Vili Nosa: health research at the cutting edge

There’s a little line in the 2002 movie Barbershop that says a lot about barbershop culture.

As the film’s central character, a young barber on Chicago’s South Side, wrestles with inheriting his family’s struggling barbershop, he’s told to hold onto his father’s belief that “something as simple as a little haircut could change the way a man felt on the inside”.

A good haircut can give you a boost, for sure, but the line points to something deeper: the confidences clients share when they’re in the barber’s chair, and the connections men can develop in the community of a barbershop.

It’s those confidences and connections that Dr Vili Nosa, an associate professor in Pacific health, is digging into with a project exploring the role that barbershops can play in boosting the health of Pacific men.

The project, which will involve interviews with Pacific men, barbers and healthcare providers, will culminate in a three-month pilot in a real barbershop, testing its effectiveness as a place to deliver health messages or simple interventions like blood pressure testing.

Vili recently gained Health Research Council funding for the project through a Pacific Health Explorer Grant, designed to foster transformative health innovation.

“This project is a passion for me,” says the Niuean health researcher, who specialises in Pacific men’s health, particularly in the field of addiction. “I want to try something different, because I’m sick and tired of our men having poor health outcomes. We need to look outside the box.”

Exploring the local context

As shown in Barbershop, the US has a rich cultural heritage of barbershops as a place where African American men not only get a haircut but can connect with each other and gain a sense of community, says Vili.

Phase one of the New Zealand project, already completed, has been a literature review, which has revealed the effectiveness of some health programmes delivered through US barbershops. One study, published in The New England Journal of Medicine, for example, showed the blood pressure of African American men was lowered to healthy levels through a project that paired barbers and their customers with pharmacists.

However, there’s been no similar research undertaken in New Zealand, says Vili, despite several of our barbers championing health activity and innovation, particularly in mental health for Māori and Pacific men, in recent years.

One of the best known is Mataio (Matt) Faafetai Malietoa Brown MNZM, who drew on his own experiences of family violence to found Christchurch barbershop My Fathers Barbers and foster it as a place where clients could share their experiences and heal. Matt, along with his wife Sarah, went on to develop a successful anti-family violence movement, called She is not your Rehab.

Another is Flaxmere barber and Hastings’ first Pacific city councillor Peleti Oli-Alainu’uese, who rose to fame as the star of The Barber. The Whakaata Māori TV show highlighted the barbershop Peleti established to provide a safe space for men to tackle issues like domestic violence and their mental well-being.

It’s both offshore and local context that Vili is considering as he’s developing the two-year research project.

“I’ve read a lot of different research that’s been published on barbershop programmes in the US that show they work, but what I didn’t want to do was just take something from the US. We have to tailor-make something that will fit us culturally, because we’re a different population.”

He sees the project as complementary to initiatives developed by barbers like Matt and Peleti in New Zealand.

“What I’m trying to do is coordinate what’s being done here and to potentially validate their work through research. I want to empower and support what they’re doing and understand how this could work best for our men here.”

In search of better things

From the village of Avatele and Hakupu in Niue, Vili moved to New Zealand with his parents as a toddler in the late 1970s. Primarily a sociologist by training, his shift to health research was sparked during his PhD in behavioural science, in which he looked at alcohol use amongst Niuean men in Auckland. He has since been driven to undertake research to improve health outcomes for Pacific people.

“My family, like many Pacific people, came to this country because it was supposed to be the land of milk and honey. But look at what happened – Niueans are ranked among the highest in New Zealand in terms of health problems, particularly for issues like diabetes and obesity. We came to this country for better things, but our health profile didn’t go that way; instead, we got sick.”

Niuean is his first language and the country “is where my heart is”, says Vili, who has been involved extensively in health research projects spanning addiction, men’s health, and infant and maternal health there. He’s also involved in research projects across the Pacific – from the Cook Islands, Papua New Guinea, Vanuatu, Hawai’I and Australia (he is an adjunct associate professor of public health at the School of Public Health in the University of Queensland’s Faculty of Medicine).

Bringing about real change

Underpinning his work is the use of traditional cultural concepts to improve health promotion messages, and always with a focus on bringing about tangible change, he says.

Phase two of the barbershop project will involve interviews with men from Niue, the Cook Islands, Samoa and Tonga, while phases three and four will respectively involve interviews with Pacific barbers and health providers. This will ensure the interventions that are piloted in the barbershop (phase five) will best meet the needs and aspirations of those stakeholders.

Some US projects have involved barbers receiving training to deliver health interventions alongside cutting hair; an aspect of the Confess Project of America, for example, involves training barbers to identify clients in mental distress and connect them with support.

However, Vili says given our barbers are already busy cutting hair, he anticipates the New Zealand pilot will involve a barbershop with an adjacent health provider, with the latter providing the interventions.

While the project aims to leverage the personal connection and communication that barbers foster with their clients, there are other factors that potentially make barbershops good outlets for promoting better health outcomes among men, says Vili.

Some men might struggle prioritising a doctor’s visit, he says, but most are likely to visit a barber regularly. Being able to talk to a health professional or get a quick, simple health test done at the same time as a haircut could prove convenient for many men.

And if the concept proves effective, Vili says it could possibly be rolled out in other places where men regularly meet, such as fai kava clubs or sports clubs.

“What I’m hoping is it will help men make their health a priority and capture those who don’t go to the doctors and get them going. Because in terms of health status, Pacific men are not doing well, so I’m trying to find another way, and a way that feels culturally comfortable.”

All, potentially, from something as simple as a little haircut.

Caitlin Sykes