CHANGING PUBLIC HEALTH

SUBSTANCE ABUSE, ELDERLY CARE MUST BE FACED

Editor's note: This is the last in a series looking at major public-health
issues in the Tulsa area. Previous columns have dealt with violence,
teen-age pregnancy and maternal and infant health issues. All are being
addressed through a collaborative effort called Turning Point made possible
by a grant from the W.K. Kellogg Foundation and the Robert Wood Johnson
Foundation.

About all you need to know about the seriousness of America's substance-
abuse problem -- the same is true locally and statewide -- is that something
like three-fourths of all prison inmates have substance-abuse problems.

While widely known, the data still have the power to shock. "A higher
percentage of inmates in 1996 than in 1989 reported use of every type of
drug except cocaine," according to a 1996 report, Profile of Jail Inmates.
"Overall, 82 percent of all jail inmates in 1996 said they had ever used an
illegal drug, up from 78 percent in 1989."

If the prison-inmate data aren't enough to convince all of the seriousness
of our drug-abuse problem, there are plenty of other statistics available
for the hard-to-convince.

A coalition representing a wide variety of fields and disciplines is
developing plans for addressing Tulsa's top five public-health issues. A
plan detailing recommended actions is to be completed by midsummer.

Substance abuse and health care for the elderly were among the five
priorities identified by an earlier effort.

That group broke the substance-abuse problem down into four separate abuse
issues: alcohol, illegal drugs, inhalants and tobacco.

If you wanted to spend the next month reviewing data on how each of those
four separate problems affects American society, you probably could.

While an occasional report suggests that drug use waxes and wanes among
adolescents -- now and then one drug drops in popularity, only to see
another one rise -- the fact is drug use remains high in America despite
these periodic swings.

Marijauna use reportedly doubled among teens between 1992 and 1996 after
declining during the previous half-decade. Drug arrests in Tulsa have
doubled in recent years, according to data compiled by the Tulsa City-County
Health Department, the lead agency in the Turning Point effort, from only
1,122 in 1992 to nearly 2,200 in 1995.

A widely respected survey of teen substance abuse shows that about 25
percent have used or regularly use marijuana. About 30 percent admit to
binge drinking (five or more drinks at a time); 50 percent admitted using
alcohol within the past month. Twenty percent report using inhalants.

The significance of high drug and alcohol use among prison inmates is this:
Often, the substance abuse is directly connected to the crime. Two separate
surveys in 1989 and 1991 showed that as many as a third of prison inmates
were on drugs at the time of their offenses. As many as 50 percent had used
drugs during the month preceding their crime.

Data show that crimes often are committed to obtain money for drugs, and at
least 5 percent of homicides are considered drug- related.

Perhaps the most common drug-related crime is drunk driving. In a 1995
survey, more than a third of U.S. high school students reported riding with
someone who had been drinking; 15 percent reported driving under the
influence themselves.

While Oklahoma has one of the lower rates of adults who report driving while
drunk at about only 1 percent of the population, that's still plenty of
dangerous drivers considering the state's population is over 3 million.

And of course excessive drinking carries health risks itself: chronic liver
disease, cancer, and danger to a fetus, among others. Health care for the
elderly

One of the many pluses of improved medical science is increasing longevity.
But with longer life-spans comes an increase in the sorts of conditions that
tend to plague the elderly.

And it isn't just conditions like chronic diseases that the elderly must
contend with. They also face serious mental health issues, transportation
and access problems, dental care problems and nutrition issues.

According to the health department, seven of Tulsa's 10 leading causes of
death occur overwhelmingly among the elderly: heart disease, cancer, stroke,
chronic lung disease, pneumonia, diabetes and arteriosclerosis.

Treatment of these conditions often is limited by financial and mobility
considerations; those considerations also come into play in addressing the
other serious issues elderly people often face. Health-care sources estimate
that 10 percent of Americans -- in Oklahoma, that means more than 300,000
people -- have functional limitations which interfere with their daily
activities.

While communities attempt to grapple with these issues, they only grow:
Every eight seconds in America, a baby boomer turns 50. Americans over the
age of 85 are the fastest growing segment of the population; between 1960
and 1994, that demographic group increased by more than 274 percent,
according to U.S. Census Bureau data.

Tulsa is witnessing the same phenomenon. Recent data show the 45- 54 age
bracket growing at a fast rate, with its numbers expected to increase from
about 103,000 now to more than 120,000 by 2003. Tulsa's 85-and-up population
also is mushrooming; it is expected to increase 21 percent within the next
five years.

While some efforts to address the aging of the community are in full swing,
all agree the need is far from met and that demand will far outstrip
available, affordable services well into the future without significant
changes. What next?

Can we really do this? Make a significant impact on some of the most
intractable and complex social and health issues society has ever faced? We
will soon know, but all involved in the Turning Point effort think
significant progress can be made.

"I think first of all when you're living in a puddle, you don't see what
color the puddle is. The first thing you have to do is raise awareness that
you've got a muddy puddle and we've got to clean it up," says Jan Figart, a
consultant with the Community Services Council who is heading up the
planning effort. "We have to get businesses to recognize that to have an
adequate work force, they have to be healthy and have to have functional
families. When they get involved, when leadership gets involved, you can
move forward."

Short-term and long-term objectives for each of the five priorities already
have been identified; the next step is to find resources and funds to meet
the objectives.

"Oftentimes there are excellent programs that exist, but because of lack of
funding or lack of knowledge people don't take advantage of them," says
Figart. "An example is free pregnancy testing and free family planning for
teens; but because of inadequate resources, people don't know about it."

In other cases, the resources or services simply don't exist. Dental care,
for example, is not widely available to people with few resources.

In some cases, policy changes -- usually in the form of legislation -- will
be needed. Legislative action might take years to accomplish.

Turning Point's objectives might be lofty, even seemingly unreachable, but
the alternative -- to allow the status quo to continue -- is unacceptable to
most.

"I don't want this to be a plan that just sits on a shelf," says health
department Director Gary Cox. "If we can create an awareness of where we are
and the magnitude of the problems, and a system for looking at data and
coming up with plans on an ongoing basis, then long after us, at least there
will be a framework in place for addressing the issues."

"The idea is we have to do public health differently in the next 100 years,"
he adds. "There's not going to be much improvement if we just keep putting
Band- Aids on things."