Running head: STRATEGIES FOR IMPROVING THE HEALTH 1

Strategies for Improving the Health of Hillsborough County

Olivia Aili Juola
University of South Florida












STRATEGIES FOR IMPROVING THE HEALTH 2
Introduction
Hillsborough County is an urban area located in the southeastern United States. The
largest city in the county would be Tampa. Other major cities of the county include Apollo
Beach, Brandon, Carrollwood, Lutz, Riverview, Ruskin, Seffner, and Plant City. Some of the
healthcare facilities in the area include Florida Hospital, Tampa General Hospital, St. Josephs
Hospital, and Moffitt Cancer Center. The top three employers in Hillsborough County are the
School District of Hillsborough County, MacDill Airforce Base, and the Hillsborough County
Government (Hillsborough, 2011).
Hillsborough Countys population is over one and a quarter million people. The
population in the county as of 2012 is approximately 1,277,746 people. The population has
significantly increased over the past twenty years. In 2011, the poverty rate in Hillsborough
County was greater than seventeen percent, which was a higher percentage than overall United
States poverty by a percentage (U.S., 2010). According to the community health profile report of
Hillsborough County, almost eighty six percent of people in Hillsborough County who are
twenty five years or older have at least a high school diploma, which is higher by one percent
than the Florida rankings. In 2011, about nine percent of people reported not speaking good
English, which is two percent lower than the Florida average (Gordon, 2011).
Leading Indicators of Health: Strengths and Weaknesses
The three leading health indicators of strength in Hillsborough County based on Healthy
People 2020s Leading Health Indicators and the United States Department of Health and
Human Services would be Maternal, Infant, and Child Health, and Tobacco (USDHHS, 2013).
Maternal, Infant, and Child Health is an area of strength in Hillsborough County because there
are many programs that the county participates in to help with Maternal, Infant, and Child Health
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such as Women, Infants, and Children, also referred to as WIC, a nutritional service for low
income mothers which provides formula and food for the baby to ensure proper nutrition
(Women, 2013). Since the initiation of WIC, the county has shown an increase in breastfeeding
duration which improves the health of the baby (Gordon, 2011). Tobacco is an area of strength
for Hillsborough County, because it participates in the Tobacco Free Florida program and many
areas of the county have recently been made smoke free. Tobacco Free Florida has information
on how to quit smoking and information on where a person can get aids to stop smoking (How,
2013).
The three leading indicators of need for Hillsborough County, based on Healthy People
2020s Leading Health Indicators, would be Obesity, Access to Health Services, and
Reproductive and Sexual Health. Hillsborough County is in need of help with obesity, because
the obesity rate is greater than twenty five percent in the area (Obesity, 2013). Although the
county does have many parks and recreational centers, many people are unaware of where they
are or do not have motivation or transportation to get to them. This nutrition and obesity problem
leads to issues that Hillsborough County struggles with such as diabetes where the number of
hospitalizations for Hillsborough County, 2,455 per 100,000, are higher than the states number
of hospitalizations, 2,130 per 100,000 (Gordon, 2011).
Access to health centers is also a major issue, because even with the few free health
clinics there are in Tampa, many of the services are not offered at one place. People have to go to
one place for a check-up, another for the lab work, and another for tests like ultrasounds or
echocardiograms. Most of people going to free clinics do not have the access to or money for
transportation to multiple destinations. The lack of readily available health care leads to more
chronic illness problems in the community, which is proven in the countys chronic illness
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numbers. For example, Hillsborough County ranks higher than the state in death from cancer in
the population. The countys numbers show around 170 per 100,000 people while the states
numbers show about 160 per 100,000 people. Hillsborough County is also not strong in the area
of Reproductive and Sexual Health. The countys numbers have been higher than the state for
reported sexually transmitted diseases. In the most recent study, Hillsborough County had
approximately 729 people per 100,000 while the state only had 507 people per 100,000 report
sexually transmitted diseases (Gordon, 2011). Although the countys population has a Planned
Parenthood campus in the city of Tampa, which offers services such as free or low cost birth
control, emergency contraceptives, STD testing, and pregnancy testing, high incidents of
sexually transmitted diseases and HIV/AIDS continue (For, 2013).
Priority Health Issue
Since poverty and low income is a big problem in the area, the priority health issue for
Hillsborough County is access to health services. Most needed are free and low cost health
clinics. The clinics should be able to provide check-ups, laboratory work, and testing in the same
area. This could solve the problems of patients not having a lot of transportation to multiple
destinations.
Population Diagnosis
The Determinants of Health Model helps describe the different aspects of health, instead
of just physical health. These include biophysical, psychological, physical environmental,
sociocultural, behavioral, and health system. Each category has sub-categories that help explain
what each section stands for. The Determinant of Health that is focused on with the plan for
Hillsborough County to have better access to health care is under the health system dimension.
The health system dimension encompasses availability, accessibility, affordability,
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appropriateness, adequacy, acceptability, and use. With Hillsborough Countys main need being
better access to care, the most important subcategories would be availability, accessibility, and
affordability (Clark, 2008).
A population diagnosis for Hillsborough County would be lack of access to affordable
and easily accessible health care. In an area such as Sligh Avenue in Hillsborough County, the
sub-group of people who live there have many similar issues as evidence by the people who
come into the only free clinic in that area, the Red Crescent Clinic. In the population around
Sligh Avenue in Tampa, as well as the entire county many people are obese and do not have
good nutrition. This is shown through the twenty five percent of the county overall being obese
(Obesity, 2013). A big risk by not having easily accessible health care is that people will not get
attention for pertinent medical issues such as multiple chronic diseases. For example if a person
has high cholesterol, but does not have easy access to a clinic that offers screenings for high
cholesterol, that person potentially could have their high cholesterol level turn into high blood
pressure, which could lead to cardiac problems such as left ventricular hypertrophy or
atherosclerosis. If these obese people in the area do not have the money or access to screenings
for high cholesterol, they may think that they do not need to do anything to change their lifestyle.
Levels of Prevention
In order to prevent more problems from occurring, and to help problems that have
already occurred resolve, interventions must be put in place for each of the three stages of
prevention: primary, secondary, and tertiary. The primary level for prevention in Hillsborough
County would be ensuring that the population is being educated early on, before disease sets in.
An example of a good intervention for this particular population would be having free blood
pressure screenings for people who are considered to be high risk for having high blood
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pressure, but these people do not already have a chronic problem with their blood pressure. The
role of the nurse for primary prevention is education to the patients. In order to prevent people
from having this chronic disease, nurses must educate patients on how to keep their blood
pressure lower. The nurse can use items such as pamphlets to send home with patients that have
information about a good blood pressure diet and a good exercise routine for people who are at
risk for developing chronic high blood pressure.
The secondary level of prevention in Hillsborough County would be helping the people
who already have high blood pressure by making sure that it does not get worse, or turn into
something else. For example with high blood pressure, if a patient does not monitor their
pressure or take care of the problem, it can turn into left ventricular hypertrophy, kidney damage,
stroke, transient ischemic attack, aneurysms, or even coronary artery disease. In the secondary
level of prevention, the goal would be to help the patient understand their problem and have
them do things to ensure that it does not get worse, such as taking blood pressure medication as
prescribed or being sure to diet and exercise. The role in the nurse is once again education, but
also as a caretaker to help patients take their medication on time and frequently check vital signs
to monitor the blood pressure levels.
The tertiary level of prevention in Hillsborough County would be management of the
chronic high blood pressure. In this stage of prevention, it is important for the patient to
constantly monitor their problems, and try to stop any activities that make the high blood
pressure worse. This would include having people attend smoking cessation classes, making
appointments with dieticians to have a low cholesterol diet, or getting a personal trainer to keep
weight in check and strengthen the heart. The role of the nurse in the tertiary stage is to be a
caretaker and researcher (At, 2006). The caretaker role is the typical role of making sure the
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patient has as prolonged and comfortable of a life as possible. The caretaker also involves
making sure vital signs are frequently check and assessing for any important changes such as
new renal or cardiac problems. The researcher role is a constant role for nursing, but is important
in this stage because it is crucial for nurses to be practicing everything up to the latest standards.
As described in chapter seven of the Patient Safety and Quality of Care Manual, if new research
comes in and the nurse is doing outdated assessing or interventions, the patient will have a better
chance of living longer and having a better quality of care (Titler, 2008).
Summary and Conclusion
Overall Hillsborough Countys greatest need is better access to quality healthcare
throughout the entire area. With the poverty level being high, compared to the United States as a
whole, and the population in the county continuing to increase, access to healthcare in the area is
crucial in order to maintain good community health. A proposal for health care centers with more
free testing options at multiple locations across the county is what would be serve Hillsborough
County. This is vital because many people do not have the transportation funding to get around
to multiple different places for different tests.
The addition of more free or low cost health care facilities with more testing would
significantly increase the level in the community, because people would be more able to get the
tests they need to possibly seek treatment for any medical problems. These facilities would have
to be funded by the government or privately operated. If the government is the source of funding,
they may be opposed to the idea because of the lack of money available for health care through
the state. In order to initiate this plan, the funding would need to be in place. Doctors and other
professionals would need to either volunteer their services or their pay would be incorporated
into the budget. The locations in the county need to be placed within a certain amount of miles
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where there is not a site nearby. Without these facilities, the overall health of the community will
continue to decline. People will keep living with chronic illnesses they may not know that they
have because they cannot get to a clinic that has free or low cost testing. More low cost or free
clinics are crucial to this countys population, and hopefully will be an addition in the near
future.
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References
At Work, Issue 43, Winter 2006: Institute for Work & Health. Toronto, Retrieved from:
http://www.iwh.on.ca/wrmb/primary-secondary-andtertiary-prevention
Clark, M.J. (2008). Community health nursing: Advocacy for population health. New Jersey:
Pearson.
Gordon, Lesline, et all. (2011). 2010-2011 County Health Profile Report. Retrieved from:
http://www.hillscountyhealth.org/pdf/HCHD_2010-
2011_Community_Health_Profile_Report.pdf
For our patients. Planned Parenthood of Southwest and Central Florida. Retrieved June 20, 2013
from http://www.plannedparenthood.org/ppswcf/for-our-patients-19415.htm
Hillsborough County- Largest Employers 2011. Retrieved June 24, 2013 from
http://www.suncoastemployers.com
How to quit. Tobacco Free Florida. Retrieved June 20, 2013 from www.tobaccofreeflorida.com
Human Health Services: 2020 LHI Topics. Healthy People 2020. (March 8, 2013). Retrieved
June 20, 2013 from http://www.healthypeople.gov/2020/LHI/2020indicators.aspx
Obesity and fast food consumption. Find the Data. Retrieved June 20, 2013 from http://county-
food.findthedata.org/l/345/Hillsborough
Titler, Marita. (2008). Chapter Seven: The Evidence for Evidence Based Practice
Implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses:
Vol. 1.
U.S. Census Bureau. (2010). Population: Hillsborough County, FL. Retrieved June 20, 2013
from http://www.hillsboroughcounty.org/index.aspx?NID=1110
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Women, Infants, and Children (WIC). United States Department of Agriculture: Food and
Nutrition Services. Retrieved June 20, 2013 from http://www.fns.usda.gov/wic