is a former Philadelphia health commissioner

Philadelphia's African American infant mortality rate was 15 per 1,000 live births between 2003 and 2005. That's more than 50 percent higher than the white infant mortality rate of 9.9 per 1,000 live births. But there's more: Philadelphia's white infant mortality rate is almost 46 percent higher than the national average of 6.8.

The picture gets even bleaker: The United States as a whole ranks about 30th in the world in infant mortality. Slovenia does better.

Despite our city's world-class medical institutions, the chance for a Philadelphia infant to reach his or her first birthday is diminished. And infants who are not as healthy cost more and add to the shared burden on society.

Healthy, happy, well-grounded children are not just born. They are nurtured in homes and safe neighborhoods by parents with good jobs.

Getting to the roots of our racial and socio-economic inequities in health is one of our great challenges in the next decade and is the subject of a four-part PBS special called Unnatural Causes: Is inequality making us sick?, which premieres Thursday on WHYY-TV (Channel 12). Unlike most medical docudramas, this series goes beyond surgical miracles or even lifestyle choices and uncovers evidence that the conditions where we live, work and play can profoundly influence our health.

The conditions for health go far beyond health care. They encompass housing, jobs, education, public safety, access to care, and our environment. Within public health, we call these broader dimensions "the social determinants of health." They shape our prospects for health and well-being as much as diet and exercise and are the foundation upon which we build our medical-care system.

We can no longer afford to divorce our health-care crisis from the inequities that plague our neighborhoods, land-use policies, economic development, or schools. Our inability to see the intersections and point out how profoundly influential these pieces are in creating healthy communities has been a major failure of our domestic policy agenda.

It should not surprise us that pouring more money into a medical system that can only repair the damage created by inequality cannot possibly create healthy conditions. Why we persist is grounded more in politics than rationality.

Why do we continue to play on an uneven playing field? Why are there such stark differences between "good" neighborhoods and "bad" neighborhoods? Just who has the power and privilege to make these rules? Do we care?

We are now in the midst of choosing our next president. Our debates center on superficial details such as likability and "gotcha" spin doctoring. How about my questions? What will you do as president to assure that an African American baby born in Philadelphia has as good a chance of making it as a white baby? What will you do to help cities like Philadelphia create neighborhoods where every infant has the same chance of living to her first birthday as those in the rest of the nation?

The answers do not lie in bigger hospitals or more doctors. Solutions must assure that every mother is safe and secure and supported so her children can be, too. They must empower the least among us and not just the wealthy. They must create equal opportunities to enjoy the richness of American life so that we can all have healthy, fulfilling lives in an America we can be proud of . . . again.