Sheriff Akinleye bends low over a customer in the barbershop, his eyes intently following the movements on a little dial, and a stethoscope in his ears. Then he straightens up.
"All right. I get 136 over 82. Which is a little high. Normal is less than 120 over 80. You have prehypertension," he tells Phillip Griffin, 42, who has heard this before - though perhaps not in this much detail.
The 26-year-old medical student explains how high blood pressure works, each organ that it affects, its links to exercise, fried food, salt.
Griffin says he plans to lose weight.
"The biggest thing you can do with your diet right now is limiting how much you eat out," Akinleye tells him.
This is the second year that a handful of University of Pennsylvania students have periodically dropped into a predominantly African American barbershop on a Saturday afternoon, armed with blood-pressure cuffs, literature, and a yearning to make a difference long before they don their white coats.
The rationale is simple: Black men have the lowest life expectancy (70 years for someone born in 2007) of any major demographic group, and some of the highest rates of conditions like hypertension (41 percent) that play a role in mortality. They are less likely to go to the doctor.
But they visit a barbershop every one or two weeks.
Some call it the black men's country club.
"I refer to it as a watering hole," says Darryl Thomas, the owner of Philly Cuts at 44th and Chestnut Streets. Everyone comes to get groomed. They mix. They talk. They allow the barbers into their personal space.
And they listen when Thomas calls out: Hey man, get your blood pressure checked!
Akinleye, who is in his third year at Penn's Perelman School of Medicine, started the barbershop program last year after seeing a demonstration at a Student National Medical Association meeting. Several other chapters around the country are doing it. In some cases, barbers are trained to take blood-pressure readings and talk with customers on their own.
As concern about health disparities and cultural gaps in care has risen on the medical agenda, a number of physicians around the country have started barbershop screenings for prostate cancer, diabetes, and sickle-cell anemia, building on familial connections of the sort that led playwright August Wilson to reminisce about Hamm's barbershop of his Pittsburgh childhood.
Black barbershops historically "allowed men opportunity for unfiltered dialogue," serving as cultural centers "where ideas are comfortably exchanged among elders and young boys listen, watch, and learn how the ritualized act of hair cutting can seamlessly be paired with social discussion," psychologist Cubie Bragg wrote this year in the American Association of Behavioral and Social Sciences Journal, summarizing prior research.
At the same time, African American men appear even less likely to seek medical help than other men - a combination, researchers say, of mistrust of health institutions, discrimination, machismo, and lack of access.
"The barbershop health screening approach has potential to bring about a generational change in the perception of health care screening in the African American population," Bragg wrote after studying a small program at Bowie State University in Maryland.
Eager to try
When the Penn students approached Philly Cuts, Thomas was eager to try it. He's watched customers die - "it's like seeing your brother" - from complications of diabetes. Acutely aware of their own health vulnerabilities, most of Thomas' 10 barbers work out at the gym together at 6 every morning.
Perhaps 40 or 50 percent of the readings taken at the West Philadelphia shop indicate high blood pressure, said Kenji Taylor, a second-year medical student who took over the program from Akinleye. He won a Schweitzer fellowship, given to graduate student projects that target unmet health needs, and he plans to expand the program.
During his senior year of college, his father died of a heart attack at 62 after what Taylor is certain was years of uncontrolled hypertension. "Walking up a hill, he would run out of breath. Profuse sweating. He would never go see a doctor," he said.
"When I was young, the place my father always took me to was the barbershop. Had there been hypertension checks, that might have been the one place where he would have gone."
When taking blood pressure, Taylor, 27, and the other students make a point of engaging people in conversation about their lives and all the little changes they might make to improve their health.
Feyona Gordon's doctor told her a year ago that she had hypertension, but she didn't do anything about it. "I'm not sure why," says the 26-year-old shampooer.
But after Taylor also measured high blood pressure several months ago, she immediately went to her doctor to get more details. She's been trying to work out three times a week and change her diet.
"I used to eat fried chicken. I'd go to the fast-food restaurant. Now when I eat out," she says, "I order, like, the baked fish with rice."
Meanwhile, Taylor has continued talking with her about how she can change her lifestyle. He's taken her blood pressure on multiple visits; it might be down slightly.
The largest randomized study of barbershop interventions involved more than 1,000 men at 17 black-owned shops in Texas. Everyone was screened, given recommendations for physician follow-up, and a pamphlet about high blood pressure. Half the barbers were trained to take blood-pressure readings and did so regularly, talking with patrons, telling their own health stories, and urging them to visit a doctor. The other half did nothing.
After 10 months, the number of men whose hypertension was under control had improved in both groups, although the improvement was 9 percent greater in the active barber group, the researchers reported in February in Archives of Internal Medicine. Extrapolating the results to 18,000 black-owned barbershops in the United States, they projected 800 fewer heart attacks, 550 fewer strokes, and 900 fewer deaths in the first year.
Still, this was an intensive intervention, and not quite under real-world conditions. The barbers were paid for taking blood pressures (something that health insurers are unlikely to do), and customers got a free haircut every time they saw a doctor as a result of a barber referral for hypertension.
The Penn students say that they are under no illusion that occasional screenings alone will cause a drop in blood pressure. Their goal is to be a presence, however small, in the barbershop, seeing people over and over and using those relationships to shape people's behavior.
Taylor points to the shampooer who went to see her doctor and, after several student visits, says she is actually changing her diet.
"Personal stories start to tell me that we're going in the right direction," he said.