The twentieth century ended with an extraordinary record of achievement in improving the health of Americans and the health care system that serves them. The average life expectancy of aU.S. citizen improved from forty-nine years at the start of the century to nearly eighty years at its close. The U.S. infant mortality rate fell by more than 90 percent between 1915 and 1977. Many communicable diseaseswere either eradicated or greatly reduced because of the widespread availability of immunizations and improvements in sanitation. The latter half of the century witnessed equally important health improvements arising from public policy interventions that affected both health and health care systems, and from community action, including a demonstrated reduction in tobacco use and an increase in the use of seat belts and bicycle helmets. But while the story of public health and medical achievement in the United States is truly a remarkable one, it also includes a metaphorical tale of two cities. Although public health and medical progress have proved beneficial for many, the evidence also indicates that Americans of color are less likely to reap the benefits of these remarkable achievements. And although there are demonstrated correlations between racial/ethnic background and socioeconomic status, poverty alone cannot explain some of the gaps in health and health care that exist between minorities and the white population.