There is overwhelming public health data on the increased incidence of many common diseases in underserved communities, as well as a lack of healthcare access and proper treatment. We as neurocritical care experts know that 795,000 individuals have a stroke each year, making it the fifth leading cause of death in this country. Statistics also show that African Americans are at greater risk than other groups. It is known that African Americans are at a fifty percent higher risk of having a stroke and suffering from cerebrovascular disease as compared to white adult counterparts. Black men are at the highest risk, with as much as a seventy percent increased risk of dying from a stroke as compared to non-Hispanic whites. About fifty-five percent of Black adults have hypertension, and Black Americans also have disproportionately higher rates of severe hypertension that develops at an earlier age. Many variables contribute to these horrible statistics, including lack of access to medical evaluation and lack of access to medication. Historical distrust of health care professionals based on past discrimination is also among the contributing factors.

We in Neurocritical care unfortunately meet these underserved individuals under our care in the ICU late in the disease process. We should make it an object of our core goals to help all underserved populations in our community. In caring for these patients we also meet family and friends, which can be an ideal opportunity to develop relationships that can aid our patients and community as a whole. Our ICU teams are multidisciplinary and can help in many different ways, as we are made up of physicians, mid-level providers, nurses, pharmacists, social workers, and therapist--all experts in the care of stroke and hypertension.

We can impact these communities by acting in two ways. First, we can take a grassroots approach and go out directly into these underserved communities, providing education and resources on an individual level with the goal of eventually achieving larger-scale societal effects. Second, we should act as advocates for underserved populations at our local hospitals and institutions as well as through our professional organizations.

Here are some simple things we can do:

• Go out and provide talks to church groups and community centers on the risks of hypertension and strokes.
• Volunteer at hypertension screening clinics.
• Establish follow-up procedures with unit pharmacists to ensure that patients have access to medications.
• Insist that our hospitals open clinics and provide health care professionals to underserved areas.
• Advocate for a robust visiting nurse service to be able to visit at-risk patients in their homes.
• Provide education days at local high schools, both to educate students on the dangers of hypertension and stroke and to recruit young people to the many health professions.
• Insist that our elected leaders provide resources and services to these communities.
• Volunteer to give interviews to local media outlets on this topic.

By doing these simple things, we can extend our impact to improve the lives of millions of our fellow citizens. This is, after all, why many of us joined the medical professions and decided to work in neurocritical care.