Major disparities exist between the health status of the overall population of the United States and that of its socioeconomically disadvantaged groups, especially African Americans, Hispanics/Latinos, American Indians, and Pacific Islanders, as shown by health survey analyses (H. Freeman, Journal of the National Cancer Institute, 83:525-7, 1991; C. Baquet et al., J. Natl. Cancer Inst., 83:551-7, 1991; M. Angell, New England Journal of Medicine, 329:126-7, 1993). The most striking health discrepancies involve shorter life expectancy as well as higher rates of cancer, birth defects, infant mortality, asthma, diabetes, and cardiovascular disease.

A recent county-by-county study of the U.S. population demonstrated that life expectancy was decreased by as much as 15 years in those communities experiencing the most severe poverty (C. Murray et al., U.S. County by County Pattern of Mortality by Race, 1965-1994, Harvard Center for Population and Development, 1997). This is particularly...

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