Running head: MANATEE HEALTH POLICY 1

Healthcare Policy in Manatee County Florida

Alexis Daubney

University of South Florida

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Healthcare Policy in Manatee County Florida

Health policy continues to develop through new research and knowledge in regard to

public health. For education and policy to be implemented it is necessary for healthcare workers

to address the population at hand. Manatee County, Florida, as other populations, is unique, and

requires specific tactics to target the health of the community depending on the particular health

issues present. Health care workers may develop a plan of interventions to better the health of

Manatee County, Florida by addressing the population and its strengths and weaknesses.

Overview of Manatee County

Florida is home to Manatee County, which sits to the west of the state on the Gulf of

Mexico. Manatee County consists of 741 square miles, and is known for its conservation areas,

and beautiful beaches, such as Anna Maria Island. Over 40 parks are located within Manatee

County, alongside multiple rivers and lakes. (Manatee County Florida 2016)

Identifying the population allows health care workers to provide higher quality care to

educate the public and prevent diseases. According to the 2010 U.S. Census, Manatee County is

considered an urban county with 322,833 residents. The majority of the population (81.9%)

identified themselves as white, and 14.9% described themselves as Hispanic or Latino. The

major employers within Manatee County are in retail trade paying 19,086 employees in 2015,

next health care/social assistance employers with 15,059 employees, followed by

accommodation/food services having 12,780 employees. (United States Census Bureau)

Comparison of Local vs. State Populations

Multiple factors have an impact on the population’s health status. Socioeconomic factors

are considered a determining factor in health care, from resources to the availability of care.

From 2010-14, Manatee County had 14.9% of the population below the poverty line (FL Health
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Charts). The state of Florida had 16.7% of the population below the poverty line in the same

year (FL Health Charts 2015). This reflects a population that may lack resources, which should

not be a factor in receiving the highest level of care.

Level of education is considered an important predictor of health, which influences health

care. In Manatee County, the population over 25 years of age without a high school diploma or

equivalent is 12.3% (FL Health Charts 2015). The state of Florida has 13.5% of the population

without this level of education (FL Health Charts 2015).

Access to health care centers or primary care providers may determine the availability for

an individual to receive care. The total hospital beds per 100,000 population from 2013-15 was

267.8 in Manatee County (FL Health Charts). Florida State had a total of 317.3 beds per

100,000 population. The County Health Department in Manatee has less than the number of

full-time employees per 100,000 population with 34.0, compared to Florida State at 51.1 (FL

Health Charts). This may lead to a lack of resources to provide or implement care.

Analysis and Interpretation of Data

Manatee County has various strengths and weaknesses when it comes to the health of its

population. The strengths and weaknesses encompass health as a whole, from physical to social

and mental health aspects. Identifying weaknesses allows health care workers to improve the

health of the population.

Identified Strengths

Manatee County holds strengths within areas that are important to overall health.

According to the Centers for Disease Control and Prevention (CDC) a body mass index (BMI)

above 30 is considered obese (2015). Manatee County was at 25% (2015) of the adult

population compared to the Florida average of 26.4% and the U.S. Healthy People 2020 goal of
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30.6% (FL Health Charts). This statistic, being lower than the goal set by Healthy People 2020,

may reflect better health through lower rates of chronic diseases such as coronary heart disease

and stroke.

The stroke age-adjusted death rate refers to the population that has died from a stroke.

Manatee County had a rate of 27.1 per 100,000 people (FL Health Charts 2015). This is less

than the state average of 34.5 per 100,000 people, and the U.S. Healthy People 2020 goal of 33.8

per 100,000 (FL Health Charts 2015). Currently, Manatee County is doing well to meet this

Healthy People 2020 goal.

Diabetes age-adjusted death rate refers to the number of deaths related to diabetes.

Manatee county had a rate of 12.1 per 100,000 population compared to the Florida rate of 19.5

and Healthy People 2020 goal of 65.8 per 100,000 (FL Health Charts 2015). Manatee County is

currently placed well ahead of the Healthy People 2020 goal.

Identified Weaknesses

Unintentional injuries age-adjusted death rate refers to deaths from injuries that were not

due to motor vehicle crashes or self-harm. Manatee County has a rate of 61.4 per 100,000

population (FL Health Charts 2015). This is much higher than the Florida rate of 42.1 and

Healthy People 2020 goal of 36.0 per 100,000 population (FL Health Charts 2015).

Unintentional injuries are one of the leading causes of death for people aged one to 44, which is

why it is an important health indicator for Healthy People 2020 (CDC WISQARS 2015).

Suicide age-adjusted death rate refers to deaths related to an individual taking his or her

own life. Manatee County has a rate of 16.4 per 100,000 population, compared to the state rate

of 14.1 and the Healthy People goal of 10.2 per 100,000 people (FL Health Charts 2015). This
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rate stems from mental health disorders such as depression and anxiety (Varcarolis & Halter

2014).

There are 34.1% of adults in Manatee County that have been told they have high blood

cholesterol, and 33.4% of adults in the state of Florida (FL Health Charts 2013). This percentage

is much higher than the Healthy People 2020 goal of 13.5% (FL Health Charts 2013). This

percentage is related to the number of adults who had their cholesterol checked in the past two

years, which is at 71.8% compared to Florida’s 73.2% (FL Health Charts 2013). It is necessary

to bridge the current gap present in the statistics, which reflect a need to change policy.

Identification of a Priority Health Issue

Hyperlipidemia (high blood cholesterol) would be the priority health issue present in

Manatee County. High blood cholesterol has an impact on overall health. With increased

cholesterol levels, there is increased likelihood for atherosclerosis that can lead to strokes or

myocardial infarctions. Since Manatee County is far from the Healthy People 2020 goal of

13.5% of adults, it is important for steps to be taken to better the health of Manatee County.

Health care providers need to educate the population that is at risk to prevent further progression

of disease, as well as public health officials to educate providers on screening patients.

Discussion and Application of Community Health Models

The health of the community encompasses a variety of components, that all must be

addressed to result in the best possible outcomes for the population at hand. Depending on the

community addressed, targeted interventions may be utilized on the population. The

Determinants of Health Model is a way in which public health workers approach community

health. This model organizes broad factors that determine health into categories to address the

community. The categories include: biology and genetics, social factors/health services,
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policymaking, and behavior (of the individual and population) (Truglio-Londrigan & Lewenson

2013). These guide the public health workers in gathering information on the community being

observed. The Determinants of Health Model may be applied to the situation present in Manatee

County with regards to high blood cholesterol.

Genetic predisposition and family history are considered biological factors for the

development of high cholesterol. Men are more at risk then women, as well as Hispanic ethnic

groups compared to non-Hispanic black or white groups. A specific genetic disorder is familial

hypercholesterolemia, which is an inherited disorder. This type of hypercholesterolemia, with

increased levels of low-density lipoproteins (LDLs), must be treated with lifestyle changes, and

medications. It is essential to target these patients due to their increased risk for a cardiovascular

event (CDC 2015).

Some environmental factors to be considered include the available nutrition for

consumption, alongside safety and potential areas to exercise. Stress levels may be a byproduct

of the environment of the community. Increased psychological stress has an influence on health,

mentally, and physically, influencing hyperlipidemia (Assadi 2017). It may be beneficial for

individuals to be educated on mental health wellness and its influence on physical health.

The culture of the community may be considered due to its influence on lifestyle

practices. Exercise and physical activity are protective factors that prevent against the

development of hyperlipidemia. When there are no safe locations or activities for individuals to

participate in, options for physical activity become limited. All of these aspects, from genetics to

the environment, are observed and accounted for to determine the best route to aid in the health

of the community.

Population Diagnosis
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Adults in Manatee County are at risk for high blood cholesterol levels as evident by

34.1% of adults in Manatee County being told they have high blood cholesterol, 44.9% of adults

who are insufficiently active, and 61.9% of adults who are overweight or obese (FL Health

Charts 2013).

Community/Population-based Interventions

Primary Level of Prevention

The primary level of prevention will be based on education regarding risk factor

modification. Health promotion at this level will prevent high blood cholesterol from being a

health concern for the general population. This education will focus on healthy balanced eating,

smoking cession, stress management and balanced lifestyle with exercise (Holben, Rambo,

Howe, Murray, & Shubrook 2017). The recipients of this education will target adult patients

through local employers in the community, as well as school curriculum in a group setting.

Implementation of a program within the workforce will influence community member’s actions

toward health promotion and lifestyle modification. This will require public health officials,

community employers, and health care providers to educate the population. There are a variety

of stakeholders regarding this general health education; specifically the local employers,

educators alongside the state and local health agencies will take particular interest. The Health

People 2020 goal is 13.5%, which is far from the current 34.1% of adults in Manatee County that

have been told they have high blood cholesterol (FL Health Charts 2013). Manatee County is

facing pressure from the federal level to improve high blood cholesterol levels within the

community. A lower percentage of adults with high cholesterol will benefit the health care

system as a whole, with fewer individuals experiencing its devastating effects.

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Education through these community level interventions does not bring about many

funding concerns. However, this step requires a group of stakeholders such as community health

nurses, employers to support the program, teachers, and other health care workers, to provide the

education in a group setting. It would be necessary to have stakeholders take initiative to carry

out the intervention of education. Community health nurses are in the position to provide both

general information in a group setting, as well as target information to individuals in a clinic.

Education is considered one of the first lines to prevent high blood cholesterol, according to the

CDC, since it is a major modifiable risk factor (2014).

A unique way to approach the adult population may be through smartphones. A study

was conducted utilizing the smartphone-based coronary heart disease prevention (SBCHDP)

program. This program targeted lifestyle behaviors that were preventable risk factors, such as

smoking and diet. Patients were able to utilize this program and document their perceived stress

and behavioral risks. This led to an increased awareness, and better behavior regarding blood

cholesterol. This approach may be used for making information easily accessible to patients

with mobile devices. (Zhang, Jiang, Nguyen, Poo, & Wang 2017)

Secondary Level of Prevention

Screening is vital for secondary level of prevention for high blood cholesterol. However,

Manatee County has a low rate of screening at 71.8% of adults. Education should be given to

providers regarding the necessity to screen patients at regular health visits, especially patients

with a family history or previous cardiovascular event (Grützmacher, Öhm, Szymczak, Dorbath,

Brzoska, & Kleinert 2017). The recipients of screenings will be adults receiving care under a

primary health care provider, or individuals receiving screenings through medical clinics. The

particular stakeholders for screening will focus on health care providers and clinic offices. When
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providers screen patients effectively in these settings, early diagnosis for hypercholesterolemia

will be possible to implement interventions such as platelet inhibitors (Grützmacher et al 2017).

Implementation of screening and modification factors will lead to a healthier patient population

with fewer patients requiring rehabilitation services due to uncontrolled high blood cholesterol

(CDC 2014). The American Heart Association recommends screening every four to six years or

more often depending on risk factors (AHA 2017). When patients are screened frequently they

have the ability to make changes to control the problem before it progresses.

The concern would be the availability of providers to instill the screenings and education,

as well as patient’s ability to return to clinics for their results. The main stakeholders for this

intervention would be the providers and community health nurses to connect with patients,

deliver results, and educate or medication. Providers may work with nurses to connect patients

with their results through other means, such as online communication or calls. Giving different

options to obtain results will better connect individuals to their health and future care.

Tertiary Level of Prevention

Once high blood cholesterol is present there are a variety of risks that may develop such

as stroke, or myocardial infarctions. This intervention focuses on preventing further negative

impacts, and dealing with consequences of high blood cholesterol for the recipient of care. After

an event has taken place it is important to care for the patient in the acute healthcare setting;

which focuses on health care providers. There are multiple levels regarding care after discharge.

With patients requiring more care upon discharge, the stakeholders may need to conduct home

visits to ensure patients are receiving adequate care through medication administration, as well as

properly implementing lifestyles changes such as diet. Some patients who are able may be

enrolled in facilities to encourage proper lifestyle changes. A meta-analysis found that for
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patients with stable coronary artery disease who utilized a level of endurance training into care

had better health outcomes to lower their risk for negative health outcomes such as stroke (Chen,

Tsai, Liou, & Chan 2017). Regarding medication compliance, the Agency for Healthcare

Research and Quality has found that patients at increased risk for stroke or myocardial infarction

benefit from taking a HMG-CoA reductase inhibitors commonly know as a “statin” (2016). This

dynamic type of intervention requires a variety of stakeholders from the health care system

community groups to improve patient outcomes and monitor disease progress, home health care

facilities to provide care if required, and funding agencies to ensure adequate care to all patients.

Concerns include the ability of patients to utilize resources due to potential financial

constraints. This may place limited availability on home health care nurses, as well as insurance

coverage issues. It will be necessary to appeal to funding organizations to ensure adequate funds

necessary to cover the patients that may not be covered typically. Community health nurses

must advocate for their patients in these settings to find the best course of action for individual

patients. This intervention will be evaluated through tracking clinics screening rates, and

tracking progress through community facilities such as home health care.

Development of Health Policy

Health policy has an impact on the way in which health issues are approached. When

particular guidelines are implemented based upon research, health policy may be formulated and

implemented correctly. The implementation of health policy should focus on the health benefits

to the community population. When addressing health policy, various populations within the

general community must be address to effectively implement policy that generates change for all.

The health policy proposal regarding high blood cholesterol will focus on education

found in primary prevention. Education and its practical application utilizing community
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resources has the ability to implement lifestyle change, thus the focused level of prevention is

primary. In the case of high blood cholesterol, changes in lifestyle through diet and exercise lead

to better health outcomes. Education sessions would provide tools such as meal planning,

locations with outdoor activities, smoking cessation information, stress management aids, and

community exercise programs/activities (Holben et al. 2017). Bettering the health of the

population can be completed by properly utilizing resources through educational programs.

Individuals will then have the tools to properly implement diet changes using fresh fruits and

vegetables present in the community. Parks and recreational activities within the community

may be utilized as a source of exercise (Derose, Marsh, Mariscal, Pina-Cortez, & Cohen 2014).

The goal of this intervention is increased physical activity within the population,

balanced eating and implementation of smoking cessation. It will be necessary for health care

providers or educators to inform individuals regarding the activities available to implement

practical lifestyle changes. Nevertheless, community members at recreational facilities and

parks can extend programs to accommodate more individuals. Intramural sports, which are

offered at recreation centers, may be of interest, as well as community groups and facilities.

There are multiple stakeholders required to implement the proposed policy. Health care

providers, community members such as educators and employers, and legislators are required to

implement the policy. The education will be provided through the workforce in local companies

as well as in the classroom setting to parents and students. These groups will be provided with

various resources about the community facilities that offer activities for physical exercise,

balanced diet information, and stress management. Employers may instill lifestyle intervention

programs (Holben et al. 2017). Where schools may implement field days to show students ways

they can have fun while being physically active (Derose et al. 2014). Health care providers are
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able to target the older populations that did not receive this education in these particular settings,

through clinics and wellness centers.

The community members and health care providers will support the policy due to the

benefits for the population. Community members and educators have the ability to influence the

population at the local level by involving patients individually in a closed setting. Health care

providers have a larger impact due to the various patients that are present in their clinics on a

daily basis. From the status of a medical professional, they will be able to influence legislation

to properly implement health care changes to benefit health. However, legislators may require

convincing. Since high blood cholesterol is an issue for Healthy People 2020, legislators may be

inclined to pursue policies that improve the county’s health outcomes for the upcoming survey.

The first step to the policy requires refinement of knowledge and targeted planning.

Employers, educators, and community health nurses may work hand-in-hand to curate a

presentation for the targeted population. This would allow them to approach the topic of

balanced eating and exercise in a way that engages and involves the participants. Preventing

high blood cholesterol will be targeted through healthful lifestyle choices at this primary level.

Then, health care providers may be approached utilizing brochures with resources available in

the community to be given to individuals that come to their practice. This would become a

practical tool for providers to help patients to implement lifestyle change; some resources in

place include the CDC and AHA educational brochure programs.

It is necessary to address the underserved population of 14.9% of the population below

the poverty line (FL Health Charts 2015). A more healthful diet is more difficult to obtain since

nutrient dense foods come at higher cost (Darmon & Drewnowski 2015). If there are no means to

bridge the gap and implement the education, no true health benefits can be seen in the
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population. Financial constraints may hinder families from implementing education, so

resources regarding inexpensive healthful options should be recommended.

Over time, the population of Manatee will have various changes in their health status.

Adults who are overweight will decrease from 36.9% (FL Health Charts 2013). Fewer adults

will be told of their status of high blood cholesterol. With implementation of this policy, the

upcoming adult patients will have better health outcomes meeting the new Healthy People 2020

goal of 13.5% of adults being told they have high blood cholesterol. Increased awareness and

practical application of education will better the long-term health outcomes for the residents of

Manatee County.

Conclusion

Manatee County Florida is doing well in various health aspects, however this county

requires a new approach in decreasing the prevalence of high blood cholesterol. The utilization

of public health education at the school and clinic levels will inform the public of necessary steps

to prevent the development of high blood cholesterol, increase the number of providers screening

their patients, and benefit the overall health of the community. The ultimate goal will be to meet

the Healthy People 2020 goal of decreased number of individuals having high blood cholesterol.

For my future-nursing career, I will be able to influence patients to improve lives. When

education is utilized at a variety of levels, patient’s lives are better off before an issue exists to

fix. Prevention of high blood cholesterol will lead to better health outcomes when there is an

acute health problem. I hope to be able make an influential change by providing resources to

patients that will truly impact them. The practical application of teaching leads to small steps,

which when added together creates immense change, leading to a more healthful community.
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References

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Assadi, S. N. (2017). What are the effects of psychological stress and physical work on blood

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