Public health is defined succinctly as “organized community efforts aimed at the prevention of disease and the promotion of health”; and the mission of public health is “the fulfillment of society’s interest in assuring the conditions in which people can be healthy” (Institute of Medicine, “The Future of Public Health”, 1988, National Academy Press, Washington, DC). The “organized community efforts” include the healthy and safe environment, the prevention and control of communicable disease, the promotion of a healthy lifestyle through education of the public, the effective delivery of services for the prevention, early diagnosis, and treatment of disease, and the development and implementation of social and health policy to protect and improve the public’s health (adapted from Winslow C, “The Evolution and Significance of the Modern Public Health Campaign”, Yale University Press, 1923, New Haven, CT).
The current state of Oklahoma’s public health is poor. Oklahoma ranks 46th overall in the 2010 State Health Rankings published by the United Health Foundation.
The 2010 ranking represents a move upward from 49th in the prior year but a marked decline from 32nd in 1990. Oklahoma ranks 46th or lower for 4 of the 7 health outcomes (e.g., cardiovascular death, cancer death, premature death, limited physical health days, and limited mental health days) and has the second highest rate of death due to cardiovascular disease in the United States. Oklahoma is the only state in which age-adjusted mortality has worsened through the 1990’s and into this century.
The behaviors and risk factors driving the poor state of health of Oklahoma are (1) a high prevalence of smoking (25%), (2) poor diet and eating habits and lack of exercise resulting in a high and increasing prevalence of obesity (32%) and diabetes (11%), and (3) a high proportion of the population (16%) without health insurance. It is also important to consider ethnicity, race, age, gender, education, social policy, and other factors which are affecting the poor state of health in Oklahoma. Of serious concern is the discordance between Oklahoma’s rank of 14th in per capita public health spending and the rankings of 40th to 48th for key health outcomes.
Despite these data, there is a pathway to a healthier future. Oklahoma may improve its relative health in future years by (1) aggressive efforts to reduce health risk factors (smoking, poor diet and lack of exercise, lack of health insurance, etc) and eliminate health disparities, (2) application of evidence-based approaches for the primary prevention of disease, injury, and disability, (3) translation into practice of evidence-based approaches for secondary prevention aimed at delaying the progression and clinical complications of disease and improving quality of life in patients early in the course of their illness (e.g. prevention of complications in patients with diabetes or pre-diabetes), and (4) enhanced investment in prevention research.
In 2002, the Oklahoma State Board of Health issued a “Call to Action” to address the poor state of Oklahoma’s health. The College of Public Health has been an active contributing partner in response to the Board’s Call to Action. Some examples of College initiatives in response include:
- Renewed and strengthened relationships with the Oklahoma State Department of Health (OSDH) and the City-County Health Departments, including a formal association agreement with the OSDH and part-time faculty appointments for senior members of the Oklahoma City-County and the Tulsa City-County Health Departments.
- Meeting public health workforce development needs through expanded access to public health professional education and by providing tuition waivers for selected Health Department employees to enable their further career development.
- Implementation of Public Health Grand Rounds as a forum for engagement and exchange of information across the broad public health practice and academic communities.
- Enhanced community-based participatory research on public health priorities including tobacco use prevention, cancer prevention, and prevention of overweight, obesity and diabetes, as well as various social marketing initiatives.
- Markedly strengthened efforts in health policy research and analysis for state and city-county health agencies and for the Oklahoma legislature.
- Participation as a leading contributor to the State Coverage Initiative in collaboration with the Oklahoma Insurance Department and the Oklahoma Healthcare Authority.
- Participation with the Oklahoma Health Improvement Plan (OHIP) including membership on the full planning team and the Executive Committee.
On a national level, the United States faces serious public health challenges. Tobacco use continues to be the leading cause of death, being responsible for an estimated 435,000 deaths each year. Poor diet and lack of physical exercise resulting in overweight and obesity is the second leading cause and is responsible for up to 365,000 deaths annually. Other leading causes of death, with the national figures in parentheses, are inappropriate alcohol consumption (85,000), infectious diseases (75,000), toxic agents (55,000), motor vehicle accidents (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and use of illicit drugs (17,000) (See Mokdad A et al. Actual causes of death in the United States, 2000. JAMA 2004; 291:1238 - 1245). All of these leading causes of death are potentially preventable. A theme is clearly emerging that the key to both improving the health of the nation and reducing health care costs is a greater emphasis on prevention of disease and injury. The OU College of Public Health is contributing to innovative research and scholarship in several of these priority areas. The College will continue to provide leadership in the area of public health workforce development, which is a priority goal for schools of public health across the nation.
The College is also facing the challenges and limitations related to the macroeconomic environment as the nation begins to recover from a serious recession. The College has experienced cuts to the budget from University/State support in five of the last nine years and is expecting another cut in FY2012. In this environment, it is prudent to carefully prioritize items in the strategic plan and identify the core and most important needs for the College which center on providing an exceptional educational experience for students and achieving continued and expanded excellence in research and scholarship.