Hip-hop's got a message real stealthy: To teach the world to be mad healthy!

In 2005, Dr. Olajide Williams felt like he had two jobs. Each evening, he'd finish up his work as a physician at Harlem Hospital Center and walk seven blocks to the studio of hip-hop artist and "The Original Human Beat Box" Doug E. Fresh.

"I would be with Doug for hours and hours into the wee hours of the morning," Williams recalls. "We would be going over different beats, different sounds."

Their goal was to create a hit but with an unusual lyrical premise — to teach people how to detect stroke symptoms and respond appropriately. Williams wanted to demonstrate that hip-hop could be used for public health interventions.

His colleagues were dubious. "There was a lot of skepticism about whether this type of work could lead to a fruitful, productive" career, he admits.

But Williams knew when it came to more traditional public health interventions, "they don't diffuse into society" as easily. "Our problem is not coming up with the answers. Our problem is often scaling those answers." To Williams, music, and hip-hop in particular, could serve as a powerful tool. "Music has always been able to diffuse not just through our personal lives but across the world," he says. "And yet in my mind, we hadn't fully leveraged it for public health."

This is what Williams and Fresh were trying to do in that Harlem studio. It took them weeks to get the beat and the lyrics of "Stroke Ain't No Joke" right, but once they had it locked in, "Doug went into the studio and I think he knocked it out in a few days," says Williams. "He was that inspired."

Williams says it was clear right away that it was going to be a winner. "When I heard those stroke symptoms in the hook of that track, I knew that there was no way this wasn't going to be just sticky, but it was also going to be contagious. And we weren't wrong. It was incredibly effective."

He and his colleague published a scientific paper in Stroke, a publication of the American Heart Association, demonstrating that efficacy. They reported that of the 582 fourth, fifth and sixth graders in Harlem that they worked with, most learned where a stroke occurs in the body, what the classic symptoms of stroke are and how to take urgent action. Williams says this knowledge translates into saving lives in a high-risk community like Harlem.

"Imagine that fourth, fifth and sixth grade children, through a hip-hop intervention, were able to do what most people can't do in the setting of that drama and that trauma," said Williams at the Skoll World Forum held in Oxford, England, last month at a session devoted to the 50th anniversary of the musical genre. "And that's the power of hip-hop."

A year later, the organization Hip Hop Public Health was born, co-founded by Williams and Fresh.

In this anniversary year, Skoll wanted to call attention to this lesser known part of hip-hop history — which continues to thrive in 2023 with new rhymes and expanded programming for young people.

Music has the power ... in medicine

Williams, now a neurologist at Columbia University, says that music has a role to play in medicine generally.

"Music helps us to learn, music augments our memories, music lowers our stress," he explains. "We use it for agitated patients with delirium — we use music to calm them down instead of using restraints. For patients with a stroke, we use melodic intonation therapy to help them to speak," which refers to hitching spoken words and phrases to different pitches and rhythmic patterns to restore speech.

"Music has powerful neurological effects on our brains," says Williams.

The team at Hip Hop Public Health says that hip-hop offers something extra when it comes to the information they're trying to relay. Darryl "DMC" McDaniels, a hip-hop pioneer formerly in the seminal group Run-DMC, says "it speaks in a youthful, fun, understandable way" while packing the intensity of punk rock or rock and roll.

There's something universal about hip-hop, says DMC, who serves on the advisory council of Hip Hop Public Health: "Old, young, white, Black, even if you don't understand English, you can relate to the feeling of it. Everything about hip-hop uniquely has a way to inspire people into transformation."

He admits this isn't a new revelation. At the Skoll World Forum, DMC, egged on by Williams sitting beside him, bet that everyone in the audience had learned something fundamental through "one of the greatest hip-hop songs in the history" — the singsong ABC song. He took his mic, sprung to his feet, and launched into the alphabet song, concluding with, "Now you know your ABC's!" Reacting to the applause, he shouted, "You know what I'm saying!?"

Using his nickname for Williams, DMC added, "So Doc is just taking what was already being done and applying it to where it was needed."

And while Hip Hop Public Health focuses on the U.S., international hip-hop artists have infused public health messaging into their music as well. For instance, in 2014, three Liberian musicians — D12, Shadow and Kuzzy of 2 Kings — created an inadvertent hit of a song called "Ebola's in Town." As NPR reported at the time, "Within three days it was all over the country and had inspired an original dance where dancers mimic kissing and hugging from a distance — a way to keep safe from infection in a country where people love to embrace when they meet."

At the Skoll World Forum, rapper Sister Fa pointed to the human rights issues of female genital mutilation and child marriage in her country of Senegal. She said most people didn't like discussing these subjects — publicly. So she turned to hip-hop "to build a better world." She said, "I decided to use my voice, to use my music to talk and to try to break the taboos around this practice."

Ali A.K.A. Mind, a Colombian rapper on the same panel, added through translation, "We're trying to use hip-hop as a vehicle for transformation — not just of the individual but also communities themselves."

Still, this fusion of hip-hop and public health wasn't always easy for Williams to sell, especially at the outset. When he was starting Hip Hop Public Health, he says, he heard concerns about the "negative force" expressed in some hip hop — "misogyny and homophobia and materialism and toxic masculinity."

But Williams recognized that hip-hop was invented to be a force for good. "Hip-hop was created to uplift people, as a cathartic vehicle for folks to release their pain and their tension and their suffering. It was used to tell the story of the streets: 'Look at what's happening here. Look at what we are enduring. We need the world to stand up for justice and equality and equity for our community.' That was what catalyzed the rise of hip hop."

It was these constructive elements "of social activism, of social justice, of lifting people up" that Williams sought to leverage, particularly within communities of color and underserved populations. And artists like DMC were eager to be a part of what Williams was building. "If hip-hop could tell people how to dress, what to drive, what to smoke, what to drink and how to act," says DMC, "why couldn't hip hop tell people how to live?"

Stoked by 'Stroke Ain't No Joke'

"Stroke Ain't No Joke" was the first in what would become a series of hip-hop tracks using the musical genre "to build health literacy and ultimately support behavior change," says Lori Rose Benson, the CEO and executive director of Hip Hop Public Health.

The organization has created more than 200 resources to date ranging from music videos to lesson plans to educator toolkits on topics including nutrition, mental health, physical activity, dementia, oral health, vaccine literacy, and disease prevention.

"We are currently in the process of concluding a randomized controlled trial look at dementia awareness in communities of color, specifically trying to destigmatize dementia," says Williams. "And we've created an acronym that helps recognize those symptoms of dementia."

Benson says her team then works with school districts and community-based organizations to get these materials into the heads and hands of K-12 students across the country.

"So it's really comprehensive," says Benson, "so that educators can help integrate this into health education in schools and after-school programs, museums, libraries — anywhere that young people are served."

When necessary, Hip Hop Public Health works to update its content. For instance, since "Stroke Ain't No Joke" debuted, the recommendations around stroke detection and prevention have expanded. Originally, the acronym was FAST, which stood for a drooping of one side of the face, a numbness or weakness in an arm, slurred speech or difficulty speaking, and ultimately, if you notice these symptoms, it's time to call 911.

But two new letters have since been added to the start of the acronym to form BE FAST. Public health professionals now recommend looking out for balance problems and trouble with the eyes like blurred or double vision. That required Hip Hop Public Health to create an entirely new track and accompanying animated video, which was posted on May 8 in honor of National Stroke Awareness Month.

Living in a vegetable-free zone

Dr. Naa-Solo Tettey, the director of an education and empowerment program for cardiac health called HeartSmarts at New York Presbyterian Hospital, applauds the work of Hip Hop Public Health. She says that it "empowers young people to be focused on their health and wellness" at an age when their peers generally have other concerns.

Tettey also acknowledges one potential drawback. After motivating a young person to make changes to improve their health, she says they might think, "'OK, I just learned in hip-hop ed that I should eat more fruits and vegetables, but I can't find that where I live.' Or, 'I've been told I need to exercise more, but perhaps I'm not comfortable walking outside where I live.'"

In other words, Tettey points to societal issues that may make altering one's behavior more difficult than a song suggests. For instance, she says that parents, who may just be "trying to put dinner on the table," may find it challenging to serve more fruits and vegetables and fewer fried foods.

But Tettey says these difficulties pale in comparison to the good that the program is doing. She says, "it's a consciousness raiser, which means it makes you start thinking about something. And to start thinking about these things at a young age is just amazing."

For hip-hop artist DMC, these hip-hop songs transform what might otherwise be ignored or disregarded into something that matters. "We make the good and necessary things cool," he says. "For instance, we can make going to get a colon checkup cool."

"The only reason this really works is this is not the Biden administration trying to make rap songs," says DMC. "The reason why it's working — you got Chuck D, DMC and Dougie Fresh. 'Nough said."

"We take the data, and then instead of making it sound like it's coming out of a medical book," he says, "we translate it."

DMC says hip-hop has been in that important business of translation for years.

For example, at the Skoll World Forum, when he was asked about the genre's relationship with mental health, he referred to the 1982 song "The Message" by Grandmaster Flash and the Furious Five. He called out the lyrics, "Don't push me cause I'm close to the edge / I'm trying not to lose my head."

(In fact, a year after "The Message" was released, it spurred a PSA that encouraged people to cross the street safely with this refrain: "Don't step out when you're close to the edge / Stop, look, listen, think, and you won't lose your head.")

Williams took the original lyrics of "The Message" one step further. "We can put safety nets in our communities and hope people don't fall through the cracks," he said to the audience at the Skoll World Forum. "We can put ambulances at the bottom of the cliff and whisk them off to the hospital. We can put fences at the edge of the cliff and hope people don't fall down. But what we really need to do is move those folks further away from the cliff so they're not at risk of falling."

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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