One City, Two Worlds (In Practice) (Report‪)‬

The scenario is becoming achingly familiar to me: a woman in her fifties with no health insurance suffers a stroke. With luck, it is a small stroke--a "warning sign." But the patients I'm likely to see as a rehabilitation physician are usually not that lucky. The stroke is invariably large, causing significant disability. And the other familiar part of this scene? While treating her, I discover, unbeknownst to the patient, that her blood sugar and blood pressure are out of control. Undoubtedly, the undiagnosed hypertension and diabetes contributed to the stroke. So what's the back story? Perhaps she works a job that doesn't provide insurance, or she can't afford the premiums. She has mouths to feed, rent to pay, and bills. She's raising her children in a violent neighborhood where the public schools are inferior, receiving a little over half of the tax dollars per student that the wealthier suburban schools do. She takes three buses to get to work. Her neighborhood has no grocery stores with healthy food, only fast food and liquor stores. Preventive health care is not an option.