the perfect storm community service council of greater tulsa

The Perfect Storm

Community Service Council of Greater Tulsa

The Perfect Storm

Key dimensions of change:

Demographic trends

Technology

Globalization and economic shifts

Resources and thinking for investing in new directions


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


The Perfect Storm…Health Insecurities

Global & U.S. Demographics

and Related Factors


Health Insecurities Increase in Developing Countries


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).


In Low-Income and Middle-Income Countries, 30 Percent of All Children Are Underweight

Source: C. Haub, 2007 World Population Data Sheet.


HIV Prevalence Is Highest in Southern Africa

Source: C. Haub, 2007 World Population Data Sheet.


Health Insecurities Increase in the United States Driven By High Costs and Lack of Insurance


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

National Health Care Expenditures and their Percentage of the GDP 1960 to 2005

5Source:CentersforMedicareandMedicaidServices,OfficeoftheActuary,NationalHealthStatisticsGroup,athttp://www.cms.hhs.gov/NationalHealthExpendData/(seeHistorical;NHEsummaryincludingshareofGDP, CY1960-2005;filenhegdp05.zip).

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.

US Health Care Expenditures 2004 Greatest in the World with Rank of 32nd 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.

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.

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.

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.

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

Health Insecurities Increase in Oklahoma and Tulsa County


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

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

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

Diminishing Population Increase Health Insecurities in Rural Areas

Prepared by the Community Service Council of Greater Tulsa

Population Trends and Projections by Age GroupOklahoma, 1970 - 2030

Source: US Census Bureau, 1970, 1980, 1990, & 2000 Censuses; US Census Bureau, Population Estimates Division, Population Projections, 2000 - 2030.

6.3

6.6

6.8

7.4

7.7

7.7

8.5

16.6

17.1

18.2

18.9

18.4

19.8

25.9

9.2

9.7

10.1

10

10.1

13.5

10.7

47.8

50.5

52.5

51.9

52.2

49.1

46.2

17.5

14.1

10.6

10.4

10.4

9

8.1

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%

Percent of population

0-4 5-17 18-24 25-64 65-84 85+

1.9

1.4

1.2

.9

.6

Pro

ject

ions 2.5

2.1

6.3

6.6

6.8

6.8

7.2

7.7

7.7

16.8

17.3

17.6

19.1

19.4

20.5

25

9.6

9.6

10.4

10.3

10.2

13.3

11.8

47.7

49.9

51.3

50.6

49.6

46

43.9

16.9

14.4

11.9

11.6

12

11.3

10.8

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%


0-4 5-17 18-24 25-64 65-84 85+

Demographics


Population Trends and Projections by Age GroupTulsa County, 1970 - 2030

Source: US Census Bureau, 1970, 1980, 1990, & 2000 Censuses; US Census Bureau, Population Estimates Division, Population Projections, 2000 - 2030.

6.3

6.6

6.8

7.4

7.7

7.7

8.5

16.6

17.1

18.2

18.9

18.4

19.8

25.9

9.2

9.7

10.1

10

10.1

13.5

10.7

47.8

50.5

52.5

51.9

52.2

49.1

46.2

17.5

14.1

10.6

10.4

10.4

9

8.1

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%


0-4 5-17 18-24 25-64 65-84 85+

1.9

1.4

1.2

.9

.6

Pro

ject

ions 2.5

2.1

Demographics

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


18

00

18

10

18

20

18

30

18

40

18

50

18

60

18

70

18

80

18

90

19

00

19

10

19

20

19

30

19

40

19

50

19

60

19

70

19

80

19

90

20

00

0

20

40

60

80

Life Expectancy

White Black

Note: Data not available for Blacks from 1860 to 1890.

Prepared by the Community Service Council of Greater Tulsa (1/2004).

Top Risk Factors for Young Children Age 0-4

Low-income and poverty

Teen mother, especially those with more than one child

Absent father

Short spacing between births (less than 24 months)

Parent, especially the mother, without a high school education

Lack of positive emotional, physical and intellectual experiences

>

>

>

>

>

>

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


18

00

18

10

18

20

18

30

18

40

18

50

18

60

18

70

18

80

18

90

19

00

19

10

19

20

19

30

19

40

19

50

19

60

19

70

19

80

19

90

20

00

0

50

100

150

200

250

300

350

400

Infant Mortality Rate

White Black

Note: Data not available for Blacks from 1860 to 1890.


Tulsa County, 2006 Estimates

Source: US Census Bureau, Population Estimates Program, 2006.

77.8%

11.5%

5.2%

2.0%

3.5%

71.1%

14.9%

6.2%2.1%

5.7%

79.0%

10.9%

5.1%2.2%

2.9%87.9%

6.2%

3.4%0.9%1.6%

White Black American Indian Asian & Other 2 or more

Total Population Under age 20

Age 20-64 Age 65 & over

Population by Age and Race and Hispanic Origin

N=577,795

N=69,089N=342,652

N=166,054

Hispanic8.8%

Hispanic8.9%

Hispanic12.1%

Hispanic2.1%

Female-headed Families with Own ChildrenOklahoma, 1980, 1990, 2000 & Estimates for 2006

Source: U.S. Census Bureau, 1980 Census, 1990 Census, 2000 Census, 2006 American Community Survey.

1980 1990 2000 2006 est.0

25,000

50,000

75,000

100,000

125,000

Number of families

0%

5%

10%

15%

20%

25%Proportion of all families w/ children

# w/ children <6 22,092 29,682 36,405 44,400

% w/ children <6 11.6% 16.2% 19.7% 23.6%

# w/ children <18 na 87,945 94,403 104,617

% w/ children <18 na 19.8% 21.7% 24.8%



Educational Attainment for Persons Age 25 & OlderOklahoma, Tulsa County, & Oklahoma County, 2006 Estimates

Source: US Census Bureau, 2006 American Community Survey.

Less thanhigh school

High schoolgraduate

Somecollege

Associate'sdegree

Bachelor'sdegree

Master'sdegree

Professionalschool degree

Doctoratedegree

0% 5% 10% 15% 20% 25% 30% 35%

Percent of persons 25+

Oklahoma

Tulsa County

Oklahoma County

Less thanhigh school

High schoolgraduate

Somecollege

Associate'sdegree

Bachelor'sdegree

Master'sdegree

Professionalschool degree

Doctoratedegree

Oklahoma 15.7% 33.9% 21.7% 6.5% 14.9% 5.1% 1.4% 0.7%

Tulsa County 12.6% 28.6% 22.2% 7.1% 20.2% 6.1% 2.3% 1%

Oklahoma County 16.5% 27% 24.4% 5.1% 17.6% 6.4% 2.1% 0.9%


Health Insurance Status, by AgeOklahoma, 2005-2006

Source: Kaiser Family Foundation.

1,673,131 (48.2%)

141,341 (4.1%)459,315 (13.2%)

553,526 (15.9%)

644,292 (18.6%)

435,497 (50.5%)

312,416 (36.3%)

113,735 (13.2%)

1,240,462 (59.9%)

95,634 (4.6%)117,044 (5.6%)

93,994 (4.5%)

524,480 (25.3%)

3,337 (0.7%)29,855 (5.8%)

473,042 (92.3%) 6,077 (1.2%)

Employer Individual Medicaid Medicare/Other Public Uninsured

Total Population Under Age 19

Age 19-64 Age 65 & over


Oklahoma's Rankings in Outcomes Associated with Poor Health, 1990 and 2007

According to United Health Foundation's State Health Rankings

Source: United Health Foundation.

#31

#27

#31

#24

#27

#47

#47

#48

#40

#50

#43

#43

Overall ranking

Poor mental health days

Poor physical health days

Infant mortality

Cardiovascular deaths

Cancer deaths

Premature death

1990 2007

Ranking: 1=best, 50=worst


Oklahoma's Rankings in Risk Factors Associated with Poor Health, 1990 and 2007

According to United Health Foundation's State Health Rankings

Source: United Health Foundation.

#44

#23#31

#24#8

#32#21

#46

#41

#47#12

#44#24

#34#38

#24#42

#42#30

#25

#40#50

#45

Personal BehaviorsPrevalence of smoking

Prevalence of Binge Drinking

Prevalence of obesity

High school graduation

Community EnvironmentViolent crime

Occupational fatalities

Infectious disease

Children in poverty

Public & Health PoliciesLack of health insurance

Per capita public health spending

Immunization coverage

Clinical Care

Adequacy of prenatal care

Primary Care Physicians

Preventable Hospitalizations

1990 2007

Ranking: 1=best, 50=worst


Summary of Risk Factors for InfantsOklahoma, Tulsa County, and Oklahoma County, 2006

Source: Oklahoma State Department of Health, Vital Statistics.

13.4%

40.9%

6.2%

22.7%

6.7%

1.6%

33.5%

19.5%

11%

11.8%

41.5%

7%

24.9%

6.5%

2%

33.4%

18.7%

11.5%

12.5%

46.1%

6.3%

27.2%

7.5%

1.8%

33.5%

19%

10.9%

Teen mother(age 15-19)

Unmarried mother

Poor prenatal care(3rd trimester/no care)

Mother w/ <12th gradeeducation

Low birthweight(1500-2499 grams)

Very low birthweight(<1500 grams)

Short birth spacing(<24 mos. apart)

Very short birth spacing(<18 mos. apart)

Premature(<37 weeks gest.)

0% 10% 20% 30% 40% 50% 60%

Percent of Births

Oklahoma

Tulsa Co.

Oklahoma Co.

Oklahoma births: 54,010Tulsa County births: 9,733Oklahoma County births: 12,265


Age-Adjusted Death Rates for the Leading Causes of DeathUnited States, 2004, Oklahoma, Tulsa County, and Oklahoma County, 2005

Source: National Center for Health Statistics, Health E-Stats; Oklahoma State Department of Health, Vital Statistics.

Heart disease

Cancer

Stroke

Chronic lowerrespiratory diseases

Accidents

Diabetes mettitus

Alzheimer's disease

Influenza & pneumonia

0 50 100 150 200 250 300

Rate per 100,000 Persons

U.S.

Oklahoma

Tulsa County

Oklahoma County

Community Profile 2008and Perfect Storm Publications

are available on our website:

www.csctulsa.org

Prepared for the Tulsa Area United Way Community Investments ProcessBy the Community Service Council of Greater Tulsa

December, 2007

the perfect storm community service council of greater tulsa

Documents

population challenges

global estimates

growing immigration

quality health care

central intelligence

growing income inequality

developed regions1

developing worldsource