Assessing Our Health and Social Services Structures

Human, health and social services provide the safety net that is essential to our society. Most Oklahomans agree that government has an essential role in ensuring that vulnerable individuals and families can meet their basic needs. Most also believe that government should promote healthy lifestyles and support a public health infrastructure.

Like all public institutions, health and social services have a long history. Limited efforts to care for the least fortunate were provided by local governments starting in the 18th century. In the 1800s, states became more involved in social services, particularly in caring for those with disabilities and mental illness, and veterans. Federal involvement grew through this period as well, providing pensions for war veterans and their widows. All of these programs evolved in the 20th century. Pensions expanded into the Social Security system. Relief efforts for the poor were expanded at every level of government in the 1920s and 1930s. At the same time, public investments in research, vaccinations, and public health campaigns were essential in fighting and eliminating some diseases, which contributed to the 20^th century’s dramatic gains in average life expectancy.  Sadly, many of these gains have stopped or even been reversed, particularly for people of color, in the 21^st century.

Health and social services are essential to a healthy community and economy. By most measures, however, the United States falls short of other developed nations, and Oklahoma struggles to keep up with the rest of the nation. We have made progress, though. Oklahoma has increased the number of children with health insurance, and we rank high in investments in public health to prevent and control infectious diseases.

Overall health has improved recently, though not as quickly as elsewhere. Oklahoma drug abuse and addiction rates are high, as are child abuse, domestic violence, accidental death, and smoking. Obesity is increasing dramatically. Overall, our health status ranks near the bottom of the 50 states. Our health and social services shortfalls hit the lower-income population hardest.

These indicators give a snapshot of where Oklahoma health and social services stand today.

Adult Health Outcomes

Source: Centers for Disease Control and Prevention, SHADAC

Oklahoma ‘s rate of accidental deaths, 62.5 deaths per 100,000 people, compares unfavorably to the national average of 49.4 deaths. Rates are adjusted for age of the population. Oklahoma ranked among the bottom ten states in rates of deaths from motor vehicle accidents and alcohol-induced death, and somewhat higher in deaths by firearms, suicide, and drug overdoses. Oklahoma’s ranking has improved over the last decade, because the nation’s accidental death rate has increased while Oklahoma’s has been stable.

Oklahoma’s smoking rate – 20.1 percent for adults, exceeds the national average of 16.4 percent, but Oklahoma’s rate has dropped since 2017 at a rate faster than the national rate. Oklahoma’s rate of adults reporting poor mental health, 36.5 percent, placed it in the middle of state rankings and just above the national average of 35.6 percent. However, Oklahoma was previously below the national average on this measure.

Adult Health Access

Source: U.S. Bureau of the Census, State Health Access Data Assistance Center

Oklahoma ranked next to last among the states in share of adults without health insurance,14.2 percent compared to 8.7 percent nationally. Over the last ten years, the gap between Oklahoma and the national average grew from three to five percentage points, because most states expanded Medicaid to low-income adults, while Oklahoma did will not do so until 2021.  Overall uninsured data mask very high uninsured rates among people of color. While 12 percent of Whites and 14 percent of Asians lacked insurance, rates were higher for Blacks (17 percent), Hispanics or Latinos (26 percent), and Native Americans (32 percent). However, uninsured rates did decline for all groups from 2016 to 2019.

Lack of insurance helps explain Oklahoma’s lower rate of adults seeing a doctor (66 percent in Oklahoma vs. the national average of 64 percent) and those who did not get care because of the cost (17 percent vs. 14 percent).

Children’s Health and Welfare

Source: KIDS COUNT, Centers for Disease Control and Prevention

The first five measures in the table above are indicators for KIDS COUNT, an annual national report on child well-being. While Oklahoma’s performance has been stable or improving, most other states are improving faster, so Oklahoma’s overall rank for child health fell from 34^th in 2014 to 43^rd in 2017.

Oklahoma continues to make progress on the percentage of toddlers having all recommended vaccines, increasing from 53.3 percent in 2007 to 67.3 percent in 2017. Oklahoma has reduced the gap between state vaccination rates and the national average from 13 to 3 percentage points in that period.

Of every 1,000 children, 9.7 were in foster care in 2017, according to the U.S. Department of Health and Human Services. Oklahoma’s rate of maltreatment was somewhat higher than the national average of 6.0 per 1,000, but the gap has narrowed in the last three years.

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