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.