Local medical professionals and public health officials worry that a bad situation is about to get much worse.

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On a map, the busy urban corridors of Williams Avenue and North Sanborn Road in East Salinas lie only a few miles from the tourist playgrounds of Monterey and Carmel. But they look and feel a world away.

The people who live here are almost exclusively Mexican immigrants, or the children of immigrants. Spanish is the dominant language on the streets and in the shops. Many here live below the poverty line. Countless are undocumented. At the end of the workday, a long line of cars rush in from all sides as men and women who have labored in the farm fields all day return to their crowded homes, apartments and trailer parks.

It is in these neighborhoods where many of the most medically vulnerable people in the County live, according to the doctors and hospital administrators who regularly treat patients here. Here, according to those medical professionals, a health crisis is brewing.

One reason is the lack of access to adequate health care programs. But another is the propensity of poorer ethnic communities to develop illnesses like diabetes and hypertension.

According to a study released this year, Paradox in Paradise: Hidden Health Inequities on California’s Central Coast, nearly one-quarter of adolescents who live below the federal poverty level are overweight, far above the state average. Latinos and African-Americans, the study says, are almost twice as likely to develop diabetes than White residents.

But there is yet another reason for the vulnerability of communities like East Salinas. That has more to do with outlook and attitude than anything else.

Standing on a street corner just south of Alisal High School last week, one person after another came to the fruit and vegetable truck stand operated by Jesus and Rocio Delgado. And one after another, each and every one of the people I spoke to told me that they didn’t have health insurance. The reasons varied.

“As long as I wake up with an appetite, I’m fine,” jokes Delgado, a mustached and portly man who doesn’t remember the last time he went to see a doctor. “I just put my health in God’s hands and hope for the best.”

Later, he admits that he’s a little afraid of what a doctor might tell him. “I know this one lettuce picker who was told by a doctor that he couldn’t eat this, couldn’t eat that,” Delgado says as he turns to his wife, who is handing out change to customers who are filling up on fruits and snacks. “But he looks fine, really, he looks perfectly healthy.”

Later a man shows up on a bicycle. His name is Juan Marquez. He’s in his 30s and says about two years ago he came down with strong pains in his stomach every time he’d eat spicy or greasy foods.

“I went to the Clinica de Salud down the street and paid $260 to get myself checked out,” he says. When asked if he was eligible to be covered by some sort of program that would pay for his costs, he says he is. “But I didn’t take it,” he says, as he half-shrugs his shoulders and looks upward. “I didn’t want to go through the paperwork and do that hassle. I just wanted to get in and get out.”

A little bit later, a 29-year-old mother comes by pushing her 2-year-old daughter in a stroller. While her daughter is insured by Medical, the mother isn’t. “I don’t know why not,” says the woman, who is probably 50 pounds overweight, and admits not having been to the doctor since her daughter was born. When asked if she’s eligible, she says she doesn’t know.

“I feel fine,” she says. “If I feel sick I guess I’ll go to the doctor and find out.”

An 18-year-old man walking by says essentially the same thing. He’s not insured. He hasn’t been to the doctor since he was a kid. And he’s not sure if he’s eligible for health insurance.

To Julie Edgecomb, director of outpatient service at the Monterey County Health Department’s clinics, this attitude is proof that immigrants don’t come to this country to access services like healthcare. If anything, they avoid them as long as possible.

But the responses by these Salinas residents speak to another issue. And that’s that a large number of people are willing to take big risks with their health, usually in order to save time or money or both.

I know this because I’m one of them.

While I earn too much to qualify for most government-sponsored healthcare programs, my wife and I figure we don’t make enough to afford the health insurance coverage available through my company for a family of four. We’ve decided that we’re willing to risk our health for a while until we figure something out. In the meantime, we try to minimize our risks by eating right and exercising as much as we can. And hoping that nothing bad happens.

Dr. John Silva at Clinica says mine is an increasingly common case in the US. He hands me a report called “Gaps in Health Insurance: An All-American Problem.” It says that 46 million people in 2004 (about 11 percent of the country’s population) didn’t have health insurance. More than 80 percent of these were either working Americans or dependents of working people.

What’s more, while low-income families were the most likely to go without insurance, 41 percent of working-age Americans with incomes between $20,000 and $40,000 were uninsured for at least part of the last year, a huge jump from the rate just five years ago.

And yet, even as more middle-income Americans begin to the feel the pinch of having no healthcare coverage, there seems to be little political pressure being put on political officials to do anything about it.

Only 4 percent of voters surveyed by the Public Policy Institute of California said health insurance was a topic they’d most like to see the state’s gubernatorial candidates discuss. That’s far behind topics like immigration, education and the economy.

Meanwhile, people like Gerardo Galban are finding their own way of dealing with the problem.

Standing outside Natividad Medical Center last week waiting to visit a friend in the ER, Galban admits that he is suffering from diabetes and has had no health insurance for the last year.

“I was on disability because of a back problem but then it ran out,” he says. “Basically, I haven’t had any money to buy my medications, so I’m not taking them.”

He says he knows it’s risky. But to compensate, he’s changed his lifestyle.

“I stopped drinking soda, I stopped eating greasy and fatty foods,” says Galban, who is 44 years. “And I’ve been doing whatever exercises I can to keep in shape.”

He says he’s never felt better and that he expects to have health coverage kick in again in a month or so if he lands a construction job he’s been courting for some time.

“There’s not much you can do in these cases,” Galban says as he throws down the cigarette he was smoking—one of his few remaining vices. “But you have to at least try.”