Running head: HILLSBOROUGH COUNTY HEALTH POLICY 1

Hillsborough County Health Policy Proposal

Evonne Piazza

University of South Florida

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Hillsborough County Health Policy Proposal

This paper evaluates the high rates of community health issues within Hillsborough

County in comparison to the state rate of Florida. After evaluating these county rates, a health

proposal was created based on a priority health issue in Hillsborough County. This lead to a step-

by-step plan on how to carry out this policy and what role nurses play in creating a health policy

proposal.

Describe and Compare Local vs. State Findings

Hillsborough County lies along the west coast of Florida and incorporates a few cities

such as Tampa, Plant City, and Temple Terrace. According to the United States census bureau,

Hillsborough County had a population of 1.292 million people as of 2013 and the majority of the

county was urbanized. Hillsborough County contained a total of 1,266.4 square miles in 2013.

From this total, there were 215.4 miles of water and 1,051 miles of land (United States Census

Bureau). A few major employers that lie within Hillsborough County are the School District of

Hillsborough County, MacDill Airforce Base, and the University of South Florida. Major health

care systems that can be found in Hillsborough County are Baycare Health Systems, Tampa

General Hospital, and HCA healthcare.

In 2013, Hillsborough County had a higher rate of families living below the poverty line

(16.6%) than the state of Florida (11.9%). In 2010, Hillsborough County had a higher rate of

individuals greater than 25 with a high school diploma (85.8%) than the Florida average

(85.3%). In 2014, Hillsborough County had a lower rate of individuals greater than the age of 5

who could not speak English (9.9%) compared to the Florida rate of 11.7%. Lastly, between

2014 to 2015, Hillsborough county and the state of Florida had the same rate for total licensed

family practice physicians at 19.10% (Florida Department of Health).

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Analysis and Interpretation of Data

From 2012 to 2014, the state of Florida had a higher rate of aggravated assault cases than

Hillsborough County (302.1 vs. 220.0 respectively, per 100,000 population). Hillsborough

County has had a decrease in trend of aggravated assaults in relation to the state stretching back

over more than 20 years. The rate of aggravated assaults for Hillsborough County dropped under

the rate for the state of Florida between 2006 and 2009. The national rate of aggravated assault

nationally between the years of 2013-2014 is 231.0; 11 points higher than the rate of

Hillsborough county from 2012-2014 (Florida Department of Health)(University of Wisconsin).

Another strength Hillsborough County had compared to the state of Florida is that Florida had a

higher rate of children living in poverty (23.6%) than Hillsborough County (23.4%) in 2013. The

national rate of children living in poverty in 2013 was 25%, which is 1.4% higher than the rate of

Hillsborough County (Florida Department of Health)(University of Wisconsin). In addition,

Hillsborough County had a lower rate of death caused by cirrhosis (10.2%) than the Florida

average (11.2%).

According to Florida Charts, one area that needed improvement in Hillsborough County

was the rate of unemployment. In 2013, the average rate of unemployment in Hillsborough

County was 11.0%, which was 8% less than the state of Floridas unemployment rate (11.8%).

While Hillsborough County had done consistently better than Florida as a while when it comes

to unemployment rates, compared nationally it has fallen short. In 2013, the national rate of

unemployment was 8.7%, 2.3% less than Hillsborough County (Florida Department of Health)

(University of Wisconsin). In addition, Florida has had a lower percentage (8.6%) of low birth

weight babies than Hillsborough County (9.1%) in 2013. However, Hillsborough County had a

higher percentage of low birth weight babies (9.1%) than the national average (8.3%) in 2013.
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(Florida Department of Health)(University of Wisconsin). Between 2012 and 2014, Hillsborough

County had a higher percentage of death caused by heart disease (169.1%) than the Florida

average (154.5%).

Identification of a Priority Health Issue

A priority health issue that should be addressed in respect to Hillsborough County is the

high death rate due to heart disease. According to Florida Charts, death caused by heart disease

in Hillsborough County was 169.1% compared to the state average which was 154.5% between

the years of 2012 and 2014 (Florida Department of Health).

Discussion and Application of Community Health Models

The Determinants-of-Health Model is composed of several categories (biological factors,

impact of health system, environmental factors, and lifestyle factors). The interrelationship

amongst these elements determine individual and population health. Since this model influences

several determinants it is more likely to be effective. These determinants of health go beyond the

traditional health care and public health divisions. Biological factors that could have contributed

to Hillsborough Countys high death rate caused by heart disease may be due to the large elderly

population that the county had. As of 2014, 11.7% of Hillsborough Countys population

consisted of persons older than the age of 65 (Florida Department of Health). Other biological

factors that can increase the risk of heart disease are an individuals ethnic background and

family history (Johnson, Davis, Law, & Sulpher, 2016). Heart disease is a very time consuming

and expensive disease to manage for both the patient and health care systems. Health care

facilities often have readmissions from patients with chronic heart disease, which means that

health care professionals have to treat these patients for the same problem continuously. These

frequent visits take time and money away from other patients who could benefit from it.
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Environmental factors that can contribute to causing heart disease are smoking and having a low

income (Canto et al., 2011). In Hillsborough County 16.6% of families lived below the poverty

line in 2014. Low families may have to choose more affordable eating habits to manage their

money effectively. These meals often have large amounts of carbohydrates, sugars, and salts,

which could potentially lead to heart disease. Other lifestyle factors that could contribute to heart

disease are smoking, alcohol, obesity, and physical inactivity (Johnson et al., 2016).

Population diagnosis

A risk of large rates of death caused by heart disease amongst citizens in Hillsborough

County related to inadequate income, use of Tabaco, use of alcohol, and high obesity rates.

Primary level of prevention

The level of recipient that the primary level of prevention was geared towards is the

community. An intervention that would have helped decrease heart disease deaths would have

been to educate the community about healthy lifestyle modifications such as healthier eating

habits, regular exercise, alcohol limitation, and smoking cessation. The stakeholders that this

intervention was targeted towards was the community members and health care providers. The

sources that would provide this education to community members would be health care

professionals. The role for the community health nurse would be to develop a plan on how to

present this information to community members in a way that everyone can understand it, such

as creating a pamphlet that has information about how to prevent heart disease. Nurses could

then go out in the community and share this information to schools, work places, and other

community facilities.

Secondary Prevention
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The level of recipient for the secondary level of prevention would be a system wide approach.

Secondary prevention for heart disease would consist of screening and regular exams to help

detect disease in premature stages. Stakeholders that the secondary prevention plan was geared

towards was community members and health care providers. Unfortunately, there may be

problems with funding for certain community members. Not all members of the community may

have health insurance so their screenings would have to be paid out of pocket, which could be

costly. The community health nurses role would be to provide education to individuals and

families of the importance of being screened for heart disease and what their results mean.

Likewise, if the patient did have a positive result, the nurse would then educate the patient on

measures that could be used to help reduce their risk of developing further complications and

improving their health.

Tertiary Level of Prevention

The level of recipient for tertiary prevention would be individuals. This prevention would

consist of monitoring compliance, monitoring treatment effects, and preventing further negative

impact on health. Monitoring compliance with patients medications can help keep the patient on

track with their medications and address any concerns the patient may have with them.

Monitoring treatment effects is important to ensure that the medication prescribed had a

therapeutic effect on the patient, if not, a change in dose or medication may be needed.

Preventing further negative impacts on the patients health can be done by monitoring medication

compliance and effects, and providing patient education. It is pertinent to help prevent these

negative health impacts so patients do not experience irreversible health changes. The

stakeholders that this intervention was geared towards was community members and health care

providers. The main funding source for these interventions would be the patients insurance.
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Unfortunately, not everyone has insurance so they would have to pay out of pocket for their

treatment. However, certain medications for heart disease are available at discount pharmacy

stores which could help these patients financially. The role of the community health nurse in this

tertiary prevention plan would be to educate and assess the client on any adverse or side effects

they may be experiencing from the medication. In addition, the nurse is also responsible for

educating the client about measures that should be taken to prevent any further negative impact

on them such as healthy diet, medication compliance, alcohol limitation, and smoking cessation.

Reflection & Synthesis of Health Policy

Effective health policies and distribution of public health resources can significantly

improve public health care. Secondary prevention would be the focus for this health policy

proposal. Screening would be the primary focus of this health policy because it would have the

greatest impact on the individual and families that have or are developing heart disease. The goal

of screening individuals for heart disease would be to catch the disease prematurely, start

treatment early on in the disease process, and take measures to reverse the disease such as

promoting a healthy lifestyle and medication administration. Stakeholders that would be affected

by the health policy would be community members and health care providers. Health insurance

would be the primary method of payment for heart disease screening. However, not every

individual has health insurance so they may not have the funds to pay for the screening by

themselves. Supporters of this health care policy would be patients and health care providers.

Patients would potentially be saving large amounts of money on future health care costs if they

were screened and treated for heart disease early in the disease process. Screening would also

help prevent the patient from worsening their health conditions. Health care providers would also

support this health policy because it would decrease admissions to the hospitals and could
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potentially give professionals more time to focus on other patients. An opponent of this health

policy may be the companies who manufacture medications for heart disease. Since this health

policy is based on prevention, non-pharmaceutical tactics may be used first instead of relying on

medications to treat the patient. Therefore, the need for heart disease medications may decrease

and these companies could potentially lose revenue.

The plan to put this policy into place would be to first educate the community in schools

and community centers on the importance of heart disease screening. This would include both

the benefits of getting screened and the consequences of not. In addition, the nurse would inform

the community about high risk behaviors that increase the risk of developing heart disease. After

discussing the screening process, the nurse would then inform the community about the different

medical facilities they can go to to get screened and what they should expect during their

screening. The underserved population may be able to access these screenings for free at certain

community health clinics. In addition, the undeserved population can use this test as a warning to

change some of the modifiable heart disease risk factors before their treatment becomes costly.

This could potentially save them from needing future treatment which they may not be able to

afford. In general, this health policy would enhance population health by decreasing the total rate

of individuals with heart disease in the community. Health screenings would inform individuals

who have and who are at risk for developing heart disease that their lifestyle choices may need to

be managed in order of avoiding further health complication.

Conclusion

Health care personnel must go through a series of steps to carry out health policies

throughout the community. Health care workers must work with each other in addition to public

officials, legislators, and community members to create effective health policies. Comparing
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county and state statistics can help health care officials determine what needs to be improved in

the county populations. These statistics are the basis for developing these health policies. This

paper informed me on the different roles and responsibilities that community health nurses have

in comparison to in-field nurses. This paper made me realize that nursing is much more than just

helping an individual in the hospital, nursing is also about preventing and optimizing health

around the world. This community health class has made me realize how nurses have the

potential to heal individuals, communities, and populations in various locations other than the

hospital.
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References

Canto, G., Kiefe, C., Rogers, W., Peterson, E., Frederick, P., French, W., Gibson, M., Pollack, C.,

Ornatio, J., Zalenski, R., Penney, J., Tiefenbrunn, A., Greenland, P. (2011). Number of Coronary

heart disease risk factors and mortality in patients with first myocardial infarction. The Journal

of the American Medical Association, 306(19), 2120-2127. doi:10.1001/jama.2011.1654

Florida Department of Health. (2016). Hillsborough County, Florida 2014 County Health

Profile. Retrieved from http://www.floridacharts.com/charts/CountyHealthProfile.aspx?

county=29&reportYear=2014&tn=31

Johnson, B., Davis, M., Law, A., Sulpher, J. (2016). Shared risk factors for cardiovascular

disease and cancer: Implications for preventive health and clinical care in oncology

patients. Canadian Journal of Cardiology, 32(7), 900-907.

doi:10.1016/j.cjca.2016.04.008

United States Census Bureau (2013). Population Estimates. Retrieved from

http://www.census.gov/popest/about/terms.html

University of Wisconsin Population Health Institute. (2013). County Health Rankings &

Roadmaps: 2013 National Benchmarks. Retrieved from http://www.countyhealthrankings

.org/sites/default/files/resources/2013 National Benchmarks.pdf

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