To overcome racial disparities in health care, Americans must also overcome racism, said health policy analyst Curtis Dance during a panel discussion on racial influences on health care.

"We can't make progress unless we make waves," he said.

Dance was one of five panelists that spoke in the Starr Auditorium in the Kennedy School of Government (KSG) during the discussion "Closing the Gap: Eliminating Racial and Ethnic Health Disparities," part of the second annual African American Labor Leaders Economic Summit.

Stephanie J. Woolhandler, associate professor of medicine at Harvard Medical School, described the decline in average health care coverage in the past few decades.

According to Woolhandler there has been a steady increase in the number of Americans without health insurance. This year 44.3 million Americans are uninsured, many of whom are employed, lower-income adults.

The increase in for-profit medicine, such as health management organizations (HMOs), has also hurt both those with and without insurance, she said.

"The quality of for-profit medicine is lower than that of non-profit medicine," Woolhandler said. "In HMOs, there are incentives for cutting back care. There is a lot of dissatisfaction driven by the fact that HMOs don't want to enroll sick people."

She said the United States is one of the few Western countries that do not provide universal health coverage for all citizens, and Americans pay 40 percent more for their coverage than do citizen of most other developed nations.

Many of the 44.3 million uninsured citizens are black Americans and other minorities, said David M. Cutler '87, Loeb professor of social sciences, who spent a year working for the Clinton Administration.

On average, he said, white patients, who tend to be wealthier, live longer.

"Economic status is clearly related to health," Cutler said. "But even people who are very well insured don't necessarily get the care they need."

According to Dance, who works for the American Federation of State, County and Municipal Employees (AFSCME), a history of racism and mistreatment of blacks is reflected in the lack of trust many black people have toward the medical profession.

Blacks are more at risk for many health issues as well, Dance said. For example, he said, 50 percent of black women are obese, 40 percent of black women have a higher risk of dying of heart disease than do white women and black men under 65 are twice as likely to get prostate cancer as their white counterparts.

Racism and mistrust have left a persistent legacy, he said.

Dance spoke of the Tuskegee experiment, in which 412 black men remained untreated for syphilis from 1932-72, even after penicillin was widely used as a cure, as part of a government experiment.

After showing a clip from an ABC Prime Time Live piece from February 1992, Curtis said that doctors should be trained to be culturally sensitive, and that there is a need for more black doctors.

"African-American doctors understand the cultural, social and economic issues in the black community, and that is essential for providing crucial services," he said.

Stephen Thomas, a professor at Emory University, said the lasting effects of the Tuskegee experiment are real. The effects are visible "when black folks come in late for necessary treatment or don't take medicine, even in the face of treatment that works," he said.

The Tuskegee experiment has become a metaphor and code word for the mistreatment of black people in the medical profession, Thomas said.

But to close the health care gap, black people must move beyond their own painful past and cooperate with health care officials, he said.