In 1995, approximately 49 million people (20 percent) in the United States lived in a household that had at least one difficulty in meeting basic needs, such as the inability to meet essential living expenses (e.g., pay utility bills, mortgage, or rent), buy food, or seek medical or dental care when needed (Bauman, 1995). Approximately 5 percent of American households reported that members sometimes did not have enough food to eat, while nearly 20 percent reported either not having enough food or the kind of food they wanted to eat (Bauman, 1995). Income, ethnicity, age, gender of householder, health insurance coverage, and Hispanic origin were among the major risk factors for not having enough food to eat.

The burden of death and disease frequently falls most heavily on some ethnic groups and on those with lower levels of education and income. The age-adjusted rates for the leading causes of death among men and women in the three largest ethnic groups (non-Hispanic whites, non-Hispanic Blacks, and Hispanics) are shown in Tables 1-1 and 1-2 (Centers for Disease Control and Prevention, 2001).1 These tables show that the highest rates among all groups are for heart disease and cancer. However, significant variations exist. Non-Hispanic white and Black males and females have significantly higher rates for these two diseases than Hispanics. For the most part, Hispanics have significantly lower rates across all leading causes of death. Male non-Hispanic Blacks have the highest rates of death for several diseases, including heart disease, cancer, cerebrovascular disease, and diabetes. Furthermore, the disparities among these groups increase with age; for example, the difference in mortality rate between Black and white males is three times greater at age 65 than at age 45.

Table 1-3 shows the age-adjusted death rates for four major causes of death from cancer for whites, African-Americans, Hispanics, Asian Americans/Pacific Islanders, and Native American


Age-adjusted data were not available for Asian Americans/Pacific Islanders and Native Americans, perhaps because these groups are small and the data are judged to be unstable.

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