Oct 8 2014.
- Baker JL, Brawner B, Cederbaum JA, et al. Barbershops as venues to assess and intervene in HIV/STI risk among young, heterosexual African American men. American journal of men's health. Sep 2012;6(5):368-382.
- Balls-Berry J, Watson C, Kadimpati S, et al. Black Men’s Perceptions and Knowledge of Diabetes: A Church-Affiliated Barbershop Focus Group Study. Journal of racial and ethnic health disparities. 2015;in press.
- Luque JS, Rivers BM, Gwede CK, Kambon M, Green BL, Meade CD. Barbershop communications on prostate cancer screening using barber health advisers. American journal of men's health. Mar 2011;5(2):129-139.
- Moore M. What It’s Like Being a Faggot at a Black Barber Shop. Thought Catalog. 2014. http://thoughtcatalog.com/madison-moore/2014/01/what-its-like-being-a-faggot-at-a-black-barber-shop/.
This publication is supported by CTSA UL1-TR000135, National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH). Its contents are the responsibility of the authors and do not necessarily represent the views of NIH.