Is it the role of government to put policy in place to impact the overall health of our citizens? As the Oklahoma legislature’s interim study committee prepares its final report on the state’s obligations under the new federal health care law, the co-chairs have posed a series of questions to committee members to elicit thoughts, opinions, and lessons learned. This post responds to a central theme of those questions, a theme we think has implications for the state’s future prosperity well beyond the new health care reform law.
Let’s assume that you stand on principle that it’s not the government’s role to engage the health care system. Then we have a gravely serious problem. We are very nearly the unhealthiest state in the country and we’re getting worse. Individual behaviors – smoking, diet, fitness – certainly affect health, but it’s by no means certain that they’re the most important factors. What we’re facing in Oklahoma is bigger than the sum of each individual resident’s health choices. Acute structural defects in the state’s health care system demand solutions that are bigger than each of us and addressing them will benefit all of us.
First, we do not have enough doctors, nurses, and health care providers in Oklahoma. If you live in an urban area, this will be hard to relate to, but it’s true. We rank 49th in availability of primary care physicians, with only about 82 physicians per 100,000 Oklahomans. The consequences of this fact should be obvious. Without access to regular preventative care and treatment when you’re sick, minor health problems can become catastrophic illnesses. Rural Oklahomans could be making healthy choices, but end up unhealthy because of lack of access to care. We need government support for efforts that promote access to care, like schools of community medicine, graduate student loans, and incentive programs for doctors who settle in remote areas. How can we attract modern economic development to a state where many residents haven’t ever had a doctor?
Second, we have hundreds of thousands of households living in poverty. Poverty affects a person’s health in innumerable ways that are beyond their control. Not being able to afford medical care, even if you have a doctor nearby, can be an insurmountable hurdle to well-being. Children living in poverty are especially vulnerable, as their health choices are totally dependent on caregivers who are already struggling to meet other basic needs like food, clothing, and shelter. The state and federal governments, through the SoonerCare/Medicaid program, currently subsidize medical care for 472,111 Oklahoma children who might otherwise go without. If you don’t think that government has a role to play in the overall health of our citizens, then you’d better be prepared to count those children out.
Other structural conditions, many perpetuated by living in poverty, also contribute to poor health:
- Lack of medical care, malnutrition, and second-hand smoke as an infant or during early childhood has lifelong effects on health.
- Limited access to healthy groceries coupled with abundant access to fast food in urban areas (‘food deserts’) significantly constrain household diet choices.
- Poor air quality exacerbates chronic conditions like asthma and other respiratory disorders.
- Fewer gyms and public parks in low-income areas make consistent exercise more challenging.
- Insufficient income to purchase nutritious food coupled with lack of knowledge about healthy eating stacks the deck against low-income households.
Government can and should invest in improving the structural conditions that destine impoverished people to a lifetime of poor health outcomes. There is no other alternative. Oklahoma households cannot continue to work, save, and invest as more and more of their labor and income is taken up caring for ailing parents and grandparents. The economic development goals of the state cannot be met with an ever-sicker, ever-poorer workforce. Individual health problems eventually become public health problems that the state must address. If we don’t come to terms with the grim reality of our health care situation on the ground, we cannot expect the state to enjoy continued, broad-based prosperity.