Running head: COLLIER COUNTY: CHILD POVERTY 1

Collier County: Child Poverty

Ardy Emile
University of South Florida
COLLIER COUNTY: CHILD POVERTY 2

Collier County: Child Poverty

Countless factors and components exist that can intertwine and influence health outcomes
of certain populations in certain regions. This paper will analyze and synthesize data on specific
determinants that effect health and healthcare. As someone who grew up in Collier County; it
would be very interesting to study. Data trends between Collier County and the state of Florida
will be compared. The information will help develop a health policy proposal that can address a
concern found in Collier County.
Overview of Collier County
As a result of Floridas 1920s land boom, Collier County is Floridas 3rd largest county
and Floridas 62nd county (Collier County Museums, n.d.). The countys rich history predates
thousands of years: hunters and gatherers traveled the peninsula in search of larger game and
warmer winters. The first permanent settlements of very small, pioneer communities didnt
happen until the late 1880s because of Floridas geographic inaccessibility. These communities
spanned across the cities of Marco Island, Naples, Everglade, and Chokoloskee (Collier County
Museums, n.d.). Farming and ranching were the main staples, but when modern development in
the 1920s produced railroads and the Tamiami Trail, the county unlocked its vast agricultural
and resort potential. The countys oil well was established in 1943 and its cypress and logging
industry became abundant in the 1950s (Collier County Museums, n.d.). After WWII, the
countys economy boomed as well as its population, spanning from 6,488 to 85,971 residents by
1980. This lively economy has been well maintained by agribusiness, real estate, and tourism.
These industries have catapulted the areas growing potential and the county has come to
represent the ideal of Southwest Floridas sophisticated lifestyle (Collier County Museums, n.d.).
Collier County is encompassed by highly populated urban/suburban areas along Greater
Collier County whereas the inland, rural, and agricultural areas of Immokalee and the Estates are
less populated (Florida Health, 2013). The three biggest employers in Collier County are Collier
County Public Schools, NCH Naples Hospitals, and Publix Super Markets. The NCH healthcare
system and the Physicians Regional healthcare system are the major healthcare systems in
Collier County (Southwest Florida, 2015). Today the population is around 357, 306
encompassing approximately 89% of residents who are white only, 7 % who are black/African
American only, and 27% who are Hispanic/Latino (United States, 2015). The percentage of
families living in poverty in Collier County is 14.3% in comparison to the states 15.7%. When
it comes to the population who are 25 and over, 85.7% have a high school diploma when
compared to the states 86.5% (United States, 2015). 31.9% of Collier Countys population that
is five years and older speak a different language at home that is not English whereas it is 27.8%
in the state (United States, 2015). The ratio of the Collier County population to primary care
physicians is 1,430:1 when compared to the states ratio of 1,390:1 (County Health, 2016).
Analysis & Interpretation of Data
Identified Strengths
Collier county displays several strengths. Among these strengths is access to exercise
opportunities. Compared to the state of Florida, the percentages are close with Collier county
being 91% and the state being 92% (County Health, 2016). Although Collier county isnt higher,
this percentage is indicative of a strength because it puts the county in the 90th percentile. This
high percentage means that numerous residents of collier county live in close proximity to an
abundance of locations that promote physical activity (County Health, 2016). The built
environment a person lives in can help or deter physical activity. Physical activity decreases the
COLLIER COUNTY: CHILD POVERTY 3

risk for type 2 diabetes, stroke, obesity, and etc. Increased physical activity equals increased
health and wellness (County Health, 2016).
Another strength in Collier county is high school graduation. Education is crucial. Not
only does it directly and indirectly affect a persons health, it can also affect an entire
generations health as well. It is found that a mothers education level affects her children and
that the parents education level overall can directly affect the children through lack of resources
and indirectly through lack of quality schools (County Health, 2016). Increased education is
correlated to higher self-esteem/self-perception and higher self-reported health status. Compared
to the state of Floridas 75%, Collier county had an 85% when it came to high school graduates:
ninth grade cohorts who graduated in 4 years (County Health, 2016).
When it comes to unemployment rates, Collier county is doing far better than the state of
Florida. In Collier county alone, the unemployment rate is only 5.9% whereas in the state of
Florida it is 6.3% (County Health, 2016). This indicates that there is a higher percentage of
active workers in the county when compared to the state. In turn, more of the countys
population will have income. With a higher income, members of different households will be
able to afford necessities such as fruits, vegetables, and other healthy foods. Employment also
affects a persons ability to afford insurance because most of the time, insurance comes through
the particular job (County Health, 2016). Without that job, there will be no insurance. Even
with a job, insurance can be unattainable because the income is insufficient. Income level is a
great indicator of wealth and poverty in different regions (County Health, 2016). The
unemployed have worse health, higher mortality, and a higher chance to increase unhealthy/risky
behaviors (County Health, 2016).
Identified Weaknesses
Although Collier county has many positive attributes, there are unfortunately various
negatives as well. To begin with, the percentage of uninsured residents is higher in comparison
to the state of Florida. In Collier county, 34% of adults under the age of 65 do not have health
insurance (County Health, 2016). It is only 29% in the state of Florida. Health insurance can be
a huge determinant of the residents ability to access health care (County Health, 2016). The
uninsured have a higher probability of reporting issues when trying to acquire necessary
healthcare and 27% of uninsured adults can go for a year without care because of cost (County
Health, 2016).
Furthermore, the death rate caused by injury in Collier county is 75/100,000 while it is
68/100,000 in the state of Florida. This is per 100,000 of the population and can be unintentional
or intentional injuries. Being one of the leading causes of death, this statistic is something that
people need to take stock of (County Health, 2016). Unintentional injuries are the 5th leading
causes of death in 2010 including poisoning, falls, and vehicle collisions. Intentional injuries are
the 10th leading cause of death and include homicide firearms, suicide firearm/suffocation
(County Health, 2016).
Lastly, 26% of children live in poverty while it is only 24% overall in the state of Florida
(County Health, 2016). This means that in households with children under 18, these families
ranked below the poverty threshold based on income (County Health, 2016). This is very
dangerous because poverty can increase mortality and can potentiate a slew of negative health
effects (Aber, Bennett, Conley, & Li, n.d.). Poverty correlates with increased mortality, intimate
partner violence, poor health behaviors, depression, and etc. This statistic would be ranked
among the top 10 causes of death if it was considered a cause of death in the United states
(County Health, 2016). Children experience greater morbidity and mortality in comparison to
COLLIER COUNTY: CHILD POVERTY 4

adults when it comes to poverty. This is due to increased instances of accidental injuries, lack of
health care access, and poor educational achievement that increases poor health and premature
mortality. Child poverty rates have a high correlation to overall poverty rates (County Heath,
2016).
Priority Health Issue
Child poverty is cruel and especially heinous. Lack of sufficient housing and resources to
support the family, community isolation, and lack of support network can lead to child
maltreatment (World Health Organization, 2016). Although poverty may not be the parents
fault, this issue can fall under maltreatment and neglect. Poverty can have actual/potential harm
to the childs development, health, dignity, and survival (World Health Organization, 2016). This
is maltreatment. It can cause malnourishment, lack of education, and the onset of health issues
that may persist throughout a childs entire life (World Health Organization, 2016). Children
living in poor neighborhoods have increased dramatically in Florida in the past decade. In Collier
county, 5,382 children lived in destressed neighborhoods in 2010. In Florida 341,00 of children
reside in areas where 30% of residents are impoverished (Freeman, 2012). Poverty is a huge
contributing factor to the homeless population. With 50% being less than five years old, 1 in 50
children are homeless (Van & Sterling, 2011). The number of homeless children in Collier
county is increasing alarmingly, varying from children who are living in hotels, children who are
living with non-relatives, children/families living with other families, and etc. (Freeman, 2012).
Homelessness may or may not fit the classic stereotypical image, but the issue is still dire.
Families are doubling and tripling up. Children are at high risk for health and developmental
challenges in most aspects of their lives when they live in high poverty situations (Speer, 2013).
This can and will transfer into their adulthood.
Impact of Community Health Model
The Determinants-of-Health Model is crucial when it comes to deciphering the source of
health issues in certain populations as well as finding solutions for these issues. This model
encompasses the social, personal, economic status, and environmental components that impact
health status (Healthy People 2020, n.d.). This model helps nurses and different healthcare
professionals identify the factors that affect a persons/populations health and use this
information to develop interventions that promote better health (Healthy People 2020, n.d.).
Biology determines how physiologic and organ systems will adapt to the outside environment
(National Center for Biotechnology Information, n.d.). Biological responses to stress, new
situations, and primary relationships can directly and indirectly affect a child. Biology can
determine a childs survival if they are living in poverty. Biology can affect a childs behavioral
processes and his/her cognition: the way he/she is able to learn (National Center for
Biotechnology Information, n.d.). Lifestyle factors and environmental factors blend in with each
other when it comes to children living in poverty. These factors may include a slew of
components that can affect health (Healthy People 2020, n.d.). These include: availability of
resources to meet daily needs, socioeconomic conditions, public safety, transportation options,
exposure to crime, availability of quality schools and education, exposure to toxic substances and
etc. Lifestyle factors of a child living in poverty can influence and shape his social and physical
environment and promote poor healthcare outcomes and poor quality of life (Healthy People
2020, n.d.). With a lack of insurance, high costs, lack of availability, these children will not have
access to quality healthcare (Healthy People 2020, n.d.). They will be unable to receive
preventative services, have unmet health needs, have delays in proper care, and have preventable
COLLIER COUNTY: CHILD POVERTY 5

hospitalizations (Healthy People 2020, n.d.). Therefore, the way the healthcare system is run can
have a tremendous, negative impact on this population.
Population Diagnosis
Children; persons under 18 years old, living in poverty in Collier County are at risk of
mortality and poor health outcomes due to lack of proper education, lack of resources, lack of
healthcare, and various other biological, lifestyle, and environmental factors.
Community/Population-based Interventions
Primary Level of Prevention
Poverty in itself is not a disease, but as mentioned before, it potentiates a vast amount of
negative, health outcomes. So it is important to help prevent child poverty and help keep
families from falling down the ladder into homelessness as a primary prevention. With this level
of prevention, the community and many systems need to be addressed. Stake holders in the
healthcare systems, school systems, and community need to collaborate together to help prevent
this. The longer the child is in poverty, the worse the effects (Magnuson, 2013). For starters,
there is inequality in poverty: African American and Hispanic American child poverty rates are
dramatically and consistently higher than Caucasian children (Magnuson, 2013). Therefore,
there needs to be discussion with state and national officials to analyze and address the
increasing inequality of income, wealth, and opportunity among different races in the United
States (Magnuson, 2013). Furthermore, its a paramount of importance to work with school
officials and the community to ensure that children are receiving a quality education and that
there are developments of programs to help kids stay in school and off the streets. Evidence
shows that high-quality, center-based, early childhood education increases long term school
attainment, earnings, and reduces adult poverty (Magnuson, 2013). It is found that children who
are in poverty are less likely to complete school and parents without high school degrees are set
up for longer periods of poverty (Magnuson, 2013). With this intervention properly done, these
children will be able to complete school and have a higher education. With a higher education,
as parents, they will be less likely to fall into poverty while taking care of their own children
(Magnuson, 2013). Lastly, it would be beneficial to conduct research on the community to
identify families who are at risk for poverty. With the help of health care professionals and
school officials, pertinent information can be provided to this research. Community health
nurses need to fully assess family income, involvement, home life, health, and etc. in all their
patients to pin point risk factors. School officials can help with this research as well by
providing information on income, family/home structures, and statistics on school achievement.
Poor school achievement is correlated with poverty (Magnuson, 2013). Of course with these
projects, funding comes into play. Schools can use their funding to provide better
education/programs because education is important. We can also use tax money to help fund
research.
Secondary Level of Prevention
With the research from the primary preventions, a transition can be made into the
secondary preventions. Once cases are found and the families who are at risk for poverty are
properly deciphered, it would be time again to consult with the community, public/state officials
to have a community/system-wide approach. Programs will need to be developed and these
families will need to be educated on these programs to keep them from falling into poverty.
Evidence shows that income support programs positively affect parents and children who are at
risk for poverty (Magnuson, 2013). In a study comparing the effect of welfare-to-work programs
(mothers are placed in the workforce without a change of economic wellbeing) and income
COLLIER COUNTY: CHILD POVERTY 6

support programs (employment should increase economic resources) on child achievement,

children of mothers who were in income support programs where their earnings were
supplemented had greater levels of student achievement than the welfare-to-work participants.
These participants showed no improvement in student achievement (Magnuson, 2013).
Consequently, the Earned Income Tax Credit (EITC) is the most prominent cash, antipoverty
program in the US that provides necessary benefits to families who fall below the poverty
threshold. This program uses a refundable income tax credit. By 1997 the EITC was as high as
$4,450 and president Clinton ensured that with full time work (minimum wage) and the help of
this supplementation as well as food stamps, families will be able to stay above the poverty line
(Magnuson, 2013). Therefore, it is very crucial for the community health nurses to complete
their detailed assessments in the primary prevention, report their findings, and work with
families (in conjunction with case/social workers) to provide counseling and information on
these available programs.
Tertiary Level of Prevention
Once these persons and their children have fallen into deep poverty, it is time to
implement tertiary level preventions. If for some reason these clients could not access or
maintain these programs in the secondary preventions; these clients would need to be helped on
an individual, community, and systemic level. Members from the community, government, and
healthcare systems will need to be consulted. These stakeholders are important because they are
the deciding factor for change of these clients living in poverty as well as their health outcomes
(throughout all prevention levels). School and community officials need to work together in
providing these families with information on resources that help them maintain their daily needs.
Information on soup kitchens, food pantries, shelters, and etc. need to be provided to these
families. In Southwest Florida, directors of social services state that vast amounts of families
come to them for food, utility, and rent assistance (Freeman, 2012). These families need as much
resources as possible. The community needs to work with state officials to form policies and
programs that further aid these individuals. For instance, charitable organizations in Baltimore
work arduously on forming public policies for at risk children and they support human-service
reform (Freeman, 2012). One thing community health nurses can do is work with
government/state officials to help provide funding for healthcare programs for children and
families living in poverty. These families living in poverty have no insurance or access to
healthcare. As someone who works at the Pasco Mobile Medical Unit, basic healthcare is
provided across this county to the uninsured/homeless population free of charge. A similar
project can be done in Collier County by using tax dollars to set up about 3-5 mobile units across
this county. This will be less costly for the state than these clients having to go to the emergency
room for untreated/preventable illnesses because tax dollars go to unpaid ER visits as well. The
average cost of an ER visit in the US is $2,168 (Abrams, 2013). These mobile medical units will
provide children and families in poverty access to healthcare free of charge and prevent them
from going into the ER. Community health nurses, nurse practitioners, and other health
professionals can directly affect these projects by referring patients to these units and pushing for
policies that maintain these units. As well as working and volunteering at these units.
Development of Health Policy
Health policy is important because it directly impacts the personal lives and health
outcomes of millions of Americans. Due to the detrimental effects of child poverty on childrens
health outcomes, the overall goal is to provide health care services and resources (free of charge
or reduced price) to this population in Collier County. This policy will help prevent/reduce
COLLIER COUNTY: CHILD POVERTY 7

illness and help prevent ER visits. This particular policy will focus on tertiary levels of
prevention to help target children under 18 living in severe poverty. By working with the state
and public officials to implement the mobile medical units, coordinating with community
organizations to provide resources, and working in conjunction with school officials to decrease
the stigma on poverty and inform these childrens families on the resources available, the
negative health outcomes can be drastically waned. This policy would be of great help to the
impoverished children/families, the uninsured, and the homeless of Collier County. Of course,
funding is always a concern. The federal government uses taxes to finance numerous public
services and a vast amount of the budget goes to defense, social security, and major health
programs (Center on Budget, 2016). We can use taxes to help fund this policy. Some citizens
who feel like their tax dollars are not going to the right causes may be opposed.
The first steps to this plan includes analyzing the Collier County region to see where the
population group is most prevalent and analyzing what kind of resources that are already
available to them. Furthermore, a written, detailed, and strategic plan will be developed that
consists of research, evidence, statistics, and ideas to bring this plan into fruition. The Collier
County Health Department and the Collier County Board of Commissioners are responsible for
providing services to protect the health, safety, welfare, and quality of life of Collier County
citizens. These departments will work in conjunction with legislators, healthcare professionals,
and community officials to bring this policy/project to light. This policy will greatly impact the
impoverished children/families, uninsured, and homeless of Collier County by providing needed
healthcare services and resources for maintaining normal activities of daily living, free of charge.
Because this populations health will be maintained, they will have more chances of survival and
chances to get out of poverty. Therefore, will be able to sustain their own health and even give
back to this community, bettering the health of the entire population.
Conclusion
Child poverty is an ever-growing issue in Collier County and is an issue that should not
be ignored. The determinants of health on children living in poverty can have drastically
negative and lasting effects on their health outcomes, even into adulthood. It is essential to take
the necessary steps: using the primary, secondary, and tertiary levels of prevention to
reduce/eradicate child poverty as well as the negative health outcomes that it is accompanied by.
Community health nursing is crucial in enhancing the health of individuals, communities,
and populations. It takes nurses out of their traditional roles in the hospital and bring them
directly to the issues in the community. This allows firsthand experience and allows the nurse to
provide care to populations who may not have had access to health care or knowledge on how to
improve their health otherwise. Frankly, this will help me as a nurse because I will encounter
patients from all walks of life in my profession. And it would be of great service to them to be
able to provide the proper care, proper information, and the proper resources that will cater to
their specific needs.
COLLIER COUNTY: CHILD POVERTY 8

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