DESPITE increases in expenditures and expansions of many US health and social welfare programs and institutions, racial disparities persist in many aspects of American society. Particularly troubling is the reality that the health of our nation's population differs so greatly by race. A number of studies in recent years have documented substantial differences between white and African Americans in health status, morbidity and mortality, access to health services, and perceptions of quality in health care services received.1-9 Consistent with these reports of differences in overall health, national opinion surveys show that African Americans are more likely than whites to rate the health services in their communities as fair or poor (46% and 23%)10; our study also indicates that African Americans are more likely to state that the health system in this country needs to be completely rebuilt (42% vs 31%). This disparity between the assessments of African Americans