Running head: HEALTH POLICY 1

Health Policy in Gulf County, Florida

Morgan Butts

University of South Florida

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Health Policy in Gulf County, Florida

Gulf County, Florida is a small coastal area made for those who chase the simpler life.

Though the quiet atmosphere and robust fishing draws the retired “snow birds” to flock, it is

important to recognize the residents and their true quality of living in this slow lifestyle. The

level of education, access to healthcare, and greatest health issues of the county can all be

compared to that of the state average to understand the community and where the system can

improve. It is by analyzing these implications that healthcare providers better understand the

consumers and the issues they face. Through this, the providers and consumers alike can create

an environment in which the community as a whole possess the ability to thrive.

Overview of Gulf County

Often referred to as the Forgotten Coast, Gulf County is situated on the northwestern

coast of the Panhandle of Florida. Two cities alone, Port St. Joe and Wewahitchka, are located

in within county limits. The southern portion scrapes the Gulf of Mexico as the western portion

boarders Tyndall Airforce Base. Gulf County and its coastal neighbors, Bay and Franklin

counties, all lay claim to the scenic highway US 98 famous for the beautiful beaches it runs

alongside.

Throughout the county, rural living is the commonality, for most residents enjoy the

small-town, southern living and the “Forgotten” label. As of 2015, the population stands at

16,491 individuals with the majority being white, middle-class, middle-aged males by

percentages. Less than 25% of the entire population ascribe to a non-white race (Florida

Department of Health, 2017). As of 2013, the largest employers in the county are GAC

Contractors, Bay St. Joseph Care & Rehabilitation Center, and Duren’s Piggly Wiggly which are

all located in Port St. Joe. Bay St. Joseph Care and Rehabilitation Center is an assisted living and
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rehab center for the elderly and is a major healthcare system for this county (Florida Department

of Transportation, 2013). Other large healthcare systems include the Florida Department of

Health in Gulf County and Sacred Heart Hospital on the Gulf (Florida Health, 2016). As a

whole, Gulf County is a homogenous, yet growing, quaint area for the working resident and

playing tourist alike.

Comparison of Local vs. State Populations

In comparison to the state of Florida, Gulf County remains statistically average for the

2015 year. The percent of families below the poverty level in the county was 10.1% while the

state average was 12.0%. Though there is a current trend upward in poverty levels in Florida,

Gulf County is experiencing a significant drop in the number of families living in poverty as of

2013. As for the population age 25 and over, 72.8% of Gulf Counties individuals have earned

high school diplomas. The same is true for 82.7% of the population age 25 and older throughout

Florida. This is a significant difference of 9.9% on average. Additionally, the population of

Gulf County age five and over that speak English less than very well is 1.3% compared to the

11.1% for the state of Florida. The total licensed Florida Family Practice Physicians in Gulf

County was 3 in 2015, or a rate of 18.2. In Florida, the count of Florida Family Practice

Physicians was 2,838, or a rate of 14.3. However, the access to specialty physicians in Gulf

County is quite limited (Florida Department of Health, 2017).

Analysis and Interpretation of Data

As a whole, Gulf County health systems are particularly proficient in ensuring the

population is cared for. Much of what is required of by the system is completed and available

for the entire community. However, lifestyle education seems to be lacking. Many of the

individuals of the community are setting themselves at risk for disease and death by sheer
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lifestyle decisions. These factors of health are further broken down by statistical strengths and

weaknesses in various categories throughout the county.

Identified Strengths

Looking at the statistical strength of the county, the Gulf County public health

department covers more of the population’s health expenditures in dollars per person than

Florida at $200.3 compared to the state average of $36.5. 97.9% of Kindergarten children are

fully immunized compared to the 93.4% in the state, while the unintentional injuries age-

adjusted death rate is 20.9 per 100,000 population for the county as compared to 42.1 per

100,000 for the state (Florida Department of Health, 2017).

Identified Weaknesses

On the contrary, the lung cancer incidence rate in Gulf County is 108.9 per 100,000

population compared to Florida’s 54.2, and the prostate cancer age-adjusted death rate is 39.4 per

100,000 males in the county compared to the 17.3 per 100,000 males in the state. Additionally,

the age-adjusted death rate for diabetes is 54.8 per 100,000 population while in Florida the rate is

19.5 per 100,000 population (Florida Department of Health, 2017).

Identification of a Priority Health Issue

As for the priority issue, the diabetes death rate must be improved in Gulf County. The

rate has increased significantly over the years to be one of the worst in the state and could

exponentially increase without an intervention. Other statistics that support this need for

intervention include the low percent of adults who meet vigorous physical activity

recommendations, which falls to 21.9 percent, and only 7.9 percent of adults in Gulf County

consume at least five servings of fruits and vegetables a day (Florida Department of Health,

2017). These both are modifiable behavioral risk factors that can lead to or aid in the
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improvement of diabetes. Additionally, diabetes is often secondary to obesity. As of 2013, 33.3

percent of the adult population were considered obese in Gulf County, and therefore, the high

percentage of obesity among the population is a dire indicator for immediate intervention

(American Diabetes Association, 2014; Florida Department of Health, 2017). With intervention,

diabetes-related diseases like coronary heart disease, stroke, and heart failure could decrease as

well in Gulf County (Kulick, E. R., Moon, Y. P., Cheung, K., Willey, J. Z., Sacco, R. L., &

Elkind, M. S., 2016). Because diabetes is a preventable, manageable, and treatable disease that

is killing many in Gulf County, it should be considered as the current highest priority health

issue.

Discussion and Application of Community Health Models

To properly understand the health of any community, it is essential to look at community

health models for comparison. One widely accepted model is the Determinants of Health Model

scripted in the Health People 2020 guidelines. This particular model evaluates the personal,

social, economic, and environmental factors affecting a community’s health. By addressing each

factor individually, the community is able to target the most impactful elements in the particular

time frame. For instance, according to Healthy People 2020, an individual’s behavior in addition

to his or her surroundings have a significant impact on the health outcomes experienced

regardless of biological factors (Office of Disease Prevention and Health Promotion, 2016).

Much of this is modifiable and, therefore, important to assess frequently in order to develop

appropriate interventions to address issues properly.

The factors that affect the death rate due to diabetes in particular can be biological,

environmental, lifestyle, and related to the health system alike. The biological implications of

diabetes are sex, race, ethnicity, age, physical ability and genetic predisposition. More African-
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Americans deaths due to diabetes have occurred in Gulf County than all other races combined

(Florida Health, 2016). Additionally, the environmental factors to assess include availability to

meet daily needs, societal norms, access to healthcare and treatment, transportation options,

access to vigorous physical activities, natural environment, and access to healthy dietary options.

All of these heavily impact a community’s ability to prevent and treat diabetes regardless of the

individual, so the racial disparity can have a large impact on the African-American in particular.

Another factor to consider is the lifestyle choices of the individual. According to the American

Diabetes Association (ADA) (2016), patients with a predisposition to diabetes should focus on a

7% weight loss and 150 minutes a week of moderate physical activity within a support group

setting. The individual predisposed to diabetes must then make these lifestyle changes to prevent

diabetes. African-Americans have a higher A1C on average making them a more vulnerable

population (ADA, 2016). Whether the racial disparity hinders the individual from obtaining

treatment is largely due to the health system. The impact of the health system is a large factor in

the death rate due to diabetes. Proper education, access to an endocrinologist, and cost must all

be evaluated within the health system.

Population Diagnosis

African-American adults in Gulf County are at higher risk for death related to diabetes

than Caucasian adults due to lack of access to healthcare specialists and racial disparity.

Community/Population-based Interventions

To aid in this major health issue, appropriate and evidence based interventions must be

implemented. According to the Intervention Wheel Model from the Minnesota Department of

Health and the Levels of Intervention Model, community based-interventions can be

implemented to take action at various point in the affected individual’s life. Discussing primary,
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secondary, and tertiary levels of prevention of diabetes for African American’s in Gulf County

can help close the racial disparity and bring change to the number of individuals dying from

diabetes (Office of Disease Prevention and Health Promotion, 2016).

Primary Level of Prevention

In the primary prevention of diabetes in African Americans of Gulf County, the county

must provide/employ more culturally diverse healthcare professionals, especially diabetic-

focused clinicians, to promote health in the minority population. Recruiting staff members that

reflect the members of the community is essential to providing culturally appropriate care

(Murayama, Spencer & Sinco, 2015). Stakeholders include community members who may be

interested in healthcare, public officials who employ these workers, and legislators who provide

the means to employ. Funding to employ these culturally diverse individuals must come from the

employers themselves, local legislature, or state grants requested by the local government and

may require budget cuts elsewhere. With this specific intervention, community health nurses can

encourage the culturally diverse to pursue these types of jobs, challenge legislators to make

appropriate changes and additions to improve diversity, and be sensitive and aware of their own

prejudices of race and culture.

Secondary Level of Prevention

In the discussion of the secondary level of prevention, the community of Gulf County

must be considered in relation to African Americans and their access to care. Because of the

racial disparities present, screening African Americans for diabetes must be pushed and

increased overall. The intervention is geared toward health care providers who have the tools and

clinical ability to screen and diagnose individuals with diabetes, for the recommended screenings

and diagnostic testing have a positive outcome in the health of patients with diabetes (ADA,
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2016). Additionally, while these tests are cost-effective, funding for these tests may need to

come from grants or the community itself. The community health nurse can help advocate for

community-wide testing days, volunteering to screen, and organizing physicians within the

community to work together to ensure follow up is completed after individuals have been tested.

Tertiary Level of Prevention

The tertiary level of prevention focuses solely on the African-American individual in

Gulf County diagnosed with diabetes and the approaches taken by the health care professional. It

is shown that the empowerment approach, a patient-centered approach to the management and

care of diabetes, is a proven intervention in improving HbA1c scores in African-American and

other minorities and preventing further negative impacts of diabetes (Kulick, 2016). The

stakeholder this intervention is geared toward health care providers. This requires no funding, for

providers have the ability at any point to empower and reinforce the identity of their minority

patients at no cost. Additionally, community health nurses can spearhead this approach in their

work environments, implement it in their own practice with minorities, and follow up with each

patient that has practiced this approach with further HbA1c testing.

Development of Health Policy

Health policy is intended to enact both short- and medium-term policies within a

community by bringing awareness and providing practical guidelines to promote positive

changes in health (World Health Organization, 2016). To truly confront the diabetes death rate in

Gulf County, it is imperative to develop a health policy to improve diabetes in African

Americans by addressing issue of racial disparity. This can be done using the proposed tertiary

level of prevention of the empowerment approach. Recent studies have shown that within six

months, consumers who had a strong racial identity showed substantial decrease in their HbA1c
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levels compared to those with a weak racial identity. The strongly identified consumers also had

an increase in diabetes self-efficacy after the study concluded (Murayama, 2016). With this

specific approach to patient care, health providers will be trained to guide consumers in creating

their own plan of care and incorporating interactive diabetes classes for minorities specifically.

African-Americans will be enabled by their health providers to take charge of their own health

through the positive reinforcement of their identities. Therefore, these individuals will be able

properly manage their diabetes while overcoming social disparities. Stakeholders effected by this

health policy will be largely health care providers, community members, and legislators. Funding

to train community members and health care providers must come from the local and state

legislators who can provide grants for minority-specific programs. Support of this proposal must

come from public officials, for their support of the underserved communities and the stigmas

surrounding their health can have a large impact on both the providers and the consumers. These

supporters also have the ability to ensure that minority groups have every resource available for

success in their diabetes management, from paved sidewalks in their communities to healthy

dietary options at the local grocery market. Opposing forces of the policy can come from

prejudice community members or other health care providers. Additionally, if the resources of

diabetes care are not available for the African Americans once they have been empowered, this

will be the greatest opposition, for no further action can be taken.

To put this health policy into motion, the plan is to begin with the health care providers in

Gulf County. Conducting phone calls and email correspondence to deliver the proposal and gain

perspective on availability and costs will be the first step. Once this information has been

gathered, a meeting must be scheduled with legislators to propose the policy and request funding

for training of the health care providers and community members. Once the meeting has been
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conducted and the funding has been provided, health care providers who previously showed

interested in the policy will be contacted again about trainings. As the trainings are taking place,

community members will be reached with flyers and newspaper ads regarding volunteer

opportunities to lead a support group. The support groups then need to be scheduled and reported

to the health care providers for referral. With this, the African Americans who have been

diagnosed with diabetes have the chance to improve their health and life expectancy. This is

projected to, in turn, improve the diabetes death rate overall in Gulf County.

Conclusion
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References

American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes

care, 37(Supplement 1), S14-S80.

Florida Department of Transportation. (2013). Gulf County Freight & Logistics Overview.

Retrieved from:

http://www.fdot.gov/planning/systems/programs/mspi/pdf/Freight/onlineviewing/Gulf.pd

f.

Florida Health. (2016). 2015-16 Community Health Needs Assessment. Port St.

Joe, FL: Florida Department of Health in Gulf County. Retrieved from:

http://gulf.floridahealth.gov/programs-and-services/community-health-planning-and-

statistics/community-health-assessment/_documents/gulfcounty-community-health-

assessment-report2015-16.pdf#Assessment.

Florida Department of Health. (2017). County Health Status Summary Profile – 2015. Bureau of

Community Health Assessment. Retrieved from:

http://www.flhealthcharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.

aspx?cid=0299.

Kulick, E. R., Moon, Y. P., Cheung, K., Willey, J. Z., Sacco, R. L., & Elkind, M. S. (2016).

Racial–ethnic disparities in the association between risk factors and diabetes: The

Northern Manhattan Study. Preventive medicine, 83, 31-36.

Murayama, H., Spencer, M. S., Sinco, B. R., Palmisano, G., & Kieffer, E. C. (2017). Does

Racial/Ethnic Identity Influence the Effectiveness of a Community Health Worker

Intervention for African American and Latino Adults With Type 2 Diabetes?. Health

Education & Behavior, 44(3), 485-493.

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Office of Disease Prevention and Health Promotion. (2017). Foundation of Health Measures –

Determinants of Health. U.S. Department of Health and Human Services. Retrieved

from: https://www.healthypeople.gov/2020/about/foundation-health-

measures/Determinants-of-Health#top.

World Health Organiztion. (2017). Health topics - Health policy. Retrieved from:

http://www.who.int/topics/health_policy/en/.