STILWELL, Okla. (AP) - Eight miles west of the Arkansas state line, where U.S. Highway 59 meets State Highway 51, is a small eastern Oklahoma town that looks much like other small eastern Oklahoma towns - there’s a county courthouse in the center, a war memorial, drab downtown shops, Ozark foothills in the distance.
This town is losing a generation of people to early deaths. It has the shortest life expectancy in the nation - 56.3 years, according to federal figures released recently - exacerbated by poverty, low education rates and unhealthy eating, according to its mayor.
“We’ve got our drug problem, which I think is part of it, but obesity and blood sugar” are the primary culprits, Stilwell Mayor Jim Spray told The Oklahoman . “Poor lifestyles and high poverty, a lack of education about nutrition. I see people at Walmart, which is our biggest shopping venue, they’ll be on food stamps but they’ll have pop and bologna, stuff you stick in the microwave, frozen pizzas.
“I think some people just live that lifestyle and you’re not going to live long living on that stuff.”
If Stilwell was a country, its life expectancy would rank 211th of 225 countries in the world, just beating out Burkina Faso and falling below the Democratic Republic of the Congo, a war-torn nation in central Africa where millions of children risk starvation, according to CIA statistics. The average life expectancy across the United States is 79 years, a stunning 23 years longer - a generation longer - than in Stilwell.
And yet, Stilwell is hardly an anomaly. Of the seven American towns or neighborhoods with a life expectancy below 60 years, three are in eastern Oklahoma: Stilwell, Checotah and Eufaula, according to the National Center for Health Statistics. Checotah and Eufaula are in McIntosh County, southeast of Tulsa.
The federal life expectancy numbers show, often in stark detail, how the town or neighborhood someone lives in can influence the length of that person’s life. In Edmond, the life expectancy is as long as 84 years, a full two decades longer than in poorer parts of Oklahoma City. In the center of Ada, the life expectancy is 66 years; just south of town, it is 84. A dozen miles north of Stilwell, the life expectancy is as high as 79.
“In eastern Oklahoma, we’re seeing a perfect storm of poverty, inadequate housing, historical and continuing trauma, lack of access to health care and serious untreated mental health and addiction,” said analyst Carly Putnam with the left-leaning Oklahoma Policy Institute, which has studied rural poverty in the state. “These issues have been neglected for too long, and Oklahomans are dying early as a result.”
Twenty years ago, Spray knew so few people with diabetes in Stilwell that he had to research the disease in order to understand it. “Now,” he said, “it seems like half our population has blood sugar troubles.”
Between 1999 and 2016, Adair County’s rate of death for diabetes was 70 per 100,000 people, nearly triple the national average, according to Oklahoma Health Department data. Its murder rate was 10 per 100,000 people, twice the national average. Stilwell is the county seat and largest city in Adair County.
“We’ve got strong police but there’s crime, there’s drugs,” the mayor said. “There are people I went to high school with who are involved in that sort of thing and most of them don’t live long. I’ve got some friends I played football and sports in school with and they’re long gone. They lived a lifestyle of danger and consumption and drugs and alcohol.”
Others live a sedentary lifestyle that, to long-term health, is nearly as dangerous. In this state-designated Strawberry Capital of the World, 99 percent of the acreage once set aside for strawberries is no longer used to cultivate the popular fruit, according to one of the few growers who remains.
“There are actually more acres of strawberries where I come from - in the Virginia Beach area - than in the ’Strawberry Capital of the World,’” said Scott Talbert of J5 Farm as he took a break from planting three acres of strawberries on recent morning.
“All told, there might be 15-17 acres planted this fall in all of Adair County,” said Talbert, who expects he will struggle to find enough workers to harvest his modest three acres. “Nobody wants to work anymore.”
There were once thousands of acres of strawberries in Adair County and plenty of employees to harvest them, residents said. The 21st century jobs that have replaced that work often involve sitting behind a desk for hours on end. Around this small town, where nostalgia for more fruitful days is a constant, the loss of agricultural work is sometimes blamed for shrinking pay checks, swelling bellies and shorter lives.
“Sixteen percent of adults over the age of 20 in Adair County have diabetes,” said Kayse Shrum, president of Oklahoma State University’s Center for Health Sciences. Making matters worse, the county has one of the lowest rates of diabetes monitoring in Oklahoma, increasing the odds of death from the disease.
Twenty-seven percent of adults in Adair County smoke, the highest rate in Oklahoma, and 42 percent of adults there are obese, also a state high. Forty-five percent of adults are covered by Medicaid, another state high, and 38 percent of adults between the ages of 25 and 44 have post-high school education, the lowest rate in Oklahoma. Its percentages of children and adults living in poverty are also state highs.
Adair County is not without doctors - 14 total, nine of whom are primary care physicians - but the average age of a primary care doctor there is 66, foreshadowing a possible doctor shortage on the horizon. Oklahoma State University is hoping to stave that off by recruiting medical school students from the state’s eastern half and operating residency programs in small towns across Oklahoma.
“There’s a lot of data that shows, if you’re training students from urban areas, training them in urban areas, doing their residency program in urban areas, there’s a very high likelihood they’re going to stay in an urban area,” said Shrum, dean of the OSU medical school. “But if you do just the opposite, those students tend to graduate and practice in rural communities.”
In 2005, country music star Carrie Underwood sang of her hometown, “Where the Wildcats beat the Ironheads.” Checotah, home to those Wildcats, has the third-shortest life expectancy in the United States, 58 years. That’s shorter than the worst neighborhoods of Chicago or Los Angeles or New York City. Eufaula, home to those aforementioned Ironheads, has the fifth-shortest, just 59.5 years.
“We see a lot of strokes, a lot of cardiac (problems),” said Jerry Lewis, the EMS director in Eufaula. “Of course, you know, the drug problem’s everywhere. Then I would say it’s just people not taking care of themselves, not trying to be healthy.”
Between 1999 and 2016, cancer rates in McIntosh County were higher than the national average and rates of lung cancer were more than twice as high, according to state data. People also died of diabetes and liver diseases at rates significantly above national averages. The death rate from lower respiratory diseases was more than twice the nationwide rate, Oklahoma Health Department figures show.
“The rate of obesity is higher in rural areas than it is in urban and there’s a relationship between that and life expectancy,” said Keith Mueller, a University of Iowa professor and director of its center for rural health policy. “Clearly, the opioid crisis that we have in the country today is disproportionately rural. Those kinds of factors all contribute to the life expectancy differential.”
Suicide rates in McIntosh County have been above the national average and state average for several years. Its murder rate of 8.9 per 100,000 people is also above state and national averages.
“We don’t see a lot of overdoses but you know it’s out there,” Lewis said.
The Muscogee (Creek) Nation is hoping to improve those health numbers. The tribe, with federal assistance, opened a 79,000-square-foot health center in Eufaula this summer that will provide care for members of all federally-recognized tribes. At an Aug. 1 ribbon cutting, Chief James Floyd said the hospital gives him hope for the future of health care in the area.
The National Center for Health Statistics narrowed its life expectancy data to census tracts of a few thousand people, which can be a small town, a large rural area or a neighborhood in a large city. Oklahoma’s least healthy areas are small towns and rural areas, but so are some of its healthiest, according to the life expectancy figures.
The highest life expectancy in Oklahoma - 89.4 years - is in a Caddo County census tract that surrounds, but doesn’t include, Anadarko. McCurtain County, in far southeast Oklahoma, is home to the second-highest life expectancy at 89 years. Sparsely populated parts of Pushmataha County, also in rural southeast Oklahoma, have an average life expectancy of 88 years.
Other long-living parts of Oklahoma include the area around Grand Lake State Park in Mayes County (86.7 years), southwest neighborhoods of Stillwater (86.6 years) and rural areas south of Kingfisher (86.1 years).
The lowest urban life expectancy is in the neighborhoods of eastern Oklahoma City. Residents in the area, home to multiple Superfund contamination cleanup sites, have a life expectancy of 64 years. Tulsa’s lowest life expectancy, 67 years, is in its impoverished north, near the town of Turley.
Experts and advocates for rural health care fear the jarring life expectancy figures in Stilwell, Checotah and Eufaula will become the norm across much of eastern Oklahoma if access to care and nutrition are not improved. Putnam at the Oklahoma Policy Institute said the state’s leaders should find the political will to take rural health more seriously.
“Adair County is at the bottom of health rankings,” said Shrum, the OSU dean, “but the truth is, there are several other parts of our state - rural areas - that probably aren’t that far behind if we don’t really take a hard look at public policy and what we can do to make changes.”
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Information from: The Oklahoman, http://www.newsok.com
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