Two studies were conducted that assessed health perceptions and functional health status among an urban, low-income population in the southeastern region of the United States. The first study was conducted with 176 hospitalized indigent patients prior to discharge from a county hospital. Patients were administered the Short Form-36 (SF-36) health status questionnaire and two additional questions regarding perceptions of health. The second study was conducted in the same geographic region with a nonhospitalized, low-income population. The SF-36 was administered by telephone to 546 randomly selected interview respondents. The results demonstrated consistent differences between black and white respondents in referents for self-perceived health. It is suggested that health expectations and perceptions may be indicative of the cultural, contextual, and social-political factors that affect the lives of this urban, low income population. The validity of global single-item health indicators for use among low-income populations is questioned. Further research is needed to develop patient-based measures that accurately reflect the meanings and values of low-income patient groups.