Oklahoma’s Journey to Promote Health, Well-Being, and Equity
Five years into the Sentinel Communities Surveillance Project, Oklahoma has a strong capacity for addressing issues of health and well-being at the state level through its health department and well-established anchor organizations. The state is further supported by significant external grant funding for broad social and health issues, however there are questions about whether this is sustainable without significant state resources. With regards to the health narrative in Oklahoma, there is an individualistic orientation to health that remains dominant. However, a focus on the social determinants of health has deepened in Oklahoma over the past five years, with cross-sector stakeholders engaging in topics such as mental health and some increasing awareness about the value of public health. Oklahoma’s approach to health equity has evolved over the past five years, with the enhanced focus on social determinants of health and more use of data to assess equity. The emphasis on social determinants of health has grown, propelled by investments from philanthropic organizations and grants received from outside the state.
Health Priorities and Narrative
Oklahoma has a strong capacity for addressing issues of health and well-being at the state level through its health department and well-established anchor organizations.
The state is further supported by significant external grant funding for broad social and health issues.
There are a few efforts—focused on health promotion, healthy childhood development, healthy eating, and healthcare access—which have matured in the past five years.
Recent efforts spurred by organizations outside of the health sector have played a role in addressing factors that influence health—such as housing stability—and pervasive health issues—such as opioid abuse.
Health Priorities and Narrative
Even with a pervasive, individual-centered health narrative, there is a growing acceptance of the importance of social determinants of health.
Over the past fiver years, there is a stronger focus on the impacts of adverse childhood experiences (ACEs) and the importance of resilience.
There remains a strong focus on improving access to health care services as a path to addressing health inequities across geographic areas.
The “conversation” of health equity is starting to take place, though there is not agreement on how much the conversation has translated to real action.
Lessons Learned: Where is Oklahoma Five Years Later?
While Oklahoma’s strong identity in individualism may be important to aspects of economic progress, that narrative has challenged consistent community investment in health.
Many institutions outside of government (nonprofits, universities, and philanthropies) are key to advancing health and well-being in the state, but questions remain regarding how much this private infrastructure can balance against government underinvestment in public health—cited in criticisms of the state’s response to COVID-19.
The issues of power and the diminishing ability for citizens to engage in decision-making are key concerns—broadly and in health action, specifically. With the recent passage of Oklahoma’s law to limit access to abortion care, there are new questions about citizen voice in health policy and concerns about negative impacts on maternal and child inequities.
Other communities can learn from Oklahoma’s approaches to building support for health activities outside of government, including novel approaches such as OK25by25 or the Medical Loan Repayment Program.
Future research should examine if and how the increased focus on social determinants of health in the state can spur a broader, systems-level approach to health equity and how communities in the state navigate tensions with state leadership in terms of health policies and investment choices.
Oklahoma has advanced its health efforts through a greater focus on social determinants of health; more investment by philanthropies; and augmented data capacity. However, Oklahoma continues to confront tensions between local innovations and state-level political will to support community health initiatives, which can make progress on health outcomes—including health equity—quite challenging.
Ballot initiatives providing residents with input on health-related decisions, such as Medicaid expansion
Philanthropic foundations bolstering health and social initiatives
Universities providing support to nonprofits, data, and healthcare capacity
State leadership focus on maintaining the status quo—including limited action on equity through systems or structural change
Economic fluctuations in state that both influence and supersede public health focus
Inequitable distribution of healthcare providers