To improve Oklahoma’s health, we must reduce inequality (Guest Post: Candace Smith)

Candace Smith
Candace Smith

Candace Smith is an OK Policy Research Fellow and a 4th year Ph.D. student in the Department of Sociology at the University of Oklahoma’s (OU) Norman Campus. She is also a research assistant at the Oklahoma Department of Human Services’ (DHS) Office of Planning, Research and Statistics.

Chronic diseases create significant quality of life challenges to patients and families, are expensive to treat, and occur with uncomfortable frequency in Oklahoma. Given our state’s poor overall health rankings, it comes as no surprise that we have some of the highest occurrences of chronic disease in the nation. Evidence shows that social inequalities drive these troubling diseases. It is abundantly clear that improving Oklahoman’s health requires reducing inequality.

A chronic disease is a health condition that lasts at least twelve months, requires ongoing medical attention, and/or limits an individual’s daily activities. They may be brought on or worsened by certain activities or behaviors: for instance, smoking commonly triggers emphysema, and unhealthy eating can cause diabetes. Although the prevalence of chronic disease is increasing around the country, the situation is especially bad in Oklahoma. Compared to both the nation and to nearby states like Arkansas, Texas, and Kansas, Oklahoma performs poorly on most chronic disease indicators.


Despite the high prevalence of chronic disease in the state, not everyone in Oklahoma is at the same risk for chronic disease. People with lower education attainment, people in poverty, people of color, and those living in rural areas are more likely to develop a chronic disease. Oklahomans who do not graduate college are more than twice as likely to have a stroke than college graduates. Just to provide a few examples, Oklahomans living in households earning less than $50,000 annually are over 35 percent more likely to suffer from arthritis compared to those earning more. Oklahomans of color are 37 percent more likely to be diagnosed with diabetes than non-Hispanic whites. The incidence of obesity is significantly higher in more rural areas.

Although these factors may seem unrelated, education level, poverty, and race/ethnicity are all components of socioeconomic status. There’s a clear link between lower socioeconomic status and being exposed to risks that can negatively impact health, such as difficulty accessing healthy food and exposure to stress.

If socioeconomic status is a major determinant of health, then this explains why Oklahoma has such a high prevalence of chronic disease. The state ranks low in educational attainment and has a higher poverty rate than the national average. The state further has a relatively low percentage of people working in white-collar jobs. Considering that race/ethnicity and rural living are tied to education, income, and occupation, their pieces in the health puzzle begin to make more sense.

Based on these findings, it is clear that enhancing Oklahomans’ socioeconomic status could reduce chronic disease. Improving educational attainment, decreasing poverty, and helping residents attain the skills needed for better-paying jobs would likely lead to significant health improvements. In return, a healthier (and more educated, less impoverished, and more skilled) populace would likely have a number of positive effects for Oklahoma, including improving the state’s struggling economy.

In addition to large-scale efforts aimed at increasing the socioeconomic status of Oklahomans, small-scale options are also available to more immediately address the impact of socioeconomic status on health. The evidence-based Chronic Disease Self-Management Program (CDSMP) is one such option. Since 2007, Oklahoma has offered free CDSMP workshops in many counties. In two-and-a-half hour weekly workshops for six weeks, participants learn about their health conditions and are taught skills related to managing disease symptoms, including healthy eating, exercising, using medication appropriately, and working with health care providers. This program, which has been found to improve health status across socio-demographic lines, has been endorsed by the Oklahoma Health Equity Campaign.

Still, while evidence-based programs such as CDSMP are beneficial and should be further expanded, the fact remains that Oklahoma is struggling. Nearly three out of every four deaths in the state are caused by chronic health conditions. In order to have the most meaningful impact, the ultimate goal should be to decrease the social and economy inequality in Oklahoma. These social forces must be addressed if we want to make lasting improvements in the health of our people.


The opinions stated in guest articles are not necessarily those of OK Policy, its staff, or its board. To see our guidelines for blog submissions, click here.

2 thoughts on “To improve Oklahoma’s health, we must reduce inequality (Guest Post: Candace Smith)

  1. I think it important to point out that one’s mental state of mind has much to do with the physical health of that individual.
    Mental anxiety, stress, sadness, loneliness, hate,anger & many other states of mind can surely contribute greatly to poor health so it is not surprising that in areas which are lacking the resources & in general the mentality of solving social issues like poverty, basic nutritional needs, substance abuse, violent tendencies & the like have less than healthy residents in general.
    I think it is also very important to point out that the healthcare industry in this country today, using orthodox methods of “healing & curing” diseases actually hinder the Human body’s natural abilities of healing itself & is a system set up more for profit than actual care.
    In short, if we are healthy, there can be no profits so it is in the best interests of the industry in general that the population at large remain sick.
    I find it to be disgusting to say the least.

  2. Community Health Centers like Morton Comprehensive Health Center are part of the largest system of lifespan preventive primary care in the nation and consistently show well-vetted improved outcomes which manage chronic conditions like no other, as they serve all, turn no one is turned away. Oklahoma has more than 60 sites that serve patients no other will serve–we are part of the solution and hope that Oklahoma will invest in this model of preventive care for all, like all contiguous states. Come visit and see for yourself! Morton is a United Way agency, a Joint Commission-certified health center system, a teaching health center for medical residents and physician assistants to help address primary care shortages and a certified medical home to assure continuity of care. Access to care barriers are removed by offering free lift-equiipped transportation to all appointments, ancillary care like oral and vision care, WIC, medical legal aid, translation, and behavioral health care with case management and care coordination-all best practice. All are welcome!

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