POOR HEALTH COVERAGE COSTS ALL AMERICANS.

Byline: Angela Glover Blackwell and Robert K. Ross

GROWING poverty and unaddressed racism are hitting all Americans where they take notice: their wallets.

Employers and workers are strained by health-care costs that outstrip the rate of inflation, while Americans in the urban and rural slums suffer from poorer health and die earlier than their affluent counterparts, who are mostly white.

The poor health conditions of many low-income and people of color cost the U.S. billions of dollars annually in medical treatment and lost productivity. These disparities pose a serious economic threat to maintaining a globally competitive U.S. - reason enough to merit swift and comprehensive national policy change.

Health spending in 2003 was $1.7 trillion, topping 15 percent of our nation's gross domestic product, but this has not translated into better health care for all. People of color and those of low income continue to be plagued by higher rates of diabetes, AIDS, asthma, heart and kidney disease, cancer and other serious conditions.

And we all pay.

There are two accelerating trends that will bring disparities in health care to a head: First is the growing number of people of color, estimated at 40 percent by the year 2010, and 50 percent by 2050. Given these projections, these disparities in health status pose a productivity deficit for the U.S. in an increasingly competitive global market.

Second, as health care costs continue to skyrocket, the millions with poor health and limited access to health care push costs even higher. The number of expensive emergency-room visits, hospitalizations and other long-term disabilities stemming from preventable and treatable conditions worsens each year.

The Institute of Medicine, which advises Congress on medicine and science, released a 2002 report, ``Unequal Treatment,'' which outlined measures that would close the quality-of-care gap. They include better collection of racial and ethnic health care data; higher awareness of the problem by health professionals; and producing greater numbers of health professionals from racial and ethnic groups.

Providing health care services that are responsive to the needs of diverse populations is critical to effective health care for all.

But researchers say that we must also look beyond medicine. A December 2004 study on African-American health, in the American Journal of Public Health, found that ``socioeconomic conditions represent a more pertinent cause of disparities than race.'' It questions ``whether more lives are saved by medical advances or by resolving social inequities in education and income.''

The likelihood of developing obesity - and subsequently, Type II diabetes - is greater if the neighborhood has no safe place to exercise or play and no grocery stores offering fruits and vegetables. Someone residing next to a toxic-waste dump or on a diesel-truck route has a much higher chance of being exposed to carcinogens and asthma triggers.

In the face of these adversities, policy and community building that emphasize prevention show the most promise.

In New York City, the Harlem Children's Zone Project demonstrates that health and well-being of children in poor neighborhoods can be improved. The project includes an asthma initiative, neighborhood revitalization and family empowerment programs.

In South Los Angeles, the Community Coalition shows that mobilized neighborhoods can improve accountability in schools and rid the community of troublesome establishments - such as liquor stores and seedy motels - that breed violence and drug-dealing.

The conditions that beget economic and racial disparities are complex. One clear way as a nation to demonstrate our commitment to social justice and improve overall health is to duplicate these community-building efforts. Healthy Americans will forge an economically healthier America.