POSTED ON JANUARY 20, 2010:
Here's to Your Un-Health
Oklahoma can't toast Mississippi anymore, considering our low health rankings
State Sen. Brian Crain is so dismayed by Oklahoma's abysmal health rankings that he employs a simple strategy when attending meetings with legislators from other states.
He always sits by someone from Mississippi, he said, "so I can feel better."
The rueful line "thank God for Mississippi" was a 20th Century staple for Oklahoma, a state all-too-accustomed to relying on our Old South cousins to spare us the shame of slipping to the bottom of myriad socioeconomic barrels.
A decade into the 21st Century, I pose two questions: Must we continue to be thankful for Mississippi, accepting as our destiny appallingly bad health outcomes for adults and children alike? Or can we agree to work together through (gasp!) state government to improve the health of Oklahomans?
I can hear the anti-government chorus now: "You bleeding heart liberal, you. Always thinking government is the answer. Always promoting the Nanny State."
Bleeding heart, yes. But since when are we so closed-minded and knee-jerk that we can't have a rational, reasoned discussion of how we--yes, the government is us--can marshal our resources to help ensure a healthier future for all Oklahomans?
The good news is, some of the brightest minds in Oklahoma already are doing just that.
Oklahoma's Board of Health, in concert with top health professionals from across the state, recently unveiled a comprehensive strategy--the Oklahoma Health Improvement Plan, also known as OHIP--aimed at enhancing the physical, social and mental well-being of state residents by targeting three key areas of attack: obesity, children's health and nutrition, and tobacco use.
The bad news is, the extraordinary effort that yielded this blueprint for a brighter, healthier, more productive future could be wasted if legislators can't steer the proposals through what is expected to be a tumultuous session dominated by the state's budget crisis.
This is no time for state leaders to be penny wise and pound foolish. Not all of OHIP's proposals will cost the state money--as Mark Newman, director of the health department's Office of State and Federal Policy, put it, "Giving up smoking doesn't cost the state any money." But even those that do require taxpayer investment are likely to produce high returns-on-investment in the form of more productive (read: taxpaying) citizens and fewer demands for costly medical treatments.
Oklahoma's overall health has reached Third-World status, U.S.-style. Last year, the Commonwealth Funds State Scorecard on Health System performance rated Oklahoma 50th in overall health systems. And the 2009 United Health Foundation America's Health Rankings Report ranked Oklahoma 49th in primary care providers.
What does this mean in practical, human terms?
Oklahoma newborns are less likely to live: The national infant mortality rate is 6.6 per 1,000 births, Oklahoma's is 8.8. Nearly one-fourth of state residents under age 65 are without health insurance--one reason 474,000 didn't visit a doctor last year.
For every child without health insurance, there are nearly three without dental coverage. Oklahoma ranks in the top five nationally in the number of obese children--leaving many doomed to a lifetime battling such ills as heart attacks, strokes and diabetes.
The most staggering statistic of all? Tulsa attorney Barry L. Smith, president of the State Board of Health, notes that if Oklahoma matched the national average in health indicators, 5,320 lives would be saved annually.
That means about 15 Oklahomans die needlessly every day.
Why the lousy overall health? Some of it is poor choices-- high-fat diets, lack of exercise or smoking. Some can be traced to the state's high poverty rate--more than half the state's children, for example, qualify for and receive free or reduced lunches.
Even so, Crain, Smith and others involved in developing OHIP believe the overall health of Oklahomans can be improved through the comprehensive plan that urges everything from increasing the state's tobacco tax to providing incentives for grocery stores or farmers markets to locate in underserved areas.
Less than two weeks before state lawmakers return to work Feb. 1, few of the OHIP proposals have found their way into proposed legislation. One possible reason: The report wasn't released publicly until last month, meaning lawmakers haven't had much time to determine how best to shepherd the proposals through what often can be a contentious legislative process. Throw in the stress over money, or lack thereof, this year and there is the potential for this to join another in a long line of exhaustive state studies now gathering dust on a bureaucrat's shelf somewhere.
Crain, for one, vows the report "will not sit on a shelf." The Tulsa Republican also pledged to work on improving his own health, noting wryly that he's just another Oklahoman who's 40 pounds overweight and "likes a good cigar." He even vowed to give up his favorite chicken fried steak, a staple of his regular Friday lunches with health board president Smith.
Crain's work is cut out for him. If he's serious about shepherding these proposals through the Legislature, he'll have to finesse stiff resistance from many of his Republican colleagues who are wholly-owned subsidiaries of big insurance and other special interests.
Do you think, for example, that tobacco interests are going to be thrilled if the state's $1.03 per pack cigarette tax is raised to the $1.34 national average? Before you start grumbling about higher taxes, consider this: Every pack of cigarettes ends up costing Oklahoma's economy $7.62 in medical expenses and lost productivity.
Sometimes, challenges facing society are so big and complex that only government can successfully serve as the catalyst to move society forward.
As one who's gained and lost a ridiculous number of pounds throughout my lifetime--and who still enjoys one too many chicken friend steaks!-- I realize it's up to each of us individually to do what we can to improve our health-- smaller portions, more nutritional fare and increased exercise.
But I also think it's time we all acknowledge that many of our fellow Oklahomans don't have access to a Whole Foods-style market of vast nutritional choices, don't have the money for anything more than a starch-filled, macaroni-and-cheese-esque diet or don't have the information to know what steps can help lead to happier, healthier, more productive lives.
It's also worth noting that it wasn't an evil, intrusive Nanny State that recently ordered our high school students to be trained in financial literacy. It was a common-sense proposal by a conservative Republican, Rep. Ann Coody of Lawton. Why can't the state play a vital role in health literacy, as well?
Now, if it works according to plan, fewer of Oklahoma's future high school graduates will be flummoxed by balancing their checkbooks or managing credit card and student loan debt.
My hunch is that state lawmakers scrambling to resolve a $1 billion budget crisis will be tempted to ignore OHIP. They do so at Oklahoma's peril. As state Health Commissioner Terry Cline put it, this generation of Oklahoma children "likely will be the first ... in a long time" to realize "a shorter life expectancy"--unless we work together to improve the state's overall health.
Do we really care about our children and future generations? Or is it just so much lip service?
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