Obesity is a costly global epidemic and is one of the most significant challenges facing the health care system. Oklahoma ranks 6th in the United States for high rates of adult obesity. Twenty-eight rural counties (36%) in eastern Oklahoma have adult obesity rates exceeding 40%. Many of the same areas have been identified as ‘inequity hot spots’ meaning, in part, the children living in these areas have limited access to quality schools, safe housing, access to healthy food, parks and playgrounds and clean air. Oklahoma ranks 5.8 on a 10-point scale for factors contributing to healthy food environments compared to the U.S. at 7.8. Regarding physical activity, 65% of Oklahomans do not have exercise opportunities and 33% report no leisure-time physical activity compared to 80% and 26% for the U.S., respectively. In addition to limited access to healthy food and physical activity opportunities, racial and socio-economic disparities exist in the high obesity counties. Collectively the Cherokee, Choctaw and Creek American Indian Nations have a 32-county footprint in eastern Oklahoma that includes 12 of the 28 high obesity counties. Poverty further exacerbates health outcomes; among the counties with high obesity the percentage of people living in poverty averaged 19.6% compared to a state rate of 15.6%.
Oklahoma is unique in that strong partnerships exist between the OSU Cooperative Extension, Oklahoma State Department of Health, Oklahoma Tobacco Settlement Endowment Trust Healthy Living Program and Cherokee Tribal Nation with mutual and proven capacity in using policy, systems and environmental (PES) approaches to decrease obesity and health disparities. Collaborative efforts have been successful in improving nutrition standards, establishing food systems and increasing miles of activity friendly routes and places for safe physical activity.
The purpose of this proposal is to broaden the population reach of these accomplishments to 11 of the 28 high-obesity counties by implementing evidence-based strategies with a focus on policy, systems and environmental approaches to increase access to healthy foods and opportunities for physical activity and, long-term, reduce health inequities in high-risk populations. The project will reach 52% of people living in the 28 high obesity counties. The target population is characterized by almost 1 in 5 residents reporting American Indian tribe membership and 1 in 5 residents living at or below the poverty level and 2 of every 5 (42.4%) having obesity. The counties are all rural, clustered in eastern Oklahoma and have strong Cooperative Extension presence, thus fostering efficient use of resources across counties with similar health inequities.
Baseline and intermediate outcome measures include: 1) increased distribution of and access to healthy food; 2) increased policies, plans and community designs that support activity friendly routes to everyday destinations; and 3) improved activities in early childhood education (ECE) to support improved nutrition, physical activity and Farm to ECE. Long term outcomes include increased health behaviors and outcomes and reduced health disparities in chronic disease.