1. The Perfect Storm Community Service Council of Greater Tulsa

2. The Perfect Storm Key dimensions of change: Demographic trends Technology Globalization and economic shifts Resources and thinking for investing in new directions Community Service Council of Greater Tulsa

3. 8 Sources of the Perfect Storm Lack of mass employment with living wage for unskilled/low-skilled persons and linked to growing income inequality Growing workforce shortage Rapid aging of the population Challenges to healthy lifestyles and access to quality health care Continued growing immigration Growing challenges to American culture Changing environmental conditions Uncertainty of future energy supply Community Service Council of Greater Tulsa

4. The Perfect Storm… Health Insecurities Global & U.S. Demographics and Related Factors Community Service Council of Greater Tulsa

5. Key Global Demographic Trends Are Attributed to Multiple Causes  Developed and Developing Countries Major Causes of Death  Underweight in Infancy  Obesity School-age  Anemia  Sanitation Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001). Community Service Council of Greater Tulsa

6. Health Insecurities Increase in Developing Countries Community Service Council of Greater Tulsa

7. Infectious Diseases Continue to be Leading Causes of Death Globally Tuberculosis Malaria Hepatitis HIV/AIDS Cholera Diptheria Dysentery Heart Disease Cancer Diabetes Tuberculosis HIV/AIDS Hepatitis B and C Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001). Community Service Council of Greater Tulsa

8. In Low-Income and Middle-Income Countries, 30 Percent of All Children Are Underweight Source: C. Haub, 2007 World Population Data Sheet. Community Service Council of Greater Tulsa

9. Percent Overweight and Obese in School Age Children Source:: United Nations Standing Committee on Nutrition (SCN), “Overweight and Obesity,” SCN News29 (Late 2004-Early 2005). Community Service Council of Greater Tulsa

10. Iron-Deficiency Anemia Remains a Problem in Many Parts of the Developing World Source: ORC Macro, MEASURE DHS STATcompiler (www.measuredhs.com, accessed June 15, 2007).www.measuredhs.com Community Service Council of Greater Tulsa

11. HIV/AIDS is More Common in Less Developed Regions Percent of population 15–49 with HIV/AIDS, 2005-2006 WORLD0.9 More developed regions0.5 Less developed regions1.1 Africa4.5 North America0.6 Latin America/Caribbean0.5 Europe0.5 Oceania0.4 Asia0.2 Source: C. Haub, 2007 World Population Data Sheet Community Service Council of Greater Tulsa

12. HIV Prevalence Is Highest in Southern Africa Source: C. Haub, 2007 World Population Data Sheet. Community Service Council of Greater Tulsa

13. Disparities in Access to Sanitation Exist Across Regions and Between Urban and Rural Areas Source: UNICEF and WHO, “Country, Regional, and Global Estimates on Water and Sanitation” (2004). Community Service Council of Greater Tulsa

14. Health Insecurities Increase in the United States Driven By High Costs and Lack of Insurance Community Service Council of Greater Tulsa

15. Health Care Expenditures in the U.S. Growing How much does the US spend on health and how has it changed? US spends over $6,500 per person on health care each year. 16% of the US economy is devoted to health care. Health care spending is consuming an increasing share of economic activity over time and has exceeded economic growth in every recent decade

16. National Health Care Expenditures and their Percentage of the GDP 1960 to 2005 5Source:CentersforMedicareandMedicaidServices,OfficeoftheActuary,NationalHealthStatisticsGroup,athttp://www.cms.hhs.go v/NationalHealthExpendData/(seeHistorical;NHEsummaryincludingshareofGDP, CY1960-2005;filenhegdp05.zip).

17. US Health Care Expenditures Exceed Global Expenditures But Outcomes Do Not Match How does US spending compare with other countries? As of 2004, health spending in the US was about 90% higher than in many other industrialized countries.

18. US Health Care Expenditures 2004 Greatest in the World with Rank of 32 nd in Health Outcomes Source: Organisation for Economic Co-operation and Development. OECD Health Data 2007, from the OECD Internet subscription database updated July 2007. Copyright OECD 2007,www.oecd.org/health/healthdata.

19. US Health Care Expenditures Vary by Age with 50% of Expenditures on 5% of the Population How does health care spending vary by person? As of 2004, a small share of people accounts for a significant share of expenses. Almost half of all health care spending was used to treat just 5% of the population. Health care spending varies by factors such as age and sex. Adults aged 65 years and older have the highest health care spending, averaging $8,647 per person.

20. Health Care Spending is Greatest in the Top 5% of the Population Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.

21. Health Care Spending is Greatest in the Aged Over 65 Years and in Women Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.

22. US Health Care Expenditures Vary by Age with 50% of Expenditures on 5% of the Population What do health care expenditures pay for and who pays them? Most health care spending is for care provided by hospitals and physicians. Private funds pay for about 55% of total health spending. Health care spending varies by factors such as age and sex. Adults aged 65 years and older have the highest health care spending, averaging $8,647 per person.

23. Health Care Spending is Greatest in Hospitals and Physicians Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.

24. Relative Expenditures by Source of Care are Increasing for Private Health Insurances Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData

25. Health Insecurities Increase in Oklahoma and Tulsa County Community Service Council of Greater Tulsa

26. Minorities are More At-risk for Health Insecurities A higher percentage having no health insurance Minorities make half as many physician visits for preventive health Minority men are employed in the most dangerous occupations (mining, construction, etc.) Men and boys are encouraged to more risky behaviors Research on health responses to specific diseases and interventions by race are underfunded Health Care Rx: Access For All The President’s Initiative on Race 1998

27. Gender Differences in Life Expectancy Favor Women Life expectancy for men and women in 1920 was 1 year difference Life expectancy for men and women in 2003 is 6 years difference Men are more likely to die than women in all the top ten causes of death At birth, there are more males than females. By age 36, the trend turns to more females than males. At age 100, women outnumber men by 8 to 1 www.menshealthnetwork.org

28. Premature Death Greater in Racial and Ethnic Minorities The racial and ethnic minorities in Oklahoma are expected to reach 50% of the Oklahoma population by 2010-2015 Infant mortality is higher in minority populations Oklahoma exceeds the national average in age adjusted death rate for heart disease, cancer and stroke with minority populations disproportionately represented Source: Center for Vital Statistics, Oklahoma State Department of Health

29. Diminishing Population Increase Health Insecurities in Rural Areas

30. Demographics

32. Life Expectancy for Whites and Blacks, 1800 to 2000 in the U.S. Has Grown Equally Dramatically

35. Total Fertility Rates for White and Black Women, 1800 to 2000 in the U.S. Have Dropped Dramatically

36. Infant Mortality Rates for Whites and Blacks, 1800 to 2000 in the U.S. Have Decreased

40. Prepared by the Community Service Council of Greater Tulsa

52. Heart Disease Deaths by Race and Sex, Oklahoma, 1980-1997 Age Adjusted Death Rates per 100,000 Population

54. Cancer Deaths by Race and Sex, Oklahoma, 1980-1997 Age Adjusted Death Rates per 100,000 Population

56. Stroke Deaths by Race and Sex, Oklahoma, 1980-1997 Age Adjusted Death Rates per 100,000 Population

57. Unintentional Injuries Deaths by Race and Sex, Oklahoma, 1980-1997 Age Adjusted Death Rates per 100,000 Population

60. Community Profile 2008 and Perfect Storm Publications are available on our website: www.csctulsa.org Prepared for the Tulsa Area United Way Community Investments Process By the Community Service Council of Greater Tulsa December, 2007