And I could go on, but what these disparities tell us is that today being a member of minority group in America can be hazardous to your health. This is the story of race in America -- not rhetoric -- but a tragic story of opportunity lost and of dreams unlikely to be fulfilled.

I wish I could tell you the one reason why that's true. But we really don't know all the reasons. Instead, there's a series of factors which, together, may have conspired to create these two different Americas.

My friend, the physician Dr. Reed Tuckson, who is Vice President of the American Medical Association, summed it up best when he said, "health is the place where all the social forces converge." He goes on to say that, if we want to respond to racial disparities in health, we must do better at understanding them.

That's why I'd like to speak for a moment about some of these social forces that may play into this crisis -- this American tragedy.

Medical research long ago told us that your risk of an early death rises as your standing in the social hierarchy falls. That's why public health professionals say that income is one of the strongest, single predictors of mortality.

Well, the fact is that despite the incredible economic gains America has made over these last six years, African- Americans and Hispanics are still about twice as likely to live in poverty as other citizens.

They're more likely to go to work at lower paying jobs where they run a higher risk of exposure to toxic chemicals and other dangerous working conditions. In fact, African Americans have the highest rate of work related injury-death in our country today.

And, after work, they're more likely to come home to dangerous communities -- and homes. Let me share a statistic with you. In 1996, the homicide rate among young white men was just over 6.4 deaths per 100,000. But it was more than double that for Asian Americans. Four times as high for Native Americans. More than seven times higher for Hispanics. And for young black men in America the homicide rate was almost 20 times greater than it was for whites.

But poverty also breeds a more subtle kind of violence. It's the quiet violence of living much nearer hazardous waste facilities than other Americans. It's the quiet violence of raising your child in a home where there's lead-contaminated paint. And it's the quiet, but no less deadly, violence of AIDS: now the leading killer of black men and the second leading killer of black women in America. And, mind you, this is true even though the overall rate of HIV infection in this country has declined sharply.

But what numbers like these can't truly measure is the depth of despair and hopelessness among so many in our minority communities.

There's a story of a seven-year old girl who once told her mother: "I want to be buried in the blue dress when I die, so I'll look pretty for you."

Then there's the mother of a black male teenager who wrote," I've gone from hoping he'll win a Nobel Prize to hoping he'll survive his walk to school."

Against this backdrop, is it any wonder that so many in our minority communities tell us that what they face isn't a health problem, but a health catastrophe in the making? This story of race and poverty in America -- must it be deadly?

In this magnificent house of worship it is well to remember Ecclesiastes: "the poor man's wisdom is despised, and his words are not heard."

Well, for the sake of our beloved country, I think it's time we all begin to listen.

Poverty is only one of the elements that may play into this crisis. There are many others and one of the most important may be access to health care.

We know for a fact that racial and ethnic minorities are more likely than whites to live in areas underserved by our health care system.

And this isn't just a question of income. In fact, a study in the New England Journal of Medicine found that poor African American and Hispanic communities had roughly 2/3rds as many physicians as poor white communities. And part of what cntributes to that is that we don't have enough minority doctors.

Now, some people don't accept that. They'll tell you that a doctor is a doctor and race shouldn't make a difference. And they're right: it shouldn't . . . but in truth -- it does. It makes a difference when you take into account the fact that African American, Asian American and Hispanic physicians are far more likely to treat Medicaid or uninsured patients than white physicians from the same area.

Nearly half of the patients seen by African American doctors are patients who are either on Medicaid or uninsured. That's why it matters that only five of every 100 doctors are Hispanic and only four of every 100 are black. Because we know from experience that those are the physicians most likely to provide the care African American and Hispanic families desperately need. But access isn't simply about having physicians to go to; it's also about being able to afford to pay them once you do.

Today, more than 43 million Americans are uninsured. It's been estimated that more than a quarter million of them are children right here in Ohio. This is our shame -- as communities and as a country. Most of the children without health insurance come from working families whose incomes are too high to qualify for Medicaid, but too low to afford private health insurance.

Now, ask yourself this: what happens when there's a shortage of physicians coupled with a high number of uninsured - many of them children? You find families with nowhere else to go but hospital emergency rooms.

That's why, today, African American families are more than twice as likely to turn to emergency rooms for what should be routine health care as white families. It's not convenience. It's not quality. It's that there is nowhere else to go.

Back in the 1970s Susan Sontag wrote "everyone who is born holds dual citizenship in the kingdom of the well and the kingdom of the sick." I'm tempted to believe that if she spent some time in a big city hospital these days, she might say she was being optimistic. But, again, it isn't just a crisis of access. It's also a crisis of education.

The vast majority of health problems I've mentioned up to now -- problems like heart disease, prostate cancer, cervical cancer, HIV, and others -- are, in large part, preventable and treatable.

For example, we know that early detection and screening can reduce the risk of death from breast cancer by almost one-third -- and that it can nearly eliminate the risk of death from cervical cancer entirely. But many minority women, especially Black women, have never even had a mammogram or Pap smear.

We face a similar challenge in combating cardiovascular disease -- particularly heart disease and stroke. For instance, we know that minorities have higher rates of hypertension, that they develop it at an earlier age, and that they're less given to controlling their blood pressure once it's diagnosed.

But while hypertension and high blood pressure can be easily treated, there's little anyone can do about it until the individual fully understands the risks they face and the options available to them.

The issue is education. Now, sometimes the problem is obvious. For example, six years ago it was almost impossible to find a single, informational brochure on mammography in this country written in Vietnamese. Now we have not only translated that information into Vietnamese, but also into Cambodian, Laotian, Chinese, Korean and Tagalog, too. But if health education was simply a matter of handing out brochures, we would have won some of our battles a long time ago.

Because what we're faced with isn't just a question of getting information into the hands of people who want it, most often it's helping to let people know that they need it. For example, over the course of ten years here in Ohio, there was a significant increase in the number of low birth-weight babies.

Now, we know that prenatal care increases the chances of a mother giving birth to a healthy child, but we also know that minority mothers are less given to obtaining it. And that holds true whether the mother dropped out of high school or finished graduate school.

And, it's not just babies who suffer. We recently funded a study that found that, over the early years of their babies' lives, the mothers of those children often experience high levels of anxiety and depression. But our challenge goes beyond filling a vacuum; it's also counteracting the public health misinformation that permeates minority communities.

I'm talking about the fact that the beer, wine, liquor and tobacco industries have carpet bombed minority communities with some of the most sophisticated advertising this country's ever seen. And, as a result, they've helped to worsen a health crisis that's already difficult enough to respond to.

Last week, the Centers for Disease Control, the National Cancer Institute and the American Cancer Society released some new statistics. The good news was that, overall, the frequency of Americans contracting and dying from cancer is falling.

But we also found some very bad news, too. It was that African Americans have the highest rate of lung cancer of any group in this country. Not only that, they also had the highest rate of prostate and colon cancer, too.

Now, while economic status and access to health care services may play some role in this, our Surgeon General, Dr. David Satcher, points out that a key factor is lifestyle. It's the simple fact that messages about the importance of a good diet, quitting smoking and regular exercise haven't effectively penetrated minority communities to the extent they need to.

Do we face a crisis in this country? I think we do. It's a crisis we still don't fully understand. And may never fully understand. In part, it may be a crisis of poverty. In part, a crisis of access. In part, a crisis of education and lifestyle. In part a crisis of distrust and fear.

When the practice of medicine is decoupled from the ethics of medicine terrible things can happen. And, in 1932 in Tuskegee, Alabama, they did. In Tuskegee the U.S. Public Health Service conducted an experiment. They allowed 399 African American men with syphilis to go untreated. It was called the "Tuskegee Study of Untreated Syphilis in the Negro Male." Forty years later, despite the discovery of a cure, these men were still untreated. Many died. Some passed it on to their children and wives. And all were scarred. Even more, America was scarred.

Even though the President has apologized we still see that scar today in the mistrust shared by so many African Americans towards medicine and medical research. We must overcome fear and distrust. It is real.

We also see how different aspects of this crisis have worked to reinforce each other. For example, we know that older people who don't feel safe in their neighborhoods are far less likely to exercise than those who do feel safe. By the same token, we also know that, even if the need is there, it's sometimes ineffective to open a health clinic at night if people are too frightened to leave their homes in the evening.

The crisis we face is complex and it's multifaceted.

But, tonight, I want to tell you that it's also a crisis that's within our power to solve. We can close these gaps . . . and it's our responsibility to do so. Challenging racism -- and ending it -- has to be about more than words -- it requires responsible action.

In 1903, W.E.B. DuBois wrote, "the problem of the Twentieth Century is the problem of the color line."

The President has resolved that it not become the problem of the 21st Century. But it will be, unless we close the divide that's created these two Americas. That only begins when we decide it's up to us to make change happen. Last year, we set a goal that's as simple as it is urgent. We said that by the year 2010, America must eliminate racial and ethnic disparities in infant mortality, diabetes, cancer screening and management, heart disease, AIDS and immunization.

And we haven't just talked the talk; we are walking the walk.

We've asked Congress to invest $400 million dollars over the next five years to battle racial and ethnic health disparities. Working with the Congressional Black Caucus, we will invest $156 million on initiatives to expand the fight against the spread of AIDS among minorities.

This President has made it clear that he's ready to back up his commitment. I know because he's also said that it's up to me and Surgeon General David Satcher, to get the ball rolling to make it happen. Now, in the six years I've served as Health and Human Services Secretary, we've tackled a lot of tough issues.

But of all the battles we've taken on - and all the dragons we've slain - I have to tell you, I can think of few more important than closing this racial divide in health.

Congressman John Lewis of Georgia has told us how, in the early days of the civil rights movement, he and other activists would sometimes take doctors to treat black families living in the Deep South. He said that, for most, it was the first time they'd ever seen a doctor.

A lot's changed since then, but too much remains the same. We live in a race-conscious society. A society where racism operates on many levels. It impacts how our institutions function. How we treat one another as individuals -- and how we see ourselves. But no matter on what level anyone experiences racism, it always effects our health.

Neither President Clinton - nor anyone else back in Washington - suffers from any illusion that between now and 2010 we can reverse all the damage that's been done to the health of minorities in America -- and to the health of our country. But we also understand that, if we don't start now, we may not have another chance.

And we understand something else, too: that there's only one way we're going to succeed, and that's if we're all in this together. Not just the federal government, but all of us: business, labor, religion, public schools, universities, city, county, state government. That's something the Tafts have always understood. Black, white, Latino - all of us planning together, all of us working together, all of us building healthier communities together.

Just last fall, my department brought together a cross section of leaders to begin the process of building new partnerships.

There were other examples, too: examples of grassroots activists forming innovative new partnerships to challenge some of America's toughest health problems.

I can think of few communities better suited to promote these kinds of efforts than Cincinnati. Cincinnati was one of the first big cities in America to pass a municipal right-to-know law to help protect people from the health hazards of toxic chemicals. I know that because a number of individuals working at the National Institute for Occupational Safety and Health in this city were involved with that effort.

At the time, some people said it was something that couldn't be done - or shouldn't be done - but the citizens of Cincinnati understood that protecting public health - looking after your neighbor's health - is everyone's business.

You didn't wait for Washington. It's part of your history. Just after the turn of the century, Cincinnatians organized the Babies Milk Fund.

Why? Because this community understood that too many infants were malnourished and that somebody had to do something about it. Again, you didn't look to Washington - or Columbus - you looked to each other and you made change happen.

Well, I want to challenge Cincinnati again. I want to challenge you to work with us to close this racial divide in health. I want to challenge you to work to make this city, and this state, and this country a healthier place for all God's children.

I want to challenge you to stand up the way Charles Taft stood up for the idea that, working together, we can build communities where every family can move ahead and where none of us is ever left behind.

Years ago, Robert Kennedy would sometimes quote George Bernard Shaw who wrote that some "see things that are and say `why,' I dream things that never were and ask `why not."

Tonight, I ask each of you to take a moment to dream. To dream of an America where every young child receives the medical care they need. To dream of an America where every man and woman can see a doctor. To dream of an America where no child would even think to take a gun or bomb to school. To dream of an America where hatred is lost in a sea of caring and new opportunity.

Tonight, I ask you to dream of a Cincinnati -- and an America -- where every family of every race, and every ethnic background is able to enjoy the good health God intended them to have. And before you go to sleep, ask yourself: why not?

Thank you and God bless you.