Interim work is underway in both chambers of the legislature. The Joint Healthcare Working Group has now had four lengthy sessions. The charge to the healthcare working group is to recommend ways to improve Oklahoma’s healthcare system. Among many useful presentations was that of Dr. Gary Raskob, Dean of the College of Public Health at the OU Health Sciences Center. Dr. Raskob discussed the evidence explaining why Oklahoma continues to rank near the bottom in the health of its citizens compared with other states.
Dr. Raskob presented findings about “Determinants of Health and their Contribution to Premature Death.” Surprisingly, healthcare services determine only 10 percent of the overall health of the population. The remaining 90 percent consists of behavioral patterns (40 percent); genetic predisposition (30 percent); social circumstances (15 percent), and environmental exposure (5 percent). Social determinants, such as economic stability, neighborhood and physical environment, education, food, and community and social context, all contribute more toward health and life expectancy than the healthcare system.
This is not to say that healthcare is unimportant. In fact, Dr. Raskob recommended, without taking a specific position on Medicaid expansion, that healthcare coverage ought to be expanded. But analysis shows that all the other determinants ultimately govern when, what kind of, and the quality of healthcare a person gets and the expected results, including life span.
Dr. Raskob presented convincing statistical analyses demonstrating that the level of education obtained by an individual determines whether they are likely to be a smoker, their income – which in turn affects the quality of housing and the neighborhood in which they lives – their diet, and whether or not they have good health insurance.
He concluded his presentation by recommending two important actions legislators could take to improve Oklahomans’ health. First, they could pass a cigarette tax to increase the cost of smoking and repeal preemption statutes that prevent local communities from restricting smoking. Studies show that cost and inconvenience drives people to quit smoking. Second, they could provide high quality, accessible education, from pre-k through higher education, including career tech. Education affects all the other social determinants (except genetics) that produce a healthier population and longer lives.
Legislators have also held informative studies recently in the House Children, Youth and Family Services committee addressing child abuse prevention, improving foster care, and providing better transition services for foster children who age-out of the system. There are 10,000 Oklahoma children in out-of-home placement due to abuse or neglect. Looking at the healthcare and children’s studies together, what happens to these foster children affects their health in both the short and long term. Excellent and accessible education and social services will lead the way to more productive people and better health, but as a state we seem to continue to see ourselves as better off being a low-tax, low-service state.