Patients begin lining up outside Capitol City Family Health Center before the doors open at 7:30 a.m.
The clinic, on a ragged stretch of the boulevard that separates the black and white sections of town, is a refuge for thousands of this old southern capital's poorest and sickest residents. They come seeking relief from diabetes, heart disease and other debilitating illnesses.
Twelve hundred miles up the Mississippi River, in the shadow of a public housing tower in St. Paul, Minn., the waiting room at the Open Cities Health Center also fills daily with the city's poorest.
But the patients in Minnesota receive a very different kind of care, which leads to very different outcomes. They are more likely to get recommended checkups and cancer screenings. If very ill, they can usually see specialists. Their doctors rely on sophisticated data to track results.
Diabetics at the St. Paul clinic are twice as likely as those in Baton Rouge to have their blood sugar under control. That can slow the onset of more serious problems such as kidney failure and blindness.
Young patients with asthma also benefit from Minnesota's more comprehensive medical system. Asthmatic children in the state's poorest neighborhoods are 37% less likely than those in Louisiana to end up in a hospital.
"Being low income doesn't destine you to poor healthcare. Where you live matters," said David Radley, a health policy expert who has led several studies on geographic disparities in medical care for the Commonwealth Fund, a nonpartisan research foundation that analyzes healthcare systems.
The extremes in America's health system are striking. In some U.S. communities, people live longer, healthier lives than the residents of Europe's wealthiest nations. In America's least healthy regions, premature death and disease are as common as in parts of Asia and Latin America.
President Obama's health law, which takes full effect this year, was designed to narrow some of the disparities by expanding coverage and providing new tools for improving quality. But with some states embracing the law and others resisting it, the gaps in health from one region to another are poised to widen.
What makes a community healthy?
Poverty and wealth are part of the answer. How much schooling people have, what they eat and whether they smoke also play a role.
But so do decisions by doctors, hospitals, business leaders and elected officials about what local health systems should do. A review of data from the nation's 306 healthcare markets, as well as interviews with scores of experts and visits to communities from Maine to Hawaii, points to many common features of America's healthiest places.
More people have health insurance. Doctors and hospitals cooperate more closely, ensuring patients get preventive care and don't fall through the cracks. Civic and business leaders help drive community efforts to expand access to healthcare, measure results and improve quality.
Those ingredients are often missing in places such as Baton Rouge, where a poorly organized health system joins poverty, low education and bad diet to form a toxic mix.
"Nearly every day, I am seeing families who need the help of doctors, and it's just not there," said the Rev. Melvin Rushing, an engineer who left a career in the petrochemical industry to become a pastor. He leads two African American congregations not far from the clinic.
Built on a bluff on the Mississippi River 80 miles from New Orleans, Baton Rouge began as a port town where sugar cane and cotton were shipped from nearby plantations. Grand antebellum homes shaded by towering live oaks still line the river to the north and south.
Today, an ExxonMobil refinery, one of the nation's largest, and the growing Louisiana State University and state government campuses give the area one of the region's few diversified economies.
But large pockets of poverty remain. Empty lots and homes listing on their foundations scar neighborhoods around Capitol City Family Health Center.