Charles Dickens’ novel “Hard Times” focuses on the struggles of urban workers in 19th century England. The situations of workers in 21st century America are not dissimilar thus making Dickens’ commentary and characters applicable to the contemporary socioeconomic scene. The number of uninsured or underinsured poor in America is rising. AHCs must go beyond their traditional mission of patient care, education and research and embrace the local neighborhoods they serve. The urban location, technical expertise, and educational mission of many AHCs make them ideally suited to assist urban populations that are at great health risk. Many Academic Health Centers (AHCs) in America found their origins in working class neighborhoods, such as those described by Dickens, and today are surrounded by the urban poor. An argument is made that AHCs have a moral obligation to these neighborhoods; it is an implied, or covert, covenant that they are obliged to honor.



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