[Clifford Gills] I broke my leg in three places. My rotator cuff, my collarbone, my back there is all messed up, I've got two slipped disks in my back. And I've got a problem with my right side hearing and my vision.

[Tobias] Gills hasn't worked since the accident. Walking is difficult. Gills spends his days watching TV, making calls to keep utilities from being shut off and arguing with caseworkers to get disability benefits. 57-year-old Brenda McCroy also has trouble getting around. She suffers from a painful muscle disorder called fibromyalgia. McCroy also has diabetes, asthma, glaucoma and a leaky heart valve.

[Brenda McCroy] I'm on 11 medications that I take daily. Every day, three times a day. My blood pressure medication, my diabetes medication, my glaucoma medication which burns my eyes and I can't see for an hour or so.

[Tobias] Gills and McCroy both say they'd be healthier if they were white. Statistics say they're right. McCroy, for example, is three times more likely to die from her diabetes than a white woman is with diabetes in Nebraska. There are glaring disparities for other conditions. Native American and African-American Nebraskans are much more likely to die of cardiovascular diseases. The prostate cancer mortality rate for African-Americans is 50 percent higher. Breast cancer mortality nearly doubles for African-Americans. And African-American, Native American and Hispanic babies are much more likely to die in their first year. Nebraska has one of the highest African-American infant mortality rates in the nation.

[Steve Virgil/NE Appleseed Ctr. for Law in the Public Interest] It's hard to explain how a society like America that has so much wealth and such advanced health care systems could have such disparity.

[Doris Lassiter/NE Minority Public Health Assn.] It is unacceptable to have these kind of racial ethnic health disparities. Because they contribute to the downfall of communities. We cannot have these. We're the good life state for everybody, aren't we?

[Tobias] Marilyn McGary heads the state Minority Health Office. She says accessing care is one problem for minorities.

[Marilyn McGary/NE Office of Minority Health] Health insurance, places to go for health care services, transportation, and then language barriers. Those could be some things as far as access issues. Actually getting quality health care after you've accessed it is another issue, and that could be a result of biases, unintentional racism, maybe uncomfortableness dealing with different people groups, that sort of thing.

[Tobias] A'Jamal Byndon teaches at Nebraska Methodist College in Omaha. He's also a community activist who's conducted health care focus groups with minorities.

[A'Jamal Byndon/Methodist College Instructor] It was painful in the sense that we've heard so many stories about people going to certain health entities and being treated rudely, or not being treated fairly, or people being denigrated or having their economic status exposed to everyone.

[Tobias] Stories from people like Brenda McCroy, Clifford Gills, and 32-year-old Nichelle Pegues. She had to temporarily leave her bank job after being hospitalized with abdominal pains, later diagnosed as lupus. All three need some degree of Medicaid to pay for health care. All three are struggling to make ends meet in North Omaha.

[Nichelle Pegues] It seems like the doctors down north really don't care. Because they're in a black neighborhood, they're guaranteed their money with Medicaid or any other insurance they can get. They know they're gonna get their money. So they just write you off, oh here just take this and this. And that might not even be the problem for you.

[McCroy] They give you all those samples. I've even had them give me some samples that were outdated. And I got home, they just give you a whole box, here take this. No explanation of how to take it, when to take it, how long to take it, and they're gone.

[Gills] Go to the hospital and stuff like that. And sometime they make you sit and wait longer, and you could be there before that person that came there that's a different race than you.

[McCroy] A prior doctor that I went to, I've seen white people go in there and ask for the type of medication they need. They just ask for it. And they're written out a prescription and it’s given to them. But if you, if us black people ask for a certain type of medication, they think you're a drug addict.

[Pegues] The system is really messed up when it comes to black, African-Americans.

[Lassiter] There's the anecdotal information out there. Some people say it's subconscious. It's not really meant to be racism, but it comes across that way. If it's perceived by the person receiving the care, it doesn't matter if it's intentional or unintentional. It's there. Dr. Larry Brown treats a diverse population - including many Hispanics - in this Creighton family practice clinic in south Omaha. He also teaches at the Creighton School of Medicine. Brown says national research supports what McCroy, Gills and Pegues had to say. He says there are documented cases where minority and white patients from the same socioeconomic background had the same health problem, but the white patient was offered a more advanced procedure.

[Dr. Larry Brown/Creighton Doctor-Professor] Certainly are there some situations where overt racism occurs in the health care system? There are. It's unfortunate, and fortunately it’s rare. Are there situations where covert racism or policies drive or systems drive disparities? Certainly there are. And then the other issue is the internalized racism. In many ways that drives the problem as much as the other two.

[Tobias] Brown and others say it would help to have more minorities interested in health care professions. He was one of maybe 6 minority students in his medical school class of 110. In the last five years fewer than 9 percent of UNMC medical college graduates have been minorities - and those don't always stay in the state.

[Brown] It is impressively important for us to insure that the health care workforce reflects the population mix in the United States.

[Lassiter] We know that the studies have shown that people are more comfortable when they go to physicians that look like them. The trust level is simply there. It's really quite simple.

[Tobias] Affirmative Action is this day's topic in Byndon's Cultural Studies class. Almost all of these students studying nursing and other medical professions are white. Byndon says that's why classes like this - required for graduation from Methodist College - are important. And why medical programs need to offer more than a once-a-year seminar during Black History Month.

[Byndon] There's this basic premise within this institution about cultural competency. In other words you cannot provide services to groups or people if you do not know anything about them.

[Tobias] Increasing cultural competency is a need throughout Nebraska's Health Care system. 60 percent of patients at the East Central District Health Department in Columbus, for example, speak only Spanish. Through recruitment and training nearly half of their employees are now bi-lingual and bi-cultural. Special staff - called promontories or promoters - accompany non-English speaking patients to appointments and provide transportation.

[Rebecca Rayman/East Central District Health Dept.] It's not just being bilingual, it's being culturally competent. For example with a Hispanic-Latino baby, you never want to say, oh what a beautiful baby and then not touch the baby. Because then you give the baby the evil eye and the baby will get sick.

[Tobias] The disparity in infant deaths has gotten the most attention so far. Governor Mike Johanns launched an effort to address infant mortality for all races four years ago. Larry Brown helps lead a program called CRIB, which addresses minority infant mortality by building physician-community partnerships throughout the state.

[Brown] The goal is to engage local communities to look at local infant mortality problems and disparities and barriers to access that drive those disparities, and to try to determine means to address those issues.

[Tobias] There are many other initiatives, programs, groups... all working to improve minority health. The state Minority Health Office and Nebraska Minority Public Health Association are each bringing together key players to find solutions. Two years ago the Legislature used some of Nebraska's share of the tobacco settlement money to fund Minority Health satellite offices in Omaha and Scottsbluff, and give money to public health clinics serving minority populations. There's still much work to be done, though.

[Tobias] Is there much of an effort that's going on right now to help minority populations realize that they don't have to accept sub-standard care?

[McGary] Not enough. There needs to be more. Not enough.

[Brown] We still have a ways to go in the health care system of getting the minorities communities to buy into the fact that we care. And that means that some of our policies, some of our systems may have to change.

[Byndon] So I really think we're going to have to have a different way or new paradigm for helping people deal with the issue. But I don't think some of the solutions can come from the same bankrupt mentality that's not addressing the issue.

[Tobias] Change can't come soon enough for Brenda McCroy, Clifford Gills and Nichelle Pegues.

[McCroy] I think that's where it first needs to begin, with how you treat people, regardless of your race. That's the first thing. And treat everybody fairly, because everybody's not being treated fairly.

[Pegues] What do we have to do. Do we have to just go dirt poor, lay in the middle of a street, almost half-dying before you decide you want to really do something.