SHALALA SEEKS TO CUT HEALTH GAP BETWEEN WHITES, BLACKS IN U.S.

ATLANTA -- Decades after the civil rights movement forced America to
confront racial inequities, disturbing disparities remain on one of
the most basic human levels: Blacks get sick easier, stay sick longer
and die sooner than whites.

``We have been -- and remain -- two nations: one majority, one
minority -- separated by the quality of our health,'' said Secretary
Donna Shalala, whose Department of Health and Human Services has
launched a $400 million program to attack the problem. ``The time has
come to stop accepting disparities with resignation.''

Shorter life expectancy

From day one, a black baby's life expectancy is 6 1/2 years shorter
than a white baby's. Blacks are more likely to be born too small and
less likely to survive their first year.

At work and in schools, blacks have made impressive gains. Poverty has
fallen. Still, disparities in health remain and in some cases are
worsening -- even among middle-class blacks with health insurance and
college degrees.

Asthma, hypertension, cancer. Name the disease and chances are blacks
face a higher risk. They're nearly twice as likely to die of a stroke
than whites, 40 percent more likely to die of heart disease. Blacks'
cancer death rates are 35 percent higher.

Other racial minorities also face disparities -- Vietnamese women have
five times as much cervical cancer, and American Indians have twice as
much diabetes as whites. But among African-Americans, the gap cuts
across nearly every major disease.

It's 9 a.m., and 26 people wait at the West End Medical Center in a
poor part of Atlanta.

``We're in the trenches here,'' says Dr. Miguel Stubbs, who like most
of the staff and patients is black.

On the first floor, pediatricians give immunizations with a shot of
advice about reading aloud to children. Upstairs, nutritionists
counsel diabetics to avoid sugar. Midwives encourage pregnant women to
stay away from cigarettes.

The problems are multifaceted. It's poverty and the poor access to
care that comes with it. It's nutrition. And it's a health system that
blacks don't always trust -- and that's not always
trustworthy.

Standing in West End's gray hallway, Lillian Boodle waits to talk with
a nutritionist about her diabetes. She doesn't always take her drugs
because they're so expensive.

``I take it one day and not the next,'' she says. ``I don't discuss it
with the doctor because I know he wouldn't agree.''

It's not unusual for poor patients to take medicine every other day to
stretch out a prescription, doctors say. And blacks are more than
twice as likely as whites to be poor and nearly twice as likely to be
without health insurance.

Still, health problems go beyond the ability to pay. Latinos are less
insured and poorer as a group, yet the health gap between Latinos and
whites is not as dramatic.

In fact, health disparities persist even among blacks who are in the
middle class. Health improves for all races as income and education
increase, yet the gap between blacks and whites remains.

Societal stresses

Why? Public-health experts note that even middle-class blacks face
extra stresses of living in a white-dominant society that still
contains racism.

And they suggest that some middle-class blacks may have grown up poor,
with early influences still affecting their health.

``You're never dealing with a person just today. You're dealing with
everything they've been exposed to throughout their lives,'' says the
nation's surgeon general, Dr. David Satcher. ``Does it ever end? Our
hypothesis is that it never ends.''

Checked-by: Patrick Henry