(Fuchs 1998) However, there is no public consensus about which services would improve health status, but class injustices in health persist. (Marchand, et. al.1998) For example, while reporters agree that the disparity between health status among Whites and African-Americans would remain after adjusting for infant mortality; race, ethnicity and income were also associated with morbidity and functional limitations and fewer preventive services. There is no clear mandate about which interventions would be effective. Black males have a higher mortality rate than white males at each income category, (La Viest et al 2000) and the Medicare black/white mortality rate was 1.6 times higher in 1995 than in 1950. (Williams 2000) Racial disparities in life expectancy among Medicare patients generally were higher in 1996 than in 1950. (Gornick 2000) In England, the infant mortality rate in the lowest socioeconomic class is double that of the highest class. That has not changed since the implementation of the National Health Service. (Whitehead 1999, Ross and Mirowsky 2000, Gunning-Schepers, and Stronks 1999, Brown 1999, Fuchs 1998).
The problem extends beyond the usual boundaries of health services. In fact, access may not be corrected under universal coverage due to time costs experienced by workers without sick leave, language barriers, isolation and physical difficulty in availing oneself of services, distance, transportation, consumer information, culture, time preferences (the rate at which people discount the future relative to the present), self-efficacy, poor lifestyle, and genetics. Unemployment appears to have a significant, widespread association with poor health although the direction of the association is not clear. Educational level is a strong covariate with health as well as poverty and employment. (Fuchs 1998, La Viest et al 2000) Systemic factors identified with poor access under universal coverage are distribution of health care professionals and differences in medical custom by small geographic area.