TWENTY-EIGHT-YEAR-OLD Jack Perkins has lifestyle choices middle-class people take for granted. From his home in Valencia, it's walking distance to both a Whole Foods and a Vons supermarket.
He exercises daily -- lifting weights in his condo's workout room or jogging through safe, quiet, meandering streets. "It's almost like it's designed for runners and walkers," he says.
Maria Sahagun's Huntington Park home has bars on the windows and doors, and the 61-year-old doesn't venture far on foot.
Her neighborhood has a hefty supply of mom-and-pop food markets where the variety of chips and sodas vastly exceeds that of fruits and vegetables.
Robberies in her neighborhood are 75% higher than the county average, so she walks on busy Pacific Boulevard only in daylight, and never alone.
Perkins, who has health insurance, and Sahagun, who does not, both have diabetes. He has Type 1, and since childhood his pancreas has not been able to make insulin; she has Type 2, and can no longer make enough insulin nor properly respond to it. For each, the disease means using insulin, medications, diet and exercise to do the work the pancreas cannot do.
Diabetes is afflicting more people, at younger and younger ages, sending doctors, insurers and public health officials into a tizzy as the epidemic threatens to overwhelm the healthcare delivery system. The annual cost of healthcare for an adult with diabetes is more than $13,000, and rates of Type 2 have risen sharply in the wake of the upsurge in obesity in this country.
A bold experiment is unfolding in Los Angeles County that may serve as a lesson for the nation as it battles the epidemic.
Experts know that the cost of care could be much lower if patients could take simple measures to control their disease and avoid complications: nerve damage, amputations, heart disease, blindness, even death. But surveys show that many, even those with adequate health insurance, do not get that care, which is costly and labor intensive, demanding daily attention from patients and timely responsiveness from doctors.
Poverty creates additional obstacles, such as finding fresh vegetables or a safe place to exercise. Study after study shows that low-income people have less access to healthcare and a greater risk of getting sick and dying prematurely.
