Customers at All in the Wrists barbershop in Indianapolis don't just get a haircut and beard trim at their appointment — they also receive blood pressure checks for hypertension, diabetes education, and important resources to assist with health care barriers. In this conversation, Marvin Taylor, owner of All in the Wrists, and Brownsyne Tucker Edmonds, M.D., vice president and chief health equity officer at Indiana University Health, discuss the importance of barbershops in the African American community, and how community health workers inside these barbershops are providing valuable health care and education.

To see the video on IU Health and All in the Wrists partnership, please visit https://www.youtube.com/watch?v=BYGawZ34n9s

Tom Haederle

Customers climb into the chair at the All in the Wrists barber shop in Indianapolis for a haircut and a beard trim, but they leave the shop with so much more, such as a blood pressure check for hypertension or important resources for those seeking child care, facing transportation issues or people who need clothing. This beloved community barber shop redefines the meaning of customer service.

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Barbershops are traditional gathering places and information hubs for the African-American community. That's why Marvin Taylor, the owner of All in the Wrists, was happy to participate in a program from Indiana University Health led by their chief equity officer, Dr. Brownsyne Tucker-Edmonds, that places community health workers inside barber shops to educate the public about their vital health statistics.

Tom Haederle

Let's give a listen in this three way conversation with Dr. Tucker-Edmonds and Joy Lewis, senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity.

Joy Lewis

Marvin, I want to kick things off with you and talk about your love of barbering and barbershops. Even as a young person, young, how you idolized barbers and frankly, how barbershops have been a sanctuary for black men in the African-American community. It's an information hub, right? So how did you combine your passion for barbering with prevention of illness and promotion of wellness?

Joy Lewis

How did those two come together for you?

Marvin Taylor

Marvin Taylor

And it wasn't until after he passed that I incorporated health and wellness. So before the health and wellness aspect began, I was always serving the community as a barber, doing things, cooking for the community, helping the unhoused, just being a resource, you know? He taught me that in order to be great, you have to greatly serve.

Marvin Taylor

And so I was doing that for a very long time. One day I was in the barber shop and there was a gentleman named Calvin. I was cutting his hair and he was talking to me about hypertension and high blood pressure. My mother and father both suffer from hypertension. And so he proposed the iHEART Initiative program, and I was on board.

Marvin Taylor

As soon as he told me about it, I was like, whatever I can do to be a resource and help the community, because there are a lot of people in the neighborhood of my barber shop that are medically underserved, unsheltered. So this was a perfect opportunity for IU Health and myself to collaborate to help some of those people.

Joy Lewis

Wow. So you're really leaning into the role as a servant leader, I think is what you're describing. Recognizing the needs of the community where you're operating your business. But right outside your doors are folks who are unhoused and a population that truly would not have access to preventive care.

Marvin Taylor

Marvin Taylor

So those numbers are definitely growing.

Joy Lewis

So Marvin, you mentioned the iHEART program, Dr. Tucker-Edmonds, you want to get in now - I know IU Health has a mission to make Indiana one of the healthiest states in the nation, something folks can get behind, right. I would imagine that the community's role in achieving this goal, this mission, is critical. You can't do it without engaging community voices.

Brownsyne Tucker Edmonds, M.D.

So partnering with folks like Marvin and the barbershop I would assume is a part of your strategy to execute on that mission. So what is the iHeart program that Marvin mentioned? And then how have partnerships and really community engagement played a role to advance this goal?

Brownsyne Tucker Edmonds, M.D.

Yeah, I mean, to start just in terms of iHeart, it's an acronym...

Brownsyne Tucker Edmonds, M.D.

always have to write it down. I love to make acronyms and then I forget what they mean. And it's Indianapolis health equity access, outreach and treatment, effectively as a community health worker led intervention. It's a place-based effort. We identified three anchor communities, really kind of mapping out overlaying cardiovascular disease morbidity and, racial disparity and social need to really identify three neighborhoods that had particularly, I think, high need and the opportunity for high impact to really partner with those communities, with community based organizations, with, you know, community businesses to really deploy a screening, outreach and navigation program

Brownsyne Tucker Edmonds, M.D.

organized around cardiovascular health. And the reason I add the navigation is consider the screening and referral piece has been shown to not be as effective. The really critical point is how do we kind of close the loop? How do we help ensure, you know, that, folks are getting to care? And we screened for cardiovascular risk as well as social determinants, drivers, impediments - your word of choice - of health.

Brownsyne Tucker Edmonds, M.D.

And then we help to try to navigate people to resources to meet medical and social needs. That's iHEART in a nutshell. But in terms of the community partnership elements, I mean, they're vital. I mean, to the point, I mean, Marvin has been an amazing partner. And I think what's so critical is the fact that you really have to kind of move into the spaces, the places that work with the people that are already trusted, that are already serving,

Brownsyne Tucker Edmonds, M.D.

right, sort of day to day. And the barriers to accessing health care in particular are significant. We just realized it's going to require that we move models of care and points of access beyond our four walls. It can't continue to be if we build it, they will come. And so moving into the community setting and working with those trusted leaders and individuals is key.

Brownsyne Tucker Edmonds, M.D.

And that's been really, a point of success for us. Partnering with barbershops, partnering with congregations, showing up in food pantries, showing up at the Urban League. I mean those places where people with needs are. And that's where we show up, and that's how we try to deliver this intervention and this opportunity to improve health care access.

Joy Lewis

It sounds like you're leveraging the Social Vulnerability Index, right, to identify where the needs are. Otherwise, many of these communities would go unnoticed, right. And then you're showing up. You're going to where those individuals are and you're providing the care on their terms in their communities, working alongside trusted partners in the community. So there are several components to your strategy.

Joy Lewis

Joy Lewis

How did you spread and scale this initiative so quickly?

Brownsyne Tucker Edmonds, M.D.

I mean, I think it speaks to a couple of things. So we set out actually with the goal of screening 10% of the adult population in our anchor communities of to be about 1,400, screenings over three years. So you can see that we are, like, way out over our pace.

Brownsyne Tucker Edmonds, M.D.

I think it boils down to three things. One is that I think it just speaks to the need. I mean, part of is that we did initially identified disinvested areas where I think that there is, really significant sort of, need. I think it speaks to a great partnership. We work very closely, really hand-in-hand with our team.

Brownsyne Tucker Edmonds, M.D.

This our community health team led by Nicole Wilson here at IU Health, and they are on roller skates. They are out with, you know, in sort of settings, with our community partners providing events, screenings, multiple kind of times a week in different settings. And with a model that's really intentional. It's not a lot of one offs.

Brownsyne Tucker Edmonds, M.D.

And I think this is where you also get the numbers and the build is that we decided we wanted to do an embedded model, a longitudinal model. So we're not just like here today, gone tomorrow. We're here every week, right. Like so those partnerships that we've said we're going to be at this pantry, you know, these two days a month or every single week, we're going to be at Marvin's on a certain date.

Brownsyne Tucker Edmonds, M.D.

So then, people also can know and share that, like, we're going to be back and that, you know, you can sort of build those relationships over time. And the last piece is actually our partners. I mean, we just have tremendous partners. And, you know, Marvin is so special in the way that he has already built trust and relationship in his community that, you know, the folks who are unhoused, kind of on his block when he comes out and says, come get your blood pressure they come.

Brownsyne Tucker Edmonds, M.D.

So I think that, you know, we've been intentional about figuring out the right partners. And that I think is also critical, to kind of the success and the quick spread of the program.

Joy Lewis

And certainly consistent with Marvin earlier point around the demand growing. Initially, you said what, Marvin, there were 4 or 5 folks outside your door, and now there are 30 plus.

Joy Lewis

I guess what are some of the challenges? What are some of the biggest challenges you've run into in terms of getting folks to say, yes, Marvin, I know you're a trusted voice. You're a trusted resource in the community, but a part of this work, you know, sometimes is not having access, but also not having education around what preventive care should look like or how it could be beneficial to one's overall health status and well-being.

Joy Lewis

So do you bring folks in kicking and screaming, or do people kind of respond when you say, come on in here?

Marvin Taylor

Well, I think that I've been in the community for so long. I grew up in this neighborhood. I'll give you an example today, it's about 96 degrees. We put out two cases of ice water. I just set them out on the corner and everybody to walk fast to get water. So I have a repeat service to the community.

Marvin Taylor

I'm consistent. And so I've built a really great bridge of trust between this community and my barbershop. Once we partner with IU, they said this and I, and I really have to say this, and I don't think they get enough credit, but the community health workers who IU have, they do an amazing job.

Marvin Taylor

And not only - so they kind of piggyback off of the trust that I've built with this community. And now the CHW's from IU Health are building independent relationships. And so now there are times when I don't even have to go outside and say, hey, it's blood pressure day. When those guys pull up and they're coming in there, it's blood pressure day.

Marvin Taylor

So they come in on their own. And sometimes I had to go out and, you know, give a little nudge, come on. I'll do it because the barbershop is such a resource. And like I said, the CHWs who are here every other Tuesday and every Thursday, they do an amazing job.

Joy Lewis

I'm curious for both of you: what has surprised you the most about this program since it's its launch?

Brownsyne Tucker Edmonds, M.D.

We had mapped at a population level like what the cardiovascular kind of morbidity rates and things were in the communities that we were going to engage. And I knew, and I know, right, I know the disproportionate burden of disease, particularly among black Americans in terms of cardiovascular disease, hypertensive disease.

Brownsyne Tucker Edmonds, M.D.

But actually in our first - I think it was the first three months of our experience and actually even out until today - our most recent sort of data that we've captured in our barbershops, you know, we're seeing like upwards of 80% of patrons that are coming in that are, you know, screen positive that have blood pressure coming in over 130, over 80.

Brownsyne Tucker Edmonds, M.D.

And even if we use the 140 over 90 cut off, it's like, roughly like half of the population, which if you look at that by comparison to the distribution of this disease in the general population, those are extraordinarily high rates. I was surprised by that degree of sort of unmet need, frankly. Because when we asked people, have you did, you know, like, has anybody told you that before?

Brownsyne Tucker Edmonds, M.D.

And I know some people maybe. But really we're finding almost 40, 50 percent, you know, high numbers of folks who are also like the first time that they were told that. And so to me, it speaks to really reaching those folks who haven't had access points, haven't had care. Now, some of that may be reflected by this relationship to the unhoused population, but I think just in general, with our screening more broadly, we're seeing really high rates speaking to really high need.

Brownsyne Tucker Edmonds, M.D.

But I also think it speaks to the opportunity for great impact.

Joy Lewis

Once you've screened these individuals, how are you getting them into routine care?

Brownsyne Tucker Edmonds, M.D.

You know, well, I don't know if our listeners do, but the barbershop is a really relatively established these barbershop, sort of outreach models are really established models for public health outreach. I think where we were trying to kind of move the needle or kind of just move that conversation forward post-pandemic, is because it had some studies that its shown that if you had like a pharmacist, you know, if you had someone on site who could prescribe, then that gave you the opportunity to do longitudinal kind of follow

Brownsyne Tucker Edmonds, M.D.

up and care management for folks who are identified with disease on site. You know, after the pandemic, we had the learnings around telehealth, and we also have the constraints, frankly, around sort of staffing models. So we were trying to find out, could we put a community health worker in that setting and then leverage sort of virtual care access to be able to try to connect people to care.

Brownsyne Tucker Edmonds, M.D.

So that's a model that we are kind of trying or piloting in our barbershop environment. There's a lot of learning to be done there. There's privacy considerations for really vulnerable folks who may not have telephones, you know, so trying to figure out if that's a viable model. I mean, that's really the question.

Joy Lewis

I'm going to wrap things up with Marvin here and just give you an opportunity to share with our listeners again, a little bit more about your passion for this work.

Joy Lewis

If you want to talk about what surprised you and looking ahead again, 2.0, how would you define success? What does that look like?

Marvin Taylor

With all the work that we've done, there's still so much more that we need to do. I see us every day, whether IU is here or not. We're reaching people. People are getting informed about their numbers, about cholesterol. And there are so many other access points that IU Health offers in terms of housing and food, things like that.

Marvin Taylor

So there's so many things that we're going to do. One of the biggest challenges was, and I think I may have said this a while back, was the cholesterol A1C checks with the finger prick of the needle. I was like, that's probably not going to fly. Everybody gets it done. Everybody loves it. So I thought that would be one of the most challenging things.

Marvin Taylor

But, we just kind of skated right past that. And I'd like to end just by saying it's been an honor and a pleasure to be a part of this program because I really enjoy serving the community in any way that I can. So it's really been an eye opener for me. I've learned a lot more about hypertension.

Marvin Taylor

We're doing great things, and I hope that we continue to expand and continue to help people and give people access to health care and the things that they may need.

Joy Lewis

Awesome. That's a great note to end on. So looking forward to further iteration of this work within your community there, working in partnership with IU health. And hopefully through this conversation we can inspire hospitals and health systems all over this country to think about these kinds of offerings and partnerships and how to establish effective community engagement models that have the potential to create better access to improve the health.

Joy Lewis

Health is the goal, really. So thank you for all you do day in and day out to advance health for the communities you serve.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.