There are major racial differences in access to health care as well as major racial differences in the quality of the health care which is provided to people. A study published in the "American Journal of Public Health" estimated that: "over 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same quality of care as whites". The key differences which they cited were lack of insurance, inadequate insurance, poor service, and reluctance to seek care. A history of government-sponsored experimentation, such as the notorious Tuskegee Syphilis Study has left a legacy of African American distrust of the medical system.