Public Health In Oklahoma

PUBLIC HEALTH: AN OVERVIEWOklahoma State Department of Health

The State of Public Health in Oklahoma

CARMINE JABRIMay 14, 2008

Introduction

“Nothing can be more important to a state than its public health,” Franklin Roosevelt (1934). 1

What is Public Health?Public Health refers to the “health status of a defined group of people and the governmental actions and conditions to promote, protect and preserve their health.”2

1. Congressional Quarterly, Inc. (2004). Public health costs of complacency. Retrieved on 5/9/08 from: http://www.governing.com/gpp/2004/public.htm

2. McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. Fifth edition. Jones and Bartlett: Sudbury, Massachusetts.

Core Functions of Public Health

Assessment Policy Development Assurance

Minnesota Department of Health. (2008). Public health core functions, essential services and goals. Retrieved on 5/13/08 from: http://www.health.state.mn.us/divs/chs/pdf/gdlinebkgrdall.pdf

DEFINITIONS

Chronic Disease: A disease or health condition that lasts longer than three months, sometimes for the remainder of one’s life. 3

Epidemic: The occurrence in a community or region of cases of an illness (or an outbreak) clearly in excess of expectancy.2

Endemic: A disease that is habitually present in a particular geographic region.2Epidemiology: The study of the distribution and determinants of disease frequency in human populations.Genetic testing: Analyzing an individual's genetic material to determine predisposition to a particular health

condition or to confirm a diagnosis of genetic disease. Genetic testing is sometimes used interchangeably with genetic screening. Generally, screening refers to a preliminary form of testing, or the assessment of asymptomatic populations. 1

Genomics: The study of all of the functions and interactions of all of the genetic material in the genome, including interactions with environmental factors. 1

Infectious Disease: An infectious disease is a disease that is caused by the invasion of a host by agents whose activities harm the host's tissues and can be transmitted to other individuals.4

1. Walden University. (2008). Pubh 6002 [week 9 glossary]. Retrieved on 4/30/08 from: http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1


3. McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. Fifth edition. Jones and Bartlett: Sudbury, Massachusetts. p. 585. 4. National Institutes of Allergy and Infectious Diseases. (2008). Emerging and re-emerging infectious diseases..

Definitions

Incidence: The number of newly diagnosed cases during a specific time period. The incidence is distinct from the prevalence, which refers to the number of cases alive on a certain date.2

Notifiable disease: A disease that by law has to be reported to the appropriate authorities.2

Outbreak: A sudden rise in the incidence of a disease.2

Genomics: The study of all of the functions and interactions of all of the genetic material in the genome, including interactions with environmental factors. 2

Public Health: the “health status of a defined group of people and the governmental actions and conditions to promote, protect and preserve their health.”3

Surveillance: The systematic collection of data pertaining to the occurrence of specific diseases, the analysis and interpretation of these data, and the dissemination of consolidated and processed information.2

1Walden University. (2008). Pubh 6002 [week 5 glossary]. Retrieved on 4/30/08 from:http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1


3. McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. Fifth edition. Jones and Bartlett: Sudbury, Massachusetts.

IMPORTANT HISTORIC FIGURES IN PUBLIC HEALTH

Dr. Edward Jenner (1796) Process of vaccination as a protection against small pox.

Dr. John Snow (1849) Studied cholera epidemic in London, concluded it was caused by drinking water from Broad St. pump. Had pump handle removed and epidemic stopped.

Lemuel Shattuck (1850) wrote report for Massachusetts. Recommended establishment of Boards of Health, collection of vital statistics, implementation of sanitary measures, research on diseases, health education, controlling exposure to smoke and alcohol.

Louis Pasteur (1862) germ theory of disease Robert Koch (1876) Koch’s Postulates – developed criteria and procedures to

establish that a particular microbe and no other causes a particular disease. Major Walter Reed (1900) Announced yellow fever transmitted by mosquitoes Dorothea Dix (1802-1897) Helped establish public mental health hospitals in

many states McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury, Massachusetts: Jones and Bartlett.

HISTORICAL BACKGROUND

– 2000 B.C. Indus Valley- bathrooms and drains in homes, sewers below street level

– 2700-1500 B.C. – Drainage Systems in Ancient Egypt, more than 700 drugs known to Egyptians.

– 2100 B.C. – Sumerian clay tablet had written prescriptions for drugs

– 500 B.C. – A.D.500 – Greeks Supplemented local city wells with water from mountains 10 miles away.

– Romans built aqueducts, sewer systems, regulation of building construction, refuse removal, street cleaning and repair. They also started hospitals.

McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury, Massachusetts: Jones and Bartlett.

Historical Background

Earliest written record concerning Public Health: Code of Hammurabi

During the Dark Ages, people believed disease was caused by demons or as punishment for sin. – Epidemics: Leprosy, 3 epidemics of Plague,

Syphilis McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury, Massachusetts: Jones and Bartlett.


Advances in Public Health were made by Dr Jenner, Dr. Snow, Lemuel Shattuck, Louis Pasteur, and Robert Koch, among others.

The American Public Health Association was founded in 1872. By 1900, 38 states had state health departments. In 1911, the first 2 local health departments were established. The first school of Public Health was in 1918, Johns Hopkins

University. In the twentieth century, the leading causes of death were

communicable diseases.– Two discoveries during WWII, antibiotic penicillin and DDT to kill insects

that transmit disease.– 1950’s vaccine to prevent Polio



1965 – Medicaid and Medicare bills passed to help the poor and the elderly

1977 – CDC study found that 48% of premature deaths were caused by one’s lifestyle. This lead to the government’s publication:– Healthy People: The Surgeon General’s Report

on Health Promotion and Disease Prevention McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury, Massachusetts: Jones and Bartlett.

Public Health Problems in the 2000’s

Rise in Healthcare costs

Environmental Concerns

Lifestyle Diseases

Emerging and Re-emerging diseases

Substance Abuse problems

Terrorism- chemical, nuclear/radiological & biological

PUBLIC HEALTH ACHIEVEMENTS

The Center for Disease Control and Prevention (CDC) has called vaccination one of the greatest public health achievements of the 20th century.1

1. Tulsa Health Department. (2008). Childhood immunizations. Retrieved on 5/1/08 from: http://www.tulsa-health.org/personal-health/child-health/immunizations/

10 Great Public Health Achievements

Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard CDC. (1999, April 2). 10 great public health achievements 1900-1999. MMWR. Retrieved on 5/12/08 from:

http://www.cdc.gov/MMWR/preview/mmwrhtml/00056796.htm

10 Most Common Causes of Death in Oklahoma (1993-2003)

Heart Disease Cancer Stroke Bronchitis/Emphysema/Asthma Unintentional Injury Influenza/Pneumonia Diabetes Suicide Kidney Disease Alzheimer's Disease Oklahoma State Department of Health. (2005). State Health Report. Retrieved on 5/10/08 from: http://www.ok.gov/health/documents/State%20Report.pdf

Healthy People 2010

What Is Healthy People 2010?Healthy People 2010 is a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the first decade of the new century. Created by scientists both inside and outside of Government, it identifies a wide range of public health priorities and specific, measurable objectives.

Overarching Goals: – 1. Increase quality and years of healthy life– 2. Eliminate health disparitiesOffice of Disease Prevention and Health Promotion. (2005). Healthy people 2010. Retrieved on 5/12/08 from:

http://www.healthypeople.gov/About/hpfact.htm

10 Essential Public Health Services

According to Walden University (2008), “The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems:

Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care

when otherwise unavailable. Assure competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health

services. Research for new insights and innovative solutions to health problems.” Walden University. (2008). Pubh 6002 [week 3 glossary]. Retrieved on 4/30/08 from:

http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1

More than a dozen states are participating in the National Public Health Performance Standards Program, developed by the CDC and other public health partners. The assessment tool sets optimum, not minimum, standards for state and local health agencies based on the 10 essential services outlined nearly a decade ago. 1


FUNDING FOR PUBLIC HEALTH

Typically top-down funding: money comes from Federal to state to local level.

The portion of Oklahoma’s public health budget derived from state general funds has been reduced 24 percent in the past two years. 1


Factors that Affect the Health of a Community

1.) Physical Factors– Geography– Environment– Community Size– Industrial Development



2. Social and Cultural Factors– Beliefs, Traditions and Prejudices– Economy– Politics– Religion– Social Norms– Socioeconomic Status


3. Community Organizing 4. Individual Behavior

Who is Responsible for Public Health?

International Agencies – World Health Organization

National Health Agencies– For the U.S., it is the Departments of Health and

Human Services (DHHS).

State Health Agencies Local Public Health Agencies McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury, Massachusetts: Jones and

Bartlett.


Quasi-Governmental Health Organizations– American Red Cross

Voluntary Health Agencies– American Cancer Society, SIDS Alliance, March

of Dimes, American Lung Association, American Heart Association, Alzheimer's Association, etc.


Philanthropic Organizations Service and Social Religious Organizations Corporate Involvement Other Governmental Agencies not related to

the DHHS

Indian Health Service (IHS)

Indian Health Service (IHS) is a federal agency within the Department of Health and Human Services.

“The Oklahoma City Area Indian Health Service serves the states of Oklahoma, Kansas, and portions of Texas. Oklahoma is home to more than 39 Tribes and Tribal Organizations, a unique characteristic of the Oklahoma City Area because a large number of Tribes have opted to operate their own health programs including large scale hospitals to the smaller preventive care programs and behavioral health programs. The Area consists of 8 Service Units with federally operated hospitals, clinics and smaller health stations.”

HIS. (2008). Oklahoma city area. Retrieved on 5/13/08 from: http://www.ihs.gov/FacilitiesServices/AreaOffices/oklahoma/index.cfm

STRUCTURE AND ROLES OF OKLAHOMA STATE AND LOCAL HEALTH DEPARTMENTS

Four major service branches, Community Health Services, Family Health Services, Disease & Prevention Services and Protective Health Services, provide technical support and guidance to 68 county health departments as well as guidance and consultation to the two independent city-county health departments in Oklahoma City and Tulsa. 1

1. Oklahoma State Department of Health. (2008). The department. Retrieved on 4/30/08 from: http://www.ok.gov/health/Organization/index.html 2. Oklahoma State Department of Health. (2008). County health departments. Retrieved on 4/30/08 from:

http://www.ok.gov/triton/modules/health/map/county_map.php

THE PUBLIC HEALTH WORKFORCE

Public health professionals are employed in a variety of settings including government federal, state and local public health and human services agencies; community-based and non-profit organizations, public and private health care institutions, and universities.

The Organizational Chart for the State Dept of Health is located at: http://www.ok.gov/health/documents/OSDH%20Org-Feb%2008.pdf

Minnesota Department of Health. (2007, Dec 18). Description of public health careers. Retrieved on 5/13/08 from: http://www.health.state.mn.us/pathways/description.html

OKLAHOMA PUBLIC HEALTH LAWS

It takes some navigation around the Oklahoma State Department of Health website to get to laws and regulations.

Go to the home page: http://www.ok.gov/health/ Then click on Forms, Regulations and Licensing Then click on Regulations Then click on the area you are interested in, for example: Consumer

Protection Then you narrow it down even further. I clicked on Retail Foods Then I clicked on

Rules for Food Service Establishments, Effective June 25, 2006 It finally took me to the regulations, which was at:

http://www.ok.gov/health/documents/Retail%20Foods257-2006.pdf

MISSION

Vision: "Add Years to Life and Life to Years." Mission: To partner with public, private, and

voluntary agencies to enableOklahomans to live increasingly long, healthy, satisfactory lives

EDUCATING THE PUBLIC

There are many programs aimed at educating the public including disease prevention programs, health and nutrition programs and WIC, among others.

The website for the Oklahoma State Department of Health is an

excellent resource for educating the public.

CONTROVERSIES IN PUBLIC HEALTH

ABORTION GENETIC TESTING

THE BASIC SCIENCE BEHIND PUBLIC HEALTH

EPIDEMIOLOGICAL STUDY DESIGNS– Descriptive Study – Analytical Study– Experimental Studies – Case control study– Cohort– Prospective cohort study– Retrospective cohort studyWalden University. (2008). Pubh 6002 [week 5 glossary]. Retrieved on 4/30/08 from:http://sylvan.live.ecollege.com/ec/crs/default.learn?

CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1

DATA SOURCES USED

DATA COLLECTED DIRECTLY BY OK STATE HEALTH DEPARTMENT:

Center for Health Statistics– The Vital Records division collects– The Health Care Information division

OK2SHARE Oklahoma Nursing Home Inspections Database Oklahoma Food Service Inspections Database Public Health Investigation and Disease Detection of Oklahoma

(PHIDDO) system.

Oklahoma State Department of Health. (2008). Center for health statistics. Retrieved on 5/13/08 from: http://www.ok.gov/health/Data_and_Statistics/Center_For_Health_Statistics/

OTHER DATA SOURCES USED

CDC WHO NIH U.S. Census Bureau

How is the data used?

The data that is gathered by the Oklahoma State Department of Health is used to assess the health of Oklahoman’s, develop policies related to Public Health and plan programs to address those health issues that were brought to attention from the assessment of the data.

INFECTIOUS DISEASE

DEFINITION: An infectious disease is a disease that is caused by the invasion of a host by

agents whose activities harm the host's

tissues and can be transmitted to other individuals. TRANSMISSION MODES:

– Direct Contact– Indirect Contact


INFECTIOUS DISEASE PROGRAMS RUN BY OK STATE HEALTH DEPT.

The mission of the Acute Disease Service is to control communicable disease through: surveillance for infectious diseases; investigation of disease outbreaks; analysis of data to plan, implement and evaluate disease prevention and control measures; dissemination of pertinent information; education of healthcare professionals and the public; and bioterrorism preparedness.

Vaccination programs

CHRONIC DISEASE

In 2005, 133 million people, almost half of all Americans lived with at least one chronic condition.

Chronic diseases account for 70% of all deaths in the United States.

The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs.

Chronic diseases account for one-third of the years of potential life lost

before age 65.

CDC (2008). Chronic disease overview. Retrieved on 5/12/08 from: http://www.cdc.gov/nccdphp/overview.htm

CHRONIC DISEASE PROGRAMS RUN BY THE OK STATE HEALTH DEPT.

Arthritis Prevention and Education Program Asthma Prevention and Control Program Cancer Prevention Programs Diabetes Prevention and Control Programs Heart Disease and Stroke Prevention Program Oklahoma Physical Activity and Nutrition Program

(OKPAN) OSDH. (2008) Chronis disease service. Retrieved on 5/13/08 from: http://www.ok.gov/health/Disease,_Prevention,_Preparedness/Chronic_Disease_Service/

GENOMICS IN PUBLIC HEALTH

Public Health Genomics is an emerging field that assesses the impact of genes and their interaction with behavior, diet and the environment on population health.1

THE IMPORTANCE OF INTEGRATING GENETICS WITH PUBLIC HEALTH

1. National Office of Public Health Genomics. (2008). Welcome to public health genomics. Retrieved on 5/13/08 from: http://www.cdc.gov/genomics/

2. National Human Genome Research Institute. (2007). A brief guide to genomics. Retrieved on 5/13/08 from: http://www.genome.gov/18016863

Oklahoma State Genetics Plan

3 Goals:– 1.) Genetic Education for healthcare providers

and the public– 2.) Development of a stable public health

genetics infrastructure to assess, implement, monitor and evaluate genetics in Oklahoma.

– 3.) Screening and genetic testing.Oklahoma State Department of Health. (2008). Genetics and public health – why does oklahoma need a state genetics plan? Retrieved

on 5/13/08 from: http://www.ok.gov/health/documents/Why%20does%20Oklahoma%20need%20a%20State%20Genetics%20Plan-%20page26.pdf

GENETIC PROGRAMS RUN BY OK STATE HEALTH DEPARTMENT

The main program is NEWBORN SCREENINGS Other than that, the OK State Health Dept. focuses

on family health histories to uncover possible genetic risk factors for disease. They also offer education regarding genetics.

The OKSDH has links to many websites regarding genetic testing and genetic services and many other websites related to genetics.

Oklahoma State Department of Health. (2008). Genetics program mission. Retrieved on 5/13/08 from: http://www.ok.gov/health/Child_and_Family_Health/Screening,_Special_Services_and_Sooner_Start/Genetics_Program/index.html

PUBLIC HEALTH IN OKLAHOMA

– Demographics– • Population estimates 9.7% increase from 1990 to 2000, 3.6% increase from 2000 to 2005

(3,145,576 to 3,450,654) Ranked 28th for growth in country

– 2000 Census– • Hispanic/Latino ethnicity = 5%– • Race

Whites = 76% Native Americans =8% Blacks =8% Other/Multiple = 8%

– • Age Under 5 = 7% Over 64 = 13% Median age = 35.5 years

– • Disability (ages 21 to 64) = 21.5%, national = 19.2%– • Individuals below poverty = 14.7%, national = 12.4%

Oklahoma State Department of Health. (2005). State Health Report. Retrieved on 5/10/08 from: http://www.ok.gov/health/documents/State%20Report.pdf

PUBLIC HEALTH IN OKLAHOMA

99thth FATTEST STATE FATTEST STATE– “Oklahoma entered the fattest ten for the first time, tying for ninth place.” 1 – 1 IN 4 OKLAHOMANS ARE OBESE

Oklahoma City is ranked the 8th Fattest City in the U.S. 3

WHY?One reason may be the Official Oklahoma State Meal: “It was formally designated by the Oklahoma legislature in 1988. And it includes: cornbread, sausage and gravy, chicken fried steak, pecan pie, barbecue pork, fried okra and squash, biscuits, grits, corn, strawberries and black-eyed peas.”2

– 1. Calorie Lab. (2008). Mississippi once again fattest state. Retrieved on 5/1/08 from: http://calorielab.com/news/2007/08/06/fattest-states-2007/– 2. Calorie Lab. (2008). Oklahoma citizen’s diet sabotaged by official state meal of chicken fried steak and pecan pie. Retrieved on 5/1/08 from:

http://calorielab.com/news/2008/01/07/oklahoma-citizens-diets-sabotaged-by-official-state-meal-of-chicken-fried-steak-and-pecan-pie/– 3. Tulsa World. (2008, Feb. 11). Mens fitness magazine ranks okc among fattest cities. Retrieved on 5/1/08 from:

http://www.tulsaworld.com/news/article.aspx?articleID=20080211_1__OKLAH63032

MAJOR PUBLIC HEALTH CHALLENGES IN OKLAHOMA

Unintentional and Violence Related Injuries are on the rise. For persons aged 1-44, unintentional injuries are the leading cause of death.

Tobacco Use in Oklahoma is is 30% higher than the

nation on the amount of tobacco

consumed per capita (103 packs vs.

79 packs).Oklahoma State Department of Health. (2005). State Health Report. Retrieved on 5/10/08 from:

http://www.ok.gov/health/documents/State%20Report.pdf

MAJOR PUBLIC HEALTH CHALLENGES IN OKLAHOMA

Lack of Physical Activity Teen Pregnancy: Oklahoma has moved up in rank

from 13th to 8th in the country. Poverty – almost 15% of Oklahoman’s have an

income below the federal poverty level. Cardiovascular Disease Obesity Diabetes Oklahoma State Department of Health. (2005). State Health Report. Retrieved on 5/10/08 from: http://www.ok.gov/health/documents/State%20Report.pdf

CONCLUSION

PUBLIC HEALTH– Past– Present – Future– Public Health in Oklahoma

References

Calorie Lab. (2008). Mississippi once again fattest state. Retrieved on 5/1/08 from: http://calorielab.com/news/2007/08/06/fattest-states-2007/

Calorie Lab. (2008). Oklahoma citizen’s diet sabotaged by official state meal of chicken fried steak and pecan pie. Retrieved on 5/1/08 from: http://calorielab.com/news/2008/01/07/oklahoma-citizens-diets-sabotaged-by-official-state-meal-of-chicken-fried-steak-and-pecan-pie/

CDC (2008). Chronic disease overview. Retrieved on 5/12/08 from: http://www.cdc.gov/nccdphp/overview.htm CDC. (1999, April 2). 10 great public health achievements 1900-1999. MMWR. Retrieved on 5/12/08 from:

http://www.cdc.gov/MMWR/preview/mmwrhtml/00056796.htm Congressional Quarterly, Inc. (2004). Public health costs of complacency. Retrieved on 5/9/08 from:

http://www.governing.com/gpp/2004/public.htm HIS. (2008). Oklahoma city area. Retrieved on 5/13/08 from:

http://www.ihs.gov/FacilitiesServices/AreaOffices/oklahoma/index.cfm McKenzie, J., Pinger, R. & J. Kotecki. (2005). An introduction to community health. (Fifth edition). Sudbury,

Massachusetts: Jones and Bartlett. Minnesota Department of Health. (2007, Dec 18). Description of public health careers. Retrieved on 5/13/08 from:

http://www.health.state.mn.us/pathways/description.html Minnesota Department of Health. (2008). Public health core functions, essential services and goals. Retrieved on

5/13/08 from: http://www.health.state.mn.us/divs/chs/pdf/gdlinebkgrdall.pdf National Office of Public Health Genomics. (2008). Welcome to public health genomics. Retrieved on 5/13/08 from:

http://www.cdc.gov/genomics/ National Human Genome Research Institute. (2007). A brief guide to genomics. Retrieved on 5/13/08 from:

http://www.genome.gov/18016863

References

Office of Disease Prevention and Health Promotion. (2005). Healthy people 2010. Retrieved on 5/12/08 from: http://www.healthypeople.gov/About/hpfact.htm

Oklahoma State Department of Health. (2008) Retrieved on 5/9/08 from: http://www.ok.gov/health/ Oklahoma State Department of Health. (2008). Center for health statistics. Retrieved on 5/13/08

from: http://www.ok.gov/health/Data_and_Statistics/Center_For_Health_Statistics/ OSDH. (2008) Chronis disease service. Retrieved on 5/13/08 from:

http://www.ok.gov/health/Disease,_Prevention,_Preparedness/Chronic_Disease_Service/ Oklahoma State Department of Health. (2008). Genetics and public health – why does oklahoma

need a state genetics plan? Retrieved on 5/13/08 from: http://www.ok.gov/health/documents/Why%20does%20Oklahoma%20need%20a%20State%20Genetics%20Plan-%20page26.pdf

Oklahoma State Department of Health. (2008). Genetics program mission. Retrieved on 5/13/08 from: http://www.ok.gov/health/Child_and_Family_Health/Screening,_Special_Services_and_Sooner_Start/Genetics_Program/index.html

Oklahoma State Department of Health. (2008). The department. Retrieved on 4/30/08 from: http://www.ok.gov/health/Organization/index.html

Oklahoma State Department of Health. (2008). County health departments. Retrieved on 4/30/08 from: http://www.ok.gov/triton/modules/health/map/county_map.php

Oklahoma State Department of Health. (2005). State Health Report. Retrieved on 5/10/08 from: http://www.ok.gov/health/documents/State%20Report.pdf

References

Schneider, M. (2006). Introduction to public health. (2nd ed.). Sudbury, Massachusetts: Jones and Bartlett.

Tulsa World. (2008, Feb. 11). Mens fitness magazine ranks okc among fattest cities. Retrieved on 5/1/08 from: http://www.tulsaworld.com/news/article.aspx?articleID=20080211_1__OKLAH63032

Walden University. (2008). Pubh 6002 [week 3 glossary]. Retrieved on 4/30/08 from: http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1

Walden University. (2008). Pubh 6002 [week 5 glossary]. Retrieved on 4/30/08 from:http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1

Walden University. (2008). Pubh 6002 [week 9 glossary]. Retrieved on 4/30/08 from: http://sylvan.live.ecollege.com/ec/crs/default.learn?CourseID=2898489&Survey=1&47=4655338&ClientNodeID=984640&coursenav=1&bhcp=1

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Public Health In Oklahoma

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