OKPOLICY.ORG
Neither the United States Constitution nor the Bill of Rights guarantee health care as a basic right for any American. Our nation and our neighbors struggle with access to affordable health care and prescription medicine.
However, for Black Oklahomans, lack of access to health care quickly turns into a death sentence. According to a 2021 report from the Oklahoma State Department of Health Equity and Minority Health, Blacks in Oklahoma experienced higher rates of illness and death compared to whites when it comes to heart disease, stroke, diabetes, breast cancer, and prostate cancer.
Evidence like this points to racial disparities in health care, though policymakers easily dismiss these facts. They instead point to smoking, obesity, and poor health choices as primary causes for these differences.
While those factors increase morbidity for any population, self-management is just one important part of a complex puzzle that determines health outcomes.
The National Institute of Neurological Disorders and Stroke modeled a framework for addressing health disparities including five core areas that converge to create inequities. Culture and societal values, socioeconomic status, access to public health care, self-management, and overall biological condition are the social determinants that create health outcomes.
First, structural racism, violence and discrimination are social determinants of health built into the foundation of American cultural and societal values that determine health outcomes.
The Center for Disease Control considers racism a serious public health threat to people living in the United States.
Over-representation of Blacks in Oklahoma jails and prisons is just one factor that points to structural racism and discrimination in Oklahoma. Black people in Oklahoma are incarcerated at a rate five times higher than white people. Despite comprising a little under 8 percent of the state’s population, Blacks represent about 26 percent of the state’s prison population.
Put another way, Blacks have the highest rate of incarceration of all races in a state that has the nation’s fourth-highest incarceration rate.
In 2022, Oklahoma’s MODERN Justice Task Force found that in one urban jail, Blacks accounted for 45 percent – nearly half – of all jail bookings in 2022 despite the county having a Black population of 15 percent. With Black people so over-represented in the state’s prisons and jails, incarceration itself becomes a social determinant of health. Upon release, justice-involved Oklahomans face severe limitations to affordable housing, jobs that pay a living wage with benefits like sick leave and paid time off as well as health insurance.
Socioeconomic status or household income is another determinant of health. Low-income households have less access to high-quality healthcare. Black people have the highest rate of poverty among all races in Oklahoma, which is telling for a state that already has the nation’s sixth-highest poverty rate. More than 1 in 4 (28 percent) of Blacks in Oklahoma live in poverty. Black people in Oklahoma are more than twice as likely to live in poverty than their white neighbors.
Another social determinant of health is the accessibility of public health care.
Blacks in Oklahoma have traditionally had high rates of being uninsured due to systematic marginalization in the employment sector. This includes having higher rates of employment in low-paying jobs without health insurance or paid time off. Low-paying jobs without benefits contribute to overall poverty and poor health, which in turn, limits an individual’s ability to work. This is the health-poverty trap that contributes to increased morbidity and mortality in the Black community.
Black people in Oklahoma also had the highest infant and maternal mortality rates.
While we are a long way from closing the gaps in racial health disparities, Oklahoma has implemented one impactful strategy to reduce the number of low-income uninsured families.
One of Oklahoma’s most significant steps toward health equity was the expansion of Medicaid in July 2021. The rate of uninsured Blacks dropped from 17.3 percent in 2019 to 11.4 percent in 2023, which is the lowest uninsured rate of all racial/ethnic groups measured with the exception of whites (9.9 percent). The expansion directly addressed disparities in coverage for historically marginalized Black communities by making health insurance more accessible for everyone.
To achieve health equity and reduce disparities, the state’s Medicaid program, SoonerCare, must build upon increased access by dedicating more resources toward education, outreach, and research. A few strategies that other states are exploring that could work well in Oklahoma include:
- Integrating behavioral health specialists into primary care settings like well-child check ups.
- Connecting Medicaid enrollees to community-based organizations through community health workers.
- Creating targeted solutions to address the health care needs of specific populations in which Blacks are over-represented, including justice-involved people and pregnant/postpartum people at high-risk of infant and maternal mortality.
Providing integrative and holistic health care like pairing primary care physicians with behavioral health practitioners would increase access to mental and behavioral health professionals. This in turn creates opportunities for increasing wellness and prevention. These integrated care models aim to bridge the gap in services, ensuring behavioral health care is more accessible and less siloed between specialties.
Community health workers have long been on the frontlines of public health serving as a liaison between health/social services and the community. In addition to connecting people with care, they also build individual and community capacity by increasing health knowledge and self-sufficiency. This comes through a range of activities like providing community education, informal counseling, social support, and advocacy. By increasing funding for education and outreach services, community health workers directly impact self-management of health and illness within the Black community.
The Oklahoma Department of Health recognized the need to provide targeted health care to confront the maternal mortality crisis in the state. Last year, the Oklahoma Maternal Health Task Force report noted that Oklahoma’s maternal mortality rate is on the rise. The rate increased from 25.2 mothers per 100,000 live births during the 2018-2020 reporting period to 31 per 100,000 from 2019-2021. Nationally, Medicaid covers almost half of all births, including more than two-thirds among Black and American Indian or Alaska Native (AIAN) individuals, who have higher rates of pregnancy-related mortality and morbidity compared to white mothers.
Oklahoma Medicaid recently extended postpartum coverage from 60 days to 12 months. In addition to expanding coverage for pregnant people, Oklahoma lawmakers passed House Bill 2152 requiring investigations and a report of all maternal deaths in Oklahoma within 72 hours. The Oklahoma Maternal Review Committee will receive those reports and review pregnancy-associated deaths and try to find ways to prevent them.
In Oklahoma, more Black babies die in infancy than any other racial group. The state health department also found infant mortality rates among the state’s Black population outweighed the rate in white populations at 9.6 per 1,000 births for Blacks vs. 6.37 per 1,000 births for whites. Nearly 1 out of every 100 Black babies die in infancy.
Starting at preterm birth, Black Oklahomans lag behind whites on nearly every measure of health. Strategies like expanding Medicaid eligibility and coverage, funding for more community health workers, and investigating maternal deaths is a start to addressing these disparities.
Yet, we must remove the shame and blame lens of racism – that poses a public health threat to everyone – and get curious about the unique ways poor health impacts Black Oklahomans. Our governments, scientific communities, and philanthropists must fund more research for diseases that disproportionately impact Blacks.
After all, the health outcomes of all Oklahomans are connected. Oklahoma is 47th in the nation for overall health. The high rates of disease in one population impact the overall health of our fellow Oklahomans. There is room to significantly improve the health of Black Oklahomans, which would improve the health of all Oklahomans.
