With the Affordable Care Act likely to shrink the number of uninsured significantly, there are several health-related areas — obesity, diabetes and tobacco deaths, particularly — in which Oklahoma has serious room for improvement.
According to the United Health Foundation, diabetes has increased by nearly 2 percent in the past five years, meaning 293,000 adult Oklahomans now have the disease. The obesity epidemic is even more alarming. Over the past decade, the number of obese Oklahomans has risen to 883,000, or 31 percent — up from just 19 percent in 2001.
And tobacco use in Oklahoma remains higher than the national average for adult smokers. Earlier this summer, in fact, the American College of Sports Medicine’s 2012 “American Fitness Index” listed Oklahoma City dead last.
For those tasked with improving the state’s health, where do you start?
“Improving the health of all Oklahomans begins with each of us,” said Terry Cline, Oklahoma’s commissioner of health. “But Oklahoma is way behind the times and our poor health outcomes reflect that delay. We have a long way to go.”
Several years ago, the state Department of Health held a series of listening sessions to identify strengths, weaknesses and concerns from different regions of the state. From those sessions emerged the Oklahoma Health Improvement Plan.
Tobacco use proved to be a persistent and significant problem. Oklahoma’s smoking rates are the 48th worst in the nation. Cline said the figures in the state are sobering, including —6,000 Oklahomans die each year from tobacco-related illnesses; —4,000 Oklahomans become addicted to tobacco each year; and —87,000 young people are projected to die from tobacco-related illnesses.
are our friends, neighbors, colleagues, fellow parishioners — all who
are dying unnecessarily,” Cline said. “Given the real-life impact on
Oklahomans, why isn’t our Legislature breaking down our doors in an
effort to reduce tobacco and save lives?”
About 20 years ago, Cline said, the tobacco industry was “very clever” when it convinced legislators to take control of smoking regulations away from local communities. Preemption makes it easier for tobacco firms to battle smoking restrictions, as it confines lobbying efforts to a centralized state Capitol, instead of scores of communities across the state. A measure to eliminate that pre-emption passed the state House this past legislative session, but never received a hearing from a Senate committee.
“The chairman of the committee, Sen. Brian Crain of Tulsa, refused to allow the bill to be heard in his committee,” Cline said, “and — like too many Oklahomans — it died an early and unnecessary death.”
Meanwhile, the tobacco industry remains big business in the U.S.
“We’ve always heard the phrase ‘kick the habit,’” said Joy Leuthard, coordinator of the Oklahoma Hospital Association’s Tobacco Cessation Systems Initiative. “But nicotine addiction is an addiction — not a habit. It’s as addictive as cocaine or heroin.”
She pointed to statistics that 70 percent of all smokers want to quit, but don’t know how. A number of stop-smoking programs are spearheaded largely by the state’s Tobacco Settlement Endowment Trust. Its “helpline” served more than 175,000 Oklahomans from 2003 through 2011.
But states trying to combat smoking can find themselves locked in a David-and-Goliath scenario. Leuthard said tobacco giants still drop about $9 billion annually on marketing, often targeting youth, minorities and members of the lesbian, gay, bisexual and transgender community.
“They refer to these new smokers as ‘replacement smokers’ for those who have died or quit,” she said.
Both Cline and Leuthard agree that while Oklahoma has a long way to go, a positive trend is developing. State health department figures show tobacco use from 2010 to 2011 dropped slightly by 1.6 percent. Cigarette sales decreased from 108 packs in 2001 to only 79 packs per person in 2009. And the number of Oklahoma’s high school youth identified as “committed nonsmokers” rose dramatically, from 25 percent in 1999 to 40 percent in 2009.
There are other reasons for optimism, too. Cline praised Gov. Mary Fallin for issuing an executive order this year to prohibit the use of tobacco on state-owned or leased property.
“That will save lives, increase worker productivity, and make these sites safer for workers and visitors alike,” he added.
Oklahoma is fat — not pleasingly plump, but grossly overweight. The state has seen the largest increase in obesity rates over the last 10 years, Cline said. If trends continue, Oklahoma could be the most obese state in the country by 2018.
The ramifications of obesity can be severe, especially in terms of diabetes and heart disease. Health experts point out that Oklahoma has the 43rd worst diabetes rate in the nation.“We have many public schools experiencing record numbers of kids who require insulin management of diabetes, driven by their obesity,” Cline said. “With a health care system already underfunded and overburdened, how will it meet the health care demands of this upcoming generation? Kids will now be managing a chronic disease for decades. There is not enough money in the world to treat the problem once it exists; we have to produce a healthier generation.”
And that necessitates cutting down super-sized portions and adding healthier foods, Cline said. That won’t be easy; Oklahoma ranks dead last for consumption of fruits and vegetables.
“‘An apple a day keeps the doctor away,’ is not just an old proverb,” said Kathy Musson, associate executive director of the Oklahoma State Medical Association. “Eating fresh fruits and vegetables is a key factor in maintaining good health.”
Musson began working for the state’s oldest medical association for physicians in 1970. Since that time, she said, the number of obese adolescents ages 12-19 has tripled, while the number of obese children ages 6-11 has quadrupled.
One of the first steps in improving Oklahoma’s poor health is to raise awareness about obesity and the importance of improved healthy lifestyles.
“About one-third of parents don’t recognize obesity in their own children,” she said. “If we do not reverse the obesity epidemic soon, today’s youth may be the first generation in American history to live shorter, less healthy lives than their parents.”
Increasing physical activity is another key factor in reducing obesity.
Oklahoma now ranks 49th nationally for physical activity.
Cline said Oklahoma City can serve as a good example of city planning geared toward fitness. Under MAPS 3, the city is adding miles of sidewalks and biking trails, along with senior wellness centers and green spaces for outdoor activities.
“And thanks to previous MAPS support, we have a thriving downtown and river where people can be seen walking, rowing and being physically active as part of their daily routine — pretty darned cool,” Cline added.
And so Cline and others do see glimmers of hope for Oklahoma.
“We know we must increase awareness about the challenges, help provide resources and tools to individuals, families and communities, and use policies to their full advantage,” he said.