There was once a man who lived in a beautiful village by a river. One day as he walked by the river, he noticed someone struggling in the water. He rushed into the river and pulled the person to safety. The next day the man was again walking by the river and noticed 2 people struggling in the water. Again he rushed into the river but was able to grab only one person and pull that person to safety; the other swept past him. So the man called out for help and a fellow villager was able to pull the second person to safety. It was not long before the entire village started taking part in pulling people from the river. The villagers trained for these rescues, developed the latest techniques, and invented equipment to help them more easily reach people in the river. You probably know the rest of the story, or at least one of its variations [horizontal ellipsis] that it was not until villagers addressed why people were falling into the river in the first place that they made any real progress in rescuing them.

This is how I feel about health disparities. Most of our efforts to date have focused on pulling people out of the river, not on determining how they got there in the first place. We have made some progress in uncovering some root causes of health disparities, such as racism (or, more broadly, social injustice) and economic, educational, and environmental inequalities-all important focal points that need our attention. But I have often wondered why we spend so much time and effort pulling people from the river when we should be focusing on what sent them into the river in the first place.

That is, until I saw my youngest son playing with a bucket.

I watched as he put water into a bucket, but the bucket had a hole in the bottom. Naturally, the water ran out of the hole and onto the ground. I asked my son why he did not stop putting water in the bucket and either fix the hole or get another bucket. He gave me the "Dad, you don't have a clue" look and said, "If I did that, then I wouldn't have any water at all."

He is right. We cannot just stop what we are doing and focus entirely on the root causes of problems. So much disparity exists in our world that we cannot stop pulling people out of the river. Even if we can address the root causes of disparity tomorrow, how long will it be before we really see a change? And what about those people already in the river or dangerously close to falling in?

We must do both.

We must continue to address health disparities at every turn, but as we do so we must also look at the root causes that have brought us to this point. In that way, we can inform and support those who will take this battle upstream. We must continue our efforts at reducing disparities and report those results, as the authors do in this issue, in order to document the greatest struggles, the opportunities for change, and the differences that can be made. Whether the disparity deals with access issues faced by US Hispanic women needing mammograms, as explained by Molly L. Aldridge and her colleagues; or cardiovascular disease, as detailed by Melissa C. Kuhajda and her colleagues, as well as Linda K. Heitman; or with physical activity and domestic violence, as reported by Deborah Rohm Young and Kerry J. Stewart, and Joslyn W. Fisher and Andrea J. Shelton, respectively-we must listen, we must dialog, and we must continue to move forward our efforts to eliminate health disparities.

These articles and the entire body of work on health disparities is greatly needed to help inform public policy so that the systematic changes that must be made to end health disparities can be made. Yet, we must be ever vigilant to those already struggling in the river.

John C. Higginbotham, PhD, MPH

Issue Editor, Associate Dean for Research and Health Policy, Director, Institute for Rural Health Research, The University of Alabama School of Medicine, Tuscaloosa Campus