Population Health Eye on Oklahoma

By Kirstin Q. Siemering, DrPH, RD

Oklahoma is one of the least healthy states in the country. In 2010, it ranked 46 in America’s Health Rankings (AHR), beating out only Nevada (47), Arkansas (48), Louisiana (49), and last place Mississippi (50). Oklahoma has struggled for some time: the state’s age-adjusted mortality rates have been consistently higher than the national average since 1981. Among Oklahoma’s health challenges, tobacco is arguably one of its most serious. In the 2010 AHR, Oklahoma ranked 49 for smoking prevalence, with only 0.2% separating it from lowest ranked Kentucky.

Nationally, smoking prevalence has declined dramatically over the past two decades, from about 30% in 1990 to about 18% in 2010. While many states’ statistics echo this trend, smoking rates in Oklahoma have held relatively steady since the mid 1990s, at about 25%. While these numbers paint a rather grim picture relative to the nation as a whole, Oklahoma’s prevention investments offer hope for a brighter future.

Since the 1998 Master Settlement Agreement (MSA), a group of national organizations has reported annually on states’ use of these funds to promote tobacco cessation and prevention. Their most recent report, entitled A Broken Promise to Our Children: The 1998 State Tobacco Settlement 12 Years Later, documents a disturbing trend to cut tobacco prevention dollars despite growing tax and settlement revenues. Oklahoma provides a notable exception. Over the past few years, while average state funding for tobacco prevention has declined by 22%, Oklahoma has increased its funding by 52%.

This investment is particularly impressive because it comes at a time when states are focused on cost-cutting. In fact, a 2005 case study of six states’ use of Master Settlement Funds revealed a diverse array of allocations beyond health and tobacco prevention, ranging from capital projects to budget shortfalls. North Carolina legislators are considering abolishing two trust funds (the Health and Wellness fund and the Tobacco fund) that receive half of the state’s share of settlement funds.

So what did Oklahoma do differently? In 2000, they created the Oklahoma Tobacco Settlement Endowment Trust (TSET) through a constitutional amendment that requires available funds be used exclusively for supporting the health of Oklahomans. Three-fourths of all new MSA funds are preserved in trust, which has grown from $500,000 in 2003 to $18.5 million currently. TSET has adopted a broad and expanding health portfolio that includes but is not limited to comprehensive tobacco prevention. Nearly $5 million has been allocated to the new “Shape Your Future” campaign, which aims to reduce preventable deaths through social marketing, policy development and enforcement, and a focus on child health. TSET has also recently increased its reach to community-based nutrition and fitness initiatives, and this month will award about $10 million to 10 programs across the state.

The 2010-2014 Oklahoma Health Improvement Plan acknowledges the enormity of the challenge in the document’s first line: “Oklahoma ranks near the bottom in multiple key health status indicators.” But this is not a state that has accepted the status quo. We hope Oklahoma’s strategic and democratic coup that created TSET and protected the MSA funding will result in the implementation of evidence-based programs and policies that will address many of Oklahoma’s health challenges and serve as a population health improvement model for other places.

Kirstin Q. Siemering, DrPH, RD is a Researcher with the University of Wisconsin Population Health Institute.