By: Jeffrey Alderman, MD
It’s no longer a surprise – but acknowledging bad news still hurts. You may need to sit down, and perhaps sip from a cup of tea, while reading the 2019 Commonwealth Fund Scorecard on State Health System Performance. Unsurprisingly, Oklahoma ranked 50th out of 51 states (which includes D.C.) – a slight drop compared to the 2018 report. Compared with our neighbors, the report indicates we Sooners are just plain unhealthy. But under the veneer of numbers and statistics, it is important to study the complicated and nuanced reasons why our citizens continue to follow a downward trajectory of poor health.
Unhealthy attitudes and social determinants
Several longstanding forces drive Oklahoma’s multiple indicators of poor health and inadequate social wellness. For example, we might point toward our long tradition of individualism. We value self-reliance, while shunning help from others, which includes seeking help for medical ailments. In other words, we often put off going to the doctor until we are critically ill.
Other factors contribute to our poor health. Inherent in our state is low literacy about health and wellness, coupled with a culture of unhealthy eating and reduced physical activity. Taken together, these factors lead to soaring rates of obesity, diabetes and cardiovascular disease. Oklahoma also suffers from relatively high rates of poverty and inequality. So-called food deserts dominate our state, making it hard to purchase healthy, nutritious food.
Medicaid expansion in Oklahoma – on the horizon?
Statewide policy is yet another factor that drives Oklahoma’s poor health. We are just one of 13 states that chose not to expand Medicaid – a safety-net program for those unable to afford health insurance individually or through an employer. It is difficult to draw clear conclusions, but states that expanded Medicaid have witnessed dramatic performance improvements, including better access to care and rising health outcomes, especially among rural dwellers.
Efforts to expand Medicaid in Oklahoma have simmered for several years and may now be reaching a boiling point. This June, our state’s supreme court rejected an effort to block a statewide ballot question from appearing in 2020 – a victory for those favoring Medicaid expansion. This is good news for those who are poor and lack health insurance.
In praise of “Care Management”
With Medicaid expansion comes the advent of strategies such as Care Management (CM). Leveraging professionals such as registered nurses and social workers, CM helps people live healthier lives. Trained care managers work directly with patients to address a variety of issues, including prenatal care, mental health, cancer prevention and the promotion of healthier lifestyles. The state-funded Sooner Health Access Network based at the University of Oklahoma-Tulsa is a shining example of a successful CM program. In just a few short years, it has made great strides in helping Medicaid recipients across the state achieve better health and better health literacy.
No magic bullet will rocket Oklahoma’s outcomes from 50th to first in the nation. Improving the health of our people requires many small, iterative changes – each of which will slowly chip away at our poor rankings. Expanding Medicaid would be a good start by extending health care coverage to and improving medical access for our poorest citizens. But to truly create change, state-funded CM programs must be scaled upward. Connecting our citizens with skilled clinicians builds trust and relationships, which, in turn, drives healthy communities.
Jeffrey Alderman, MD, is the director of the Institute for Healthcare Delivery Sciences and an associate professor of community medicine at The University of Tulsa’s Oxley College of Health Sciences.