Community Context 

The state of Oklahoma—geographically situated just north of Texas—is a mostly rural state with two large metropolitan cities: Oklahoma City and Tulsa. 

Though the state is predominantly White, it is home to diverse populations. Oklahoma has the second largest American Indian population in the United States. Though there has been a long, fraught history between tribal nations and the state of Oklahoma and the U.S. federal government, there have been efforts on both sides to work collaboratively to improve community health across the state. 

Oil production has been a key economic driver in Oklahoma, though the state has experienced substantial fluctuations in the production and success of the oil industry, subjecting the state to a “boom and bust” economy. The state’s unpredictable economy not only affects employment opportunities for residents, but also has severe implications for the funding allocated to the education sector, as well as the provision of health and social services. 

The identity of many Oklahomans is characterized by a sense of individualism and the idea of “pulling oneself up by their bootstraps.” This has undergirded beliefs about lack of governmental involvement in residents’ lives and decision-making, particularly in relation to health. Oklahoma has a large proportion of adults living in poverty (nearly 15%) compared to the national average (12.1%). Oklahoma ranked 46th in health outcomes in 2019 and confronts significant racial and ethnic health disparities. 

Challenges with addressing health issues have been further exacerbated by healthcare provider shortages across the state. Though Oklahoma’s response to the COVID-19 pandemic was ranked at the bottom compared to other states, the economy was reopened only a few weeks after shutting down. Local universities were critical in providing guidance around how to respond to the pandemic. The state still faced challenges because there was no consistency in decision-making or a standard way of addressing COVID response across the two main cities and the rural areas of the state.

Community Actions

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.

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. 

Facilitators:

  • 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

Barriers:

  • 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