It is important to note that a relatively high score means lower levels of inequality – not a reflection of the overall state of health. In fact, Oklahoma as a state typically ranks very poorly against other states in numerous health measures. According to the United Health Foundation’s 2019 America’s Health Rankings, Oklahoma ranks 46th in overall health status, better only than four states – Alabama, Arkansas, Louisiana, and Mississippi.
Health is a product of interrelated individual and systemic or structural factors, including genetic predispositions, community and environment, policies and practices of health care systems, and quality of healthcare. Those factors and many others can also be called social determinants of health (SDOH) – the social, economic, and physical characteristics defining the communities in which people live, work, and play. SDOH have considerable influence on health outcomes and health disparities among different groups of people. Disparities in life expectancy, morbidity and mortality, functional limitations, healthcare expenditures, and overall health status are all in part due to different experiences with social, economic, and physical environments.
At 63.33, Health Care Access is the highest scoring topic of all 18 topics in Tulsa’s Equality Indicators this year. Two of the three indicators in this topic rank in the top five highest scoring indicators in the report.
One of those top scoring indicators, Health Insurance by Race, is initially surprising because Oklahoma ranks very poorly compared to other states in health insurance coverage – second to last with 14% of the state’s population uninsured. Because this report measures the level of equality in health insurance coverage, it indicates that Tulsans in general, regardless of race, are relatively equally uninsured. In spite of the “good” equality score for health insurance by race, a highly uninsured population is very detrimental to the community, as it results in inadequate levels of preventive care, greater usage of emergency rooms for non-emergency care, and poorer health outcomes, all of which increase healthcare costs.
Last year Tulsa’s Veterans Affairs (VA) clinics outperformed the national average in appointment wait times exceeding 30 days, resulting in a score of 100 for that indicator. This year the share of Tulsa’s VA clinic appointment wait times exceeding 30 days rose slightly, causing the indicator’s score to decline quite a bit, but still remain one of the top scoring indicators. In spite of this considerable one-year drop in score, the actual change in raw data was fairly minor. While the national average share of appointments over 30 days remains relatively constant, Tulsa’s slight increase was enough to push it below the national average. Because the percentages for both Tulsa and the nation are very low to begin with, any small shift will register as a substantial change to the ratio between the two and therefore in the equality score.
The Mortality topic focuses on disparities in infant mortality, cardiovascular disease mortality, and overall life expectancy.
The infant mortality rate, often used as an indicator of the overall health of a community, exhibits intense and persistent racial disparity. Infant mortality continues to devastate African American communities at significantly higher levels than other populations across the nation, even when socioeconomic status and environmental characteristics are held constant. Many researchers believe this relentless disparity is the result of both generational trauma associated with historic racial discrimination and present-day racism in general and specifically in the healthcare system.
As a whole, Oklahoma ranks 49th among the states in deaths from cardiovascular disease, meaning only one state, Mississippi, has a higher cardiovascular death rate than Oklahoma. African Americans have a higher cardiovascular disease mortality rate than any other racial group in Tulsa County.
Disparities in life expectancy among residents of different Tulsa zip codes have been a serious concern for years. Latest data show about an eight and a half year difference in average life expectancy between North and South Tulsa. Every other health measure shapes this one – access to healthcare, personal and generational experiences of trauma, behavior choices, quality of care, and health care policies. This indicator is impacted by all of the disparities across all of the themes in Equality Indicators – economic opportunity, education, housing, justice, and services.
 Taylor, Jamila, Cristina Novoa, Katie Hamm, and Shilpa Phadke. 2019. “Eliminating Racial Disparities in Maternal and Infant Mortality.” Center for American Progress, May 2, 2019. https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/; Weinstein, Ann Diamond. 2020. “Racial Disparities in US Maternal and Infant Mortality Rates.” Psychology Today, March 6, 2020. https://www.psychologytoday.com/us/blog/the-beginning/202003/racial-disparities-in-us-maternal-and-infant-mortality-rates; Leimert, Kelycia B., and David M. Olson. 2019. “Racial Disparities in Pregnancy Outcomes: Genetics, Epigenetics, and Allostatic Load.” Current Opinion in Physiology, Volume 13, Feb. 2020. https://www.sciencedirect.com/science/article/pii/S2468867319301890?via%3Dihub.
The Well-being topic addresses disparities in three distinct areas – food insecurity, mental health, and smoking. Two of these indicators are new to Tulsa Equality Indicators this year. Since the inception of Equality Indicators in Tulsa, inclusion of indicators focusing on food desert distribution and a measure of mental health disparities have been recommended.
For an urban area, a food desert is defined as a geographic area that is both low-income (poverty rate of 20% or higher) and is not within a mile of a full-service grocery store. Living in a food desert limits the ability to access nutritious food choices including fresh fruits and vegetables, and consequently has a major impact on overall health. Because food deserts are low-income areas, residents are less likely to have a vehicle, further restricting access to nutritious food.
Meaningful mental health related data that meet the criteria for inclusion in Equality Indicators are not readily available, which has caused a frustrating gap in the Health theme for the last two years. An extensive search for possible indicators led to the selection of one that assesses disparity in frequency of mentally unhealthy days by income level. The data are derived from the Behavioral Risk Factor Surveillance System (BRFSS) through the question “thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” The results reveal that adults earning less than $50,000 annually are more likely than those earning more to experience at least 14 days of poor mental health in a month. This level of frequency is significant as it is strongly associated with diagnosis of mental disorders, such as depression and anxiety. Oklahoma is consistently found to have one of the highest incidence rates of mental health disorders in the nation. We hope to expand our analysis of disparities in mental health in future years to better reflect the significance of the issue to Tulsans.
As the only indicator in the health theme to directly measure health behaviors, smoking serves as a valuable proxy because it is the leading cause of preventable death and disease in the United States. Residents of North Tulsa are more likely to smoke than residents of any other part of Tulsa. The prevalence of smoking continues to decline in both Oklahoma and the nation, but at 20% the state still ranks in the top ten highest states.