PETERSBURG, Va. -- Health officials weren't surprised when lead paint poisoning spiked in this mostly black city of Civil War-era homes.

More striking was one of the causes -- inability to afford freshly painted housing, said Michael Royster, a former district health director who helped emphasize low income among the poisoning risk factors Petersburg officials now recognize.

It's long been suggested that socio-economic issues, like lack of transportation to a doctor's office, can influence rates of disease in minorities. Now officials in some states are investing more resources into ide.jpgying those factors.

They're revamping health departments to focus less on scie.jpgic data and more on the role of "social determinants" -- things like poverty and discrimination some say are widening the health gap.

Their target: Numbers that show minorities dramatically outpacing whites in everything from diabetes to infant mortality.

"A lot of that is related to socio-economic factors as well as the impact of perceived racism," said Royster, recently named the first licensed physician to oversee Virginia's Office of Minority Health and Public Health Policy.

A woman experiencing stress related to unemployment, for example, could struggle with carrying a healthy baby, he said.

"Ultimately, those stresses impact a person throughout their life, and even before someone is born," said Royster, who will hire a social epidemiologist and plans town hall discussions of health inequities.

Both will help officials uncover more root causes of minority illness and tailor responses.

Where before health officials may have focused on high rates of smoking as a cause for cancer among minorities, for example, Royster said they might instead look at the prevalence of tobacco ads in urban communities.

"What we're looking at is not only health care, but the roles that health care, health behaviors and these broader social determinants play in creating health inequities," Royster said.

The National Association of State Budget Officers estimates states spend roughly a third of their budgets on health care annually. At the same time, many have seen surges in the population of Latinos -- ranking alongside blacks in rates of things like HIV and asthma.

States are looking for creative ways to cut costs, explained Tony Iton, director of public health for Alameda County in California.

Officials there have created a strategic health plan that considers the effects of institutional racism, sexism and discrimination.

"Health care spending has exceeded the rate of growth of all sectors in most state budgets, and they're not getting the results they would expect to get," Iton said.

"You're seeing people being open to looking at this more comprehensively."

Pennsylvania last year created an Office of Health Equity, in part to determine why groups like blacks -- around 10 percent of the state population -- lead in most types of cancer.

"Nothing is as simple as just dealing with the numbers," said Stacy Kriedeman, spokeswoman for the Pennsylvania Department of Health. "The agency is looking at a wide number of things, including those socio-economic factors."

Minnesota health officials spent years examining how those factors influenced health disparities -- including statistics that showed in the mid '90s infant mortality rates among American Indians were three times that of whites in the state.

Lawmakers later used the results to shape legislation aimed at cutting disparities in infant mortality in half by 2010. The Eliminating Health Disparities Initiative also pairs officials with community members to ide.jpgy root causes of health disparities, said former Minnesota health commissioner Jan Malcolm.

"We let the community groups design the interventions they thought would work," she said. "It was not the usual top down or outside in approach ... where the experts declare the problem and design the solutions."

Still, health departments lack the legislative power to improve housing or increase wages, cautioned James Marks, senior vice president of the Robert Wood Johnson Foundation, a New Jersey nonprofit that helps fund programs targeting underserved groups.

"It is often policies that are outside (health officials') responsibility that needs to be changed," he said. "It requires mayors and governors ... they've got to be the ones to call together the private sector and the public sector."

Gov. Timothy M. Kaine urged the overhaul of the health department's approach to minority health.

At United Way of Greater Richmond and Petersburg, Betty Hobbs says officials have long linked things like illiteracy with high teen pregnancy rates. State efforts could ide.jpgy even more root causes, Hobbs said.

"It helps us to see what the gaps are," she said.

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