5. Demographic Trends in Wagoner County & Broken Arrow Population growth in Wagoner County exceeding that of TAUW service area. Greater cultural diversity particularly among the population under 25 years of age Living arrangements are changing significantly with more children in single headed households and other relative households Larger number of people over 65 years of age are living alone… especially women Median family income varies by race Large population of mobile renters

30. Human Development: Key Points Middle class is disappearing Many households lack adequate income Stress of inadequate income and related conditions is widespread Starting life in Wagoner County for many is risky business

31. Human Development: Key Points… continued Populations of aging and persons with disabilities are large and growing Health challenges are critical to individual and community well-being Poor human conditions impact crime and growing incarcerations Overall progress in human development is tied to educational success

32. The Middle Class is Disappearing ~Lower income groups greatly expand, middle shrinks, highest income group increases dramatically

37. Many Households Lack Adequate Income ~More and more households lack adequate income to meet living needs

63. Prepared by the Community Service Council of Greater Tulsa

74. Starting Life for Many is Risky Business ~Combination of many risk factors takes heavy toll and early screening for risk level is inadequate

75. Adequate Early Screening Essential for All Children to Assess Impact of Risk Factors Some evidence indicates only small portion of children receive needed screening Sufficient data do not exist to clearly indicate extent and nature of problem

76. What is early intervention? Early intervention applies to children of school age or younger who are discovered to have or be at risk of developing a handicapping condition or other special need that may effect their development. Early intervention consists of the provision of services such children and their families need for the purpose of lessening the effects of the condition. Early intervention can be remedial or preventive in nature – premeditating existing developmental problems or preventing their occurrence.

78. Populations of Aging and Persons with Disabilities are Large and Growing ~These populations will significantly test the capacity of resources needed to enable them to be most self- sufficient

81. Health Challenges are Critical to Individual and Community Well-being ~Inadequate income, high risks of starting life and poor lifestyle choices contribute to major health concerns

82. Oklahoma and Tulsa County faring poorly compared to US in age-adjusted death rates Age-Adjusted Death Rates, 1980 to 2002

83. OBESITY Trend: America’s weight gain epidemic – 25% of Americans are obese – more than doubled in 15 years. Benchmark: We must reverse this trend. Bad: Consequences – –high healthcare costs. –Increased heart disease, type II diabetes, osteoarthritis, hypertension, gallbladder disease, breast cancer, endometrial cancer and colon cancer. Bad: OK and Tulsa Co heart disease rates are higher than the rest of the nation – only one state ranks worse than OK. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, Center for Health Policy Research and Development, OUCPH, 2005; NCHS, CDC; THD; Tulsa County Health Profile; NIH; United Health Foundation; BRFSS, CDC; St. Francis Health System FY 2004 Community Needs Assessment. OK US THD – Patel/Woodruff 9/05 Major Health Concern: Poor Lifestyle Choices -- Obesity

84.  Trend: Percent of adult smokers (2003): 22.7(Tulsa Co), 25.1(OK), 22.0(US), state rank=36.  Benchmark: Smoking bans in public venues, smoking cessation programs, and increasing cigarette taxes = curtailed adult smoking and youth take-up rate.  Good: OK youth smoking percent is below the national average— 26.5(OK) and 27.5(US); adult smokers declining locally, statewide and nationally (2003).  Bad: Smoking is a major cause of premature death, cardiovascular and pulmonary system disease including heart attack, stroke and cancer. THD – Patel/Woodruff 9/05 NCHS, CDC; THD;Tulsa County Health Profile; NIH; BRFSS, CDC Major Health Concern: Poor Lifestyle Choices -- Smoking

85. THD – Patel/Woodruff 9/05 NCHS, CDC; THD;Tulsa County Health Profile; NIH; BRFSS, CDC Poor health conditions leave safety net severely challenged - Growing Uninsured Population Suburban Counties of Tulsa MSA, 2003

86.  Tulsa’s uninsured and Medicaid beneficiaries seek primary care in Tulsa hospital ERs. ER visits by Medicaid recipients actually exceeded uninsured visits by 25%.  Tulsa hospital ER patient survey found that 73% were not true emergencies: 30% treated for non-emergency conditions – another 43% could have been treated in non-emergency facilities within 48 hours.  Using hospital ERs for non-emergency care is a costly and inefficient.  Non-emergency ER use is a major contributor to overload and frequent divert status of Tulsa hospital ERs — especially in the last 2 years. THD – Patel/Woodruff 9/05 Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, Center for Health Policy Research and Development, OUCPH, 2005; THD CAP Poor health conditions create huge inefficient demand on resources - Misuse of Hospitals and Emergency Rooms

87.  Of the 80 largest US metro areas, only Tulsa and Wichita lack ALL the components of a traditional public healthcare safety net infrastructure for indigent care. No public or university hospital. No comprehensive sponsorship of specialties/sub- specialties at medical schools. No hospital receiving Medicaid Disproportionate Share Hospital (DSH) funds for indigent care served. No hospital specifically organized and tasked to provide indigent care. No statewide support of Federally Qualified Health Centers (FQHCs); only one fully functional FQHC in Tulsa. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, OU Center for Health Policy, 2005 THD – Patel/Woodruff 9/05 Overall lack of health care resources for indigent care No Local Traditional Safety Net

88. Higher poverty correlates closely with higher percentages of uninsured and Medicaid recipients. Oklahoma ranks 40 th in the United Health Foundation’s state index rankings, but we are right on the average for states with similar levels of poverty. Poverty may be the greatest single determining factor in a state’s health rank accounting for almost 55% of the variance explanation. Generally, states with low poverty levels can expect to achieve higher health ranking without regard to other public health measures. THD, 2005; United Health Foundation State Health Rankings, 2004 OK The Influence of Poverty on Health Rankings

89. Poor Human Conditions Impact Crime and Growing Incarcerations ~Trends greatly affected by substance abuse

90. Oklahoma’s prison population was relatively stable until 1980 when laws passed to curb illegal drug use came into effect Oklahoma’s Prison Population 1950-2005 Source: Oklahoma State Department of Corrections, Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission in Tulsa. 1980 Note: Number of inmates in Oklahoma prisons, data as of June 30 of each year

92. Overall Progress in Human Development is Tied to Educational Success ~From preschool through post secondary education

97. Education Success: Preschool

99. Education Success: Post-Secondary-Higher Education

100. Growing importance of coordination among higher education institutions to promote system efficiency System Overview The State Regents prescribe academic standards of higher education, determine functions and courses of study at state colleges and universities, grant degrees, recommend to the state Legislature budget allocations for each college and university, and recommend proposed fees within limits set by the Legislature. A primary goal for the State Regents is “System Efficiency” especially focused on reduced program duplication. Tulsa Community College provides the lower level (Freshman & Sophomore) courses in Tulsa County and articulates agreements with all state supported four-year colleges and universities in Oklahoma for students wishing to pursue a bachelor’s degree. Tulsa Community College provides educational opportunities that can lead to Associate Degrees in Arts, Science, or Applied Science and to Certificates of Achievement.

101. Tulsa Community College serves as primary source of higher education enrollment Percent Distribution of Tulsa Area Higher Education Enrollment Tulsa Area Public Colleges, Fall 2003

102. Public College Remediation Rates Among HS Graduates Tulsa County and Oklahoma, 1999-2003

103. Human Development: Key Points Middle class is disappearing Many households lack adequate income Stress of inadequate income and related conditions is widespread Starting life in Wagoner County for many is risky business

104. Human Development: Key Points… continued Populations of aging and persons with disabilities are large and growing Health challenges are critical to individual and community well-being Poor human conditions impact crime and growing incarcerations Overall progress in human development is tied to educational success

107. Our Health at Risk… Health rankings

111. Our Health at Risk… Lack of Health Insurance

113. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, OU Center for Health Policy, 2005;. THD – Patel/Woodruff 9/05 Major Health Concern: Uninsured – Tulsa to Comparable Cities

114. Our Health at Risk… Persons with Disabilities

124. Our Health at Risk… Death Rates

127.  Good:  Tulsa Co death rates parallel those of OK  Tulsa rates below the OK rate for most years;  2002 Tulsa rate lower than some metro areas of similar size and scope, including Oklahoma City.  Bad: By 2002 Tulsa County rate was 14.5% higher than the nation. THD – Patel/Woodruff 9/05 Major Health Concern: Tulsa’s high age-adjusted death rate compared to other areas Age-Adjusted Deaths Rates for Tulsa and Comparable Areas, 2002