Factors contributing to poor health outcomes among african americans include:
discrimination
cultural literacy
barriers
lack of access to health care
all of these

Discrimination, cultural barriers, and lack of access to health care.

Explanation:

There are certain factors that determine the health state of an individual and those factors come from where we live, work, worship and learn. These factors could lead to different health inequalities faced by the people, which has to do with the various opportunities available to them to achieve the highest state of health.  

The poor health outcomes among African American emanate from the varying cultural lifestyles they have and other social inequalities [brought upon by discrimination] which brings about the discrepancies in the way they access health care and other unfair behaviors by the health providers.  

the answer is selfishly. hope this !

c or d both can be the answer