2Care of Blacks and African Americans

The health status of African Americans and other black Americanscontinues to lag behind that of other racial and ethnic groups (1);this persistent disparity and its contributing factors have been ex-tensively described (2-4). Even with societal consensus on approach and sufficient resources, closing of the black-white health status gap is uncertain (5). Furthermore, the relation between blacks and the medical establish-ment has been bittersweet (6,7). Although blacks have enjoyed the im-proved overall survival rates experienced by all races and ethnic groups during the last century (4), they have also suffered morbidity in the name of “medical advancement ” (6). Missed opportunities to establish trust and a therapeutic alliance be-tween providers and African American patients persist. As with any ethnic group, family social structure and influences, geographic distribution, envi-ronmental risks, communication patterns, and lifestyle preferences influence the health beliefs and behaviors of African Americans. Generally, however, African Americans still lack overall confidence in the health care system and believe they are less likely to receive the same medications, treatments, or quality of care as whites (8). Providers must meet the challenge of improv-ing African American health outcomes by directly addressing important issues and building a foundation of trust with the black community. Definitions African Americans are people of African descent who live in the United States. The term black is used in a similar manner; this term is common in the scientific literature. Strictly speaking, African Americans are descende