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Running head: HEALTH POLICY 1

Health Policy for St. Johns County

Michael Sandin

University of South Florida


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Health Policy for St. Johns County

Heart failure is a chronic condition that has deteriorating effects on the patient, family,

and community as a whole. This paper discusses the heart failure death rates in St. Johns County

versus the death rates in Florida as a whole, and proposes a health policy that is aimed towards

decreasing those death rates. This chronic condition is a concern for St. Johns due to its ill

effects on those diagnosed, and the resulting effects on the families of the diagnosed individuals

and the health care systems.

Overview of St. Johns County

St. Johns County is on the North-East coast of Florida which mainly encompasses

Jacksonville, Florida. The area is filled with neighborhoods and apartments generally for

middle-income families. There are many elementary, middle, and high schools in the area. It has

a total population of about 190,000 people and comprises of three major cities including St.

Augustine, St. Augustine Beach, and Hastings city (St. Johns County Government, n.d.). St.

Johns County, Florida is roughly 608 square miles, and has multiple tourist attractions like

historical sites and beaches which attracts populations of various ages.

St. Johns County is primarily composed of suburbs, but does have some urban areas in

for the cities. The population includes families and a large pediatric population with about

twenty elementary schools, three K-8 schools, seven middle schools, seven high schools, and

seven other schools (St. Johns County Government, n.d.). The three major employers of St.

Johns County include the St. Johns County School District with 4,046 employees; Flagler

Hospital with 1,900 employees; and Northrop Grumman with 1,200 employees (St. Johns

County Government, n.d.). The three major health care systems in St. Johns County include

Flagler Hospital, Mayo Clinic Jacksonville, and Baptist Medical Center.


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Comparison of Local vs. State Populations

The population and socioeconomic factors of St. Johns County tended to fair better off

than of all of Florida. In St. Johns county, the percentage of the population underneath the

poverty line is 11.4%. This compares to the higher poverty rate of 15.4% in all of Florida (U.S.

Census Bureau, 2015). The percentage of the population that has only a high school level of

education is 21.2% in 2015 for all of St. Johns County compared to 29.5% for all of Florida

(Florida Health Charts, 2015). In St. Johns County, 2.5% of the population did not speak

English in 2015 compared to that of the 11.7% of all of Florida (Florida Health Charts, 2015).

St. Johns county has about 249 physicians per 100,000 population in 2015 compared to 735 per

100,000 population in all of Florida (Florida Health Charts, 2015). Overall, St. Johns County

does share some similarities with the population of Florida, but has shown to be better off in

other areas as well.

Analysis and Interpretation of Data


Identified Strengths

The age-adjusted death rate for Alzheimer’s Disease in St. Johns is a rate of 13.9 per

100,000 population, which is lower than the 22.3 per 100,000 population for all of Florida in

2015 (Florida Health Charts, 2015). The rate of AIDS cases in St. Johns Florida is 4.2 AIDS

cases per 100,000 population in a single year versus 11.2 people in 100,000 for the state of

Florida, which a lower rate than the state average in 2015 (Florida Health Charts, 2015). The

percentage of adults who are current smokers was 14.7% in St. Johns in 2013, which is lower

than the 16.8% of the population of adults who are current smokers in Florida in 2013 (Florida

Health Charts, 2013).

Identified Weaknesses
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The suicide age-adjusted death rate for St. Johns Florida is 18.5 per 100,000 population,

which is higher than the 14.6 rate for all of Florida in 2015, which suggests a need for

improvement (Florida Health Charts, 2015). The rate of alcohol-suspected motor vehicle traffic

crash deaths in St. Johns was 11 for a rate of 5.1. The deaths for all of Florida was 916 for a rate

of 4.6, lower than that of St. Johns in 2015. (Florida Health Charts, 2015). The cancer age-

adjusted death rate in St. Johns was 169.4 versus a lower 154.3 rate for all of Florida, meaning

that there is a higher death rate from cancer in St. Johns (Florida Health Charts, 2015).

Another weakness in St. Johns compared to all of Florida is the death rate from heart

failure. Specifically, the heart failure death rate for the population ages 65 and over in St. Johns

county was 100.2 per 100,000 population. This is a higher death rate than the 89.5 per 100,000

population death rate for all of Florida in 2015 (Florida Health Charts, 2015).

Identification of a Priority Health Issue

A priority health issue in St. Johns County would be the deaths associated with heart

failure for the 65 year and older population. This is a health priority because heart failure is a

chronic disease that has multiple effects to the patient, family, friends, and the community as a

whole. This ranges from the grief associated with the death of a family member, to the cost for

the long-term maintenance of the disease. It can pose a big toll on the family by causing a

decrease in the patient’s ability to care for themselves.

The various effects of fragility syndrome caused by heart failure was discussed in an

article by Uchmanowicz, Wleklik, and Gobbens. This article found the Tilburg Frailty Indicator

score, a score that accounts for the sociodemographic and other effects of frailty, increased with

the duration of the disease (Uchmanowicz et al., 2015). All this comes together to form a

priority health issue because the increase in fragility and eventual death of patients with heart
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failure can result in further effects on the population as a whole, and especially the family of the

patients. This includes the results of life altering diseases in general, as it can be taxing on the

family emotionally, and expensive in terms of medications for the disease.

Discussion and Application of Community Health Models

The Determents of Health Model is a model that looks at the multiple factors that affect a

population’s health. These include things from personal factors, social, economic, behavioral,

health policies of the area, and economic factors (U.S. Department of Health and Human

Services, 2017). All these things come together to determine the health outcomes of the

population. The use of this model therefore encourages analysis and appropriate changes to

those determents that can be causing bad health outcomes. It also ensures that all aspects that go

into inflicting a population’s health are addressed.

This model is particularly important for heart failure because many factors go into the

cause and eventual progression of the disease. Addressing these issues before they arise, or

monitoring some of the determinants presented in the Determinants of Health Model when they

already have the disease can easily play a role in better outcomes for the patients. All of this

may, in turn, cause for better outcomes and could decrease the rate of heart failure patients over

65 who die each year in St. Johns County.

Population Diagnosis

Heart failure patients 65 and older in St. Johns county are at increased risk of death due to

the frailty and other health effects caused by heart failure comparted to Florida overall as

evidenced by St. Johns having a death rate of 100.2 per 100,000 population and Florida having a

death rate for heart failure patients 65 and older 89.5 per 100,000 population (Florida Health

Charts, 2015).
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Community/Population-based Interventions

There are multiple interventions that can take place to improve the outcomes of patients

65 years and older who have heart failure in St. Johns county. These range from primary,

secondary, and tertiary interventions. Primary prevention can take place to help prevent the

disease from developing in the population. The primary intervention in this case is a policy that

can be done in the school systems to promote healthy diets in children. The secondary

intervention is mainly something that can take place to help with the screening and diagnosis of

the disease. Tertiary prevention is focused on the treatment of the disease.

Primary Level of Prevention


The goal of primary prevention for decreasing heart failure deaths would be to target

ways to prevent heart failure from developing in the first place. This can be done by changing the

modifiable risk factors of the population. Some of the modifiable risk factors that can lead to

heart failure include other diseases like hypertension, hyperlipidemia, diabetes mellitus, obesity,

as well as lifestyle choices like smoking and use of drugs or alcohol (Osborn et al., 2010). This

can be done through education based on the risks of smoking or using drugs, and education about

the adverse effects of obesity, diabetes, and other risk factors of heart failure.

One such primary prevention that can help reduce the risk of developing heart failure,

and the eventual deaths is a healthy eating program in the school systems. Having an

educational system where a dietitian or registered nurse is allowed to visit the schools in the St.

Johns County School District would allow for the possible prevention of one of the modifiable

risk factors like diabetes mellitus and obesity identified by Osborn et al., 2010. The stakeholders

are the children who attend the St. Johns County School District, as they are the ones receiving

the education by the intervention. The funding of this intervention wouldn’t be too taxing on the

St. Johns County School district ask a whole. While the St. Johns County School District does
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report financial and economic pressures, the funding in 2016 was raised by 10.4 million dollars

(Budget Department, n.d.). The only funding this intervention would need would be to the

educators themselves. A community health nurse could provide the education themselves, or

work with dietitians to help work with the children in setting up healthy eating habits.

Secondary Level of Prevention

Secondary level of prevention for deaths related to heart failure could include early health

screenings for the middle-aged population in St. Johns County. This can allow for an assessment

of risk factors, and can lead to education and hopeful lifestyle changes that could decrease the

risk that the population would develop heart failure, and thus could decrease the deaths related to

heart failure in the 65 and older population. One such intervention is providing health screenings

at the local businesses. The stakeholders in this case would be the community members because

they would be the ones receiving the screenings. A group of community health nurses could be

funded to provide screenings in the St. Johns County area, and would be responsible for the

screening for diseases like heart failure.

Tertiary Level of Prevention

Tertiary prevention, in the case of heart failure, is more for easing the symptoms and

decreasing the progression of the disease. This can be accomplished through, for example,

pharmacological management. This would be done through use of medications that stop the

progression of the disease, such as medications like ACE Inhibitors, angiotensin II receptor

blockers, beta blockers, diuretics and more (Osborn et al.., 2010). The role of a community

health nurse in this case could be to provide medication management to those affected by the

disease. Whether it be by going to nursing homes or the patient’s homes of those who have heart
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failure, the management of medications could help in easing the management of the disease

itself.

Development of Health Policy

With coronary artery disease being one of the major causes of heart failure, a health

policy targeting the progression of this disease can lead to better health outcomes for the

population of St. Johns County. One way to prevent coronary artery disease is through primary

prevention involving education on diet and exercise. This could be in the form of a health policy

through school systems in St. Johns County suggesting schools provide education on healthy

eating and dietary choices. Doing this would provide quality education earlier on, and may lead

to better health outcomes for these individuals later in life. The proposed goal is to decrease the

heart failure associated death rate in St. Johns County from 100.2 per 100,000 population to 50

per 100,000 population by 2055. This date is specifically chosen due to the time the disease

usually develops, and the age of those being educated. It would take years for the disease to

develop, so providing the education on children under 18 would allow for the prevention of the

disease.

This goal would make the rate the lowest it’s been since 2008. The primary stakeholders

affected by this policy would be children in the St. Johns County School District, as they are the

individuals who would be receiving the education for healthy eating and lifestyle choices.

Administrators of the various schools would also have to be on board, as they would be the ones

to accept or reject such policies. If the school district did not wish to allow community health

nurses and dietitians to provide education dietary and lifestyle modifications that would prevent

coronary artery disease and heart failure later in life, then the way the children at these schools

receive this information may need to be adjusted. To get this policy implemented, a presentation
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focused on the need for this education can be provided to administrators of the schools on why

this educational program is important. It would be focused on showing the benefits of having the

education, and explaining that having education on healthy dietary and lifestyle choices for

school-aged children may lead to healthy eating habits, and could prevent some of the risk

factors for heart disease.

The adjustment of diet for both the management and prevention of heart failure and other

diseases is also supported by many studies. One such study suggests that providing interventions

to decrease sodium intake and increase exercise in long term care facilities can improve the

health outcomes for patients with heart failure (Heckman, G. A., et al.). This shows that now

only can there be primary prevention for reducing the risk of heart failure, but there can be

tertiary prevention in regards to health policies targeting diet and exercise with those with heart

failure. Ultimately, this proposal could help prevent heart failure cases and deaths in the

community.

Conclusion

Overall, the health status of the St. Johns population fairs well compared to Florida as a

whole. Through a health policy focused on getting clinics, hospitals and other providers to

provide education healthy lifestyle choices for people 40 and older the health outcomes for St.

Johns Florida in regards to deaths from heart failure of our 65 year or older population can be

improved. This is a relevant paper is it allows me to be able to take a focused look on a

population, giving me the tools to look at populations I may deal with on a daily basis, and using

those tools to ensure that a well-rounded form of care is provided.


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References

Budget Department. (n.d.). Retrieved from http://www.stjohns.k12.fl.us/budget/

U.S. Census Bureau (2015). American Community Survey 5-year estimates. Retrieved from

https://censusreporter.org/profiles/05000US12109-st-johns-county-fl/

U.S. Department of Health and Human Services. (2017). Determinants of Health. (n.d.).

Retrieved from

https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-

Health

Florida Department of Health, FL Health. (2015). County-State Profile St. Johns County, Florida

2015. Retrieved from

http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.Cou

ntyStateProfile

Heckman, G. A., Boscart, V. M., D'Elia, T., Kelley, M. L., Kaasalainen, S., McAiney, C. A., . . .

McKelvie, R. S. (2016). Managing Heart Failure in Long-Term Care:

Recommendations from an Interprofessional Stakeholder Consultation. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/27917754

Osborn, K. S., Wraa, C. E., & Watson, A. B. (2010). Medical-Surgical Nursing: Preparation for

Practice (Second ed.). Boston: Pearson.

St. Johns County Government. (n.d.). Retrieved from

http://www.sjcfl.us/EconomicDevelopment/Employers.aspx#.WUQICWjyvDd

Uchmanowicz, I., Wleklik, M., & Gobbens, R. J. (2015, May 18). Frailty syndrome and self-

care ability in elderly patients with heart failure. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/26028966
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