 Aside from financial barriers to access, there are several important kinds of non-financial barriers to access. These include forms of discrimination and exclusion, such as racism and gender-bias; geographical barriers; and language and cultural barriers, including cultural attitudes toward disease and medical care. In the United State, for example, we know that the prevalence of certain health conditions is much higher among African Americans than whites. Controlling for insurance coverage, income, and educational differences, African-Americans are still less likely to receive important treatments for a range of serious illnesses, including heart disease and certain kinds of organ failure (IOM 2002). Just how to explain these utilization disparities is a matter of ongoing research, some of which focuses on conscious and unconscious attitudes and racial stereotypes. Until advocacy groups for women, such as the National Breast Cancer Coalition, lobbied successfully to alter research funding policy, some women’s diseases were systematically under funded in the U.S. Similarly, there are significant differences in access to care that derive from the geographical maldistribution of providers, including physicians, and services. Thus physicians concentrate their practices in wealthier urban and suburban areas, leaving poor urban and rural areas underserved. Many hospitals face the problem of overcoming language barriers because of the large and diverse immigrant populations that they serve, and striking examples abound of failures to meet health needs because of cultural views about disease and medical care (Fadiman 1997).