[Editor's note: This story was modified on Sept. 9 for clarification purposes.]
FAIRFAX, Okla. – Osages living on the tribe’s reservation tend to have “poorer health” statuses than their fellow tribal citizens living elsewhere, according to the results of a health survey in which more than 6,000 Osages participated earlier this year.
The survey – titled “Health of the Nation: Reservation at Risk” – questioned 9,850 Osages when applications for the $500 Health Benefit Card were mailed out this past spring. The survey was conducted by Fairfax-based Paradox Consulting LLC which is operated by Dr. Joe L. Conner (Osage) and his wife Dr. Carol Nice Conner.
The questionnaire polled Osages about their health history, demographics and income with 6,602 filled-out surveys returned which is a 67 percent response rate.
According to the survey results released in July, 25.1 percent of Osages living on the reservation rated their general health as fair or poor. That’s 10 percent greater than the 14.5 percent of the U.S. population with citizens rating their health as fair or poor in 2009. In Oklahoma, 19.5 percent of the state’s population also rated their general health as fair or poor last year.
“The local area is significantly at risk, people can get sick,” Joe Conner said of the survey which indicates obesity, smoking (which could lead to respiratory problems) and depression are health dangers associated with many of the survey takers.
Poorer qualities of health can shorten a person’s life span, Carol Conner said adding those who report fair-to-poor health statuses could have “a significant medical event in the next year” such as a heart attack or stroke, for example.
In comparison with other fellow tribal citizens, 14.4 percent of Osages living in Oklahoma (outside the reservation) rated their health as fair to poor and 12.5 percent of out-of-state Osages did too.
The survey also reports that poverty rates for Osages living on the reservation are higher than those not living there with 21.5 percent living in poverty compared with the United States rate of 10.3 percent. “Poverty extracts its effects on the health of populations in many different ways,” the survey reports, listing examples such as “fewer dietary and exercise opportunities that help maintain healthy lifestyles” and “less access to routine preventative health measures.”
“The health status is also reflected in very high rates of obesity and diabetes,” according to the survey which notes the “reservation rates of obesity are higher than any comparable rate in the U.S. Mississippi leads the U.S. with a rate of 32.8 (percent), while the reservation rate is almost 35 percent, a full 5 percent higher than Oklahoma’s.”
The diabetes rate on the reservation is more than double the U.S. rate with 20.7 percent of Osages reporting they have been diagnosed with diabetes and the U.S rate is 8.3 percent. Over 13 percent of Oklahoma Osages not living on the reservation reported being diagnosed with diabetes and the same rate for out-of-state Osages is 9.6 percent.
Joe Conner said officials with Indian Health Service have described the survey as “the largest survey of a single tribe” when it comes to health matters.
“The (2006) Constitution requires the tribe to provide health services and ‘prevention of illnesses and chronic disease, and of services that promote mental and physical well-being,’” Carol Conner said. “That’s part of why we did this (survey). You have to know the health status before you provide services.”
The percentage of Osages living on the reservation who have been diagnosed with heart disease is also double the rate of non-reservation Osages with 11.3 percent reporting a diagnosis and 5.7 percent for Oklahoma (non-reservation) Osages and 5.1 percent for those living out-of-state.
The U.S. rate for heart disease is 3.8 percent, the survey states. When it comes to high blood pressure, 35.4 percent of reservation Osages reported being diagnosed with it. The rates for other Osages were slightly lower with Oklahoma (non-reservation) Osages at 29.9 percent and out-of-state Osages at 25.3 percent.
Also noted in the health survey:
Just over 18 percent of reservation Osages report being treated for depression which is nearly three times the U.S. rate at 6.7 percent.
Thirty-five percent of reservation Osages report they smoked within the last 30 days, which is higher than the U.S. rate of 21 percent. Twenty-six of Oklahoma (non-reservation) Osages reported they smoked in the last 30 days and the rate is 19.3 percent for out-of-state Osages.
When it comes to binge drinking, 14 percent of reservation Osages report drinking five or more alcoholic drinks on one occasion in the last 30 days which is one point higher than Oklahomans (in general) at 13 percent. Men on the reservation are more likely to have binged (17 percent) than women (10 percent).
The average age of the survey takers was 44.6 with 45.4 percent being males and 54.5 female. The average number of people living in the household was 2.7.
Out of the total number of survey takers, 17.2 percent of reservation Osages completed the health survey; 32.8 percent (non-reservation Oklahoma Osages); 49.7 percent (out-of-state Osages); and 0.17 percent (Osages living outside the United States).
“Of the 6,602 adult Osage citizens, 18 years or older, who completed the survey, 17.2 percent or 1,135 live on the reservation, meaning a significant majority of nearly 60 percent of adult Osages living on the reservation completed the survey,” Conner said. “From previous studies it has been found that there are 1,700 to 2,000 adult Osages who live on the reservation.”
The average income of a survey taker was $50,878.84 but the poverty rates for reservation Osages is higher than those living off-reservation. Twenty-two percent of reservation Osages live below the poverty line set by the U.S. Census Bureau. “On the reservation, this represents 150 to 250 families living below the official poverty level. Some of these families are living on as little as $11,201 per year.”
More Osage women live in poverty than Osage men in all three areas listed in the survey. On the reservation, 24.8 percent of women live below the poverty line and the rate is 17.7 percent for Osage men on the reservation; for non-reservation Oklahoma Osages, 18.9 percent of Osage women live in poverty and 11.7 is the rate for men; and 14 percent of out-of-state Osage women live in poverty and the rate is 7.5 percent for out-of-state Osage males.
“Poverty is a terrible overriding issue that impacts health,” Carol Conner said. “If you got a job, you’re going to get up and go to work and less likely to smoke or sit on the couch,” she said of people tending to stay active while working. “On the reservation, economic opportunities are limited but if the tribe improves economic conditions there will be better opportunities for better health,” she said.
The average out-of-pocket cost for medical expenses for reservation Osages was $1,374; for non-reservation Oklahoma Osages, $1,468; and $1,843 for out-of-state Osages.
In the last year, just under 36 percent of Osages report having trouble paying for medical bills and of those who answered “yes” to this question, 36.4 percent are still paying on those bills.
Prescription medication and doctor visits top the list of out-of-pocket medical expenses incurred annually by all Osages with medicine costing an average of $500 per year and $300 for doctor visits.
In conclusion, the survey states: “many of the indicators of poor health, if not quickly reversed, cascade into other more serious problems. As an example, recent research shows that those who suffer from depression are more likely to suffer from dementia into their elderhood. Further, those with diabetes are also more likely to develop dementia.”