There is indeed a health care crisis in this country. More than 47 million people go without any care at all, and others spend an inordinate amount of time and money trying to meet their basic health care needs. Health care reform is a part of every politicians stump speech, but here's a critical part of the story that never quite makes it onto the campaign trial. Most politicians and others consider economic factors to be the significant determinant of access to health care. The stats, however point us to a complication in such conventional thinking—race.

The Kaiser Family Foundation published a report in February which demonstrated that the infant mortality rate is more than twice as high among African Americans as among whites. Death from heart disease is highest among African Americans, as is mortality from breast, lung, and colorectal cancer. Even sudden infant death syndrome strikes black babies at higher rates than it does infants from any other groups.

The New York Times published a story that reported these trends:

In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.) The overall jump in Mississippi meant that 65 more babies died in 2005 than in the previous year, for a total of 481.

And this week, The American Prospect published an interview by Madeline Drexler with David Williams, sociologist and professor at the Harvard School of Public Health. Ms. Drexler asked Professor many questions; here are a couple of the most telling:

What statistic that relates to health disparities do you consider to be the most appalling? Is it the black/white gap in life expectancy? Premature mortality? Infant mortality?

The single example of health inequality that's most dramatic to me is what occurs when we look at racial-ethnic differences and, at the same time, at measures of socioeconomic status. For multiple indicators of health, the most advantaged or the best-off African Americans are doing more poorly than the worst-off whites.

A good example to make that concrete: African American women. According to national data, African American women aged 20 years and older with a college degree or more education have higher rates of low birth weight infants, and higher rates of infants who die at birth, than do white women who are high school dropouts. Remember: These are the African American women who are doing the best.

Why is it that the best-off African American women are doing worse than the least-off white women? It exists for infant mortality, birth outcome, obesity, hypertension.

And you've written that medical care may be crucially important to vulnerable populations. Why?

Because in the context of great vulnerability, when facing lots of deficits, medical care can become an important health-enhancing resource. Especially medical care that takes a holistic view of the individual.

An example of that is prenatal care. For the average middle-class woman who is doing well in terms of her nutrition and her lifestyle in taking care of the baby, prenatal care doesn't add much. But it can add a lot for a poor woman who was already in poor nutrition—it could provide dietary supplements and, by monitoring, identify a potential risk.

More and more people are becoming wise to these trends, yet as the reports pour in, little seems to be changing. In an excellent article, Kai Wright for ColorLines magazine tracks the progress following the National Healthcare Disparities Report. Conservatives acknowledge and even condemn the disparities documented therein, but where their analysis falls short however is in the proposed solutions to this problem. From Wright's article:

For three decades, conservative thinkers have worked mightily to discredit race-based considerations in public policy and cement the belief that America today is, as it should be, a colorblind society. "It really begins in the early '70s," says Bard University sociologist Amy Ansell, author of New Right, New Racism. "Conservatives believe that with the civil rights movement the barriers were brought down, and that's when racism ends. At that point, government and society have nothing more to do."

Professor Williams' research has demonstrated that this is effectively incorrect reasoning and that, in fact, by focusing on individual risk factors we miss the real problem. Those individual risk behaviors, like exercise and smoking are relevant but do not account for most of the social inequalities in health. Instead, Williams calls on us to think about the ways in which the larger social environment affects whether it is possible for individual people and families to lead a healthy lifestyle at all.