Professional Documents
Culture Documents
Michael Sandin
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
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
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
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
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
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).
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
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
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
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
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
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 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
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.
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
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
population, giving me the tools to look at populations I may deal with on a daily basis, and using
References
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
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., . . .
https://www.ncbi.nlm.nih.gov/pubmed/27917754
Osborn, K. S., Wraa, C. E., & Watson, A. B. (2010). Medical-Surgical Nursing: Preparation for
http://www.sjcfl.us/EconomicDevelopment/Employers.aspx#.WUQICWjyvDd
Uchmanowicz, I., Wleklik, M., & Gobbens, R. J. (2015, May 18). Frailty syndrome and self-
https://www.ncbi.nlm.nih.gov/pubmed/26028966
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