Running head: HEALTH POLICY PAPER 1

Health Policy Paper: Polk County, Florida

Courtney P. Whyte

University of South Florida

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Health Policy Paper: Polk County, Florida

It is important to address major health outcomes in order to help improve the health of the

people. For Polk County one of the major health issues is the number of newly diagnosed cases

of chlamydia. This paper will give an overview of Polk County, strengths and weaknesses in

regards to health outcomes in Polk County, the three levels of prevention in relation to

chlamydia, as well as a proposed healthy policy to address the rising number of newly diagnosed

chlamydia cases.

Overview of Polk County

Polk County is located in the central part of Florida, and is the fourth largest county by

size, with Polk County accounting for approximately 1,800 square miles of Florida’s total size of

around 53,600 square miles (United States Census Bureau [USCB], 2010). Polk County is home

to approximately 666,000 residents, and around 13.5 percent of those residents live in a rural

area (County Health Rankings & Roadmaps [CHR&R], 2018). In Polk County the top three

employers are Polk County School Board, Publix Super Markets, and Lakeland Regional Health

(Central Florida Development Council [CFDC], 2018). Polk County School Board employs

13,000 individuals, Publix employs 11,721 individuals, and Lakeland Regional Health employs

5,605 individuals. (CFDC, 2018). Polk County has five major medical centers, Lakeland

Regional, Watson Clinic, and Winter Haven hospital being the three largest; Lakeland Regional

Health is the fifth largest hospital in Florida, and has the busiest emergency room in Florida.

(CFDC, 2019).

Comparison of Local vs. State Populations

In Polk County, approximately 16 percent of the residents are living in poverty, which is

two percent higher than that of Florida’s average of 14 percent (USCB, 2017).When comparing
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the percent of the population of those 25 years and older who have graduated high school, the

state percent is approximately 88 percent compared to Polk County’s 84 percent. In Polk County,

around 21 percent of the population ages five years and older speak a different language than

English at home, whereas for Florida that percent is higher, at nearly 29 percent. (USCB, 2017).

In Polk County, there are a total of 318 primary care physicians for the county, as of data

published in 2015 (CHR&R, 2015). The ratio of population to primary care physicians in Polk

County is 2,040:1 (CHR&R, 2015). In Florida the ratio of population to primary care physicians

is 1,380:1 (CHR&R, 2015).

Analysis and Interpretation of Data

Every county in the United States has strengths and weaknesses when it comes to health

outcomes and health factors for those living in that county. This information can be found on the

County Health Rankings & Roadmaps. This next section will analysis the strengths and

weakness of the health outcomes and health factors in Polk County as well as the impact that the

weaknesses have on the population.

Identified Strengths

When comparing statistics in Polk County to those of the state average and in some cases

the national average, three areas where Polk County is better or is showing improvement is, the

percent of women who receive mammography screenings, the incidence rate of motor vehicle

crashes, and the percent of the population who report being excessive drinkers. Polk County’s

average for those who receive mammography screenings is higher than the state average but less

than the Top U.S. Performers; the average for Top U.S. Performers is 71%, followed by Polk

County at 69%, and then the average for the state of Florida at 68% (CHR&R, 2014). Polk

County has a lower incidence rate of motor vehicle crashes compared to the state of Florida. For
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Polk County the rate per 100,000 population is 1,523.3, whereas for Florida it is 1,955 per

100,000 (Florida Department of Health [FLDH], 2016). In comparison to the state of Florida,

Polk County’s percent of those who reported being excessive drinker is lower that the state

average. Excessive drinking is considered binge drinking or heavy drinking (Centers for Disease

Control and Prevention [CDC], 2018). Binge drinking for women is considered as drinking 4 or

more drinks on occasion and for men it is drinking 5 or more (CDC, 2018). Heavy drinking for

men is considered drinking 15 or more drinks per week for and for women it is drinking 8 or

more drinks per week (CDC, 2018). For Polk County, 15% of the population report being

excessive drinkers, whereas for Florida the average is 18%, and the Top U.S. Performers is 13%,

(CHR&R, 2016).

Identified Weaknesses

In comparison to state and national data, Polk County definitely has some areas for

improvement when it comes to health outcomes. Three of these areas are: teen birth rate,

sexually transmitted infections (STI’s), specifically the number of newly diagnosed cases of

chlamydia, and the percent of adults that are obese. The teen birth rate in Polk County is worse

than the state average and the Top U.S. Performers average. The number of births per 1,000

females ages 15-19 is 36 in Polk County, 25 for the state of Florida and 15 for the Top U.S.

Performers (CHR&R, 2016). Adolescents have a higher rate of poor birth outcomes such as

premature births and low birth weights (McCracken & Loveless, 2014). The number of newly

diagnosed cases of chlamydia per 100,000 population is substantially higher in the state of

Florida, especially in Polk County. In Florida the rate is 454.8 per 100,000, in Polk it is 482.3 per

100,000 compared to the Top U.S. Performers average of 145.1 per 100,000, (CHR&R, 2015).

Repeat infections are in common in those who have had chlamydia before and for women repeat
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infections increases a women’s risk for ectopic pregnancies and pelvic inflammatory disease

(CDC, 2016). Obesity is an issue nationwide, with that Top U.S. Performers averaging at 26%,

the state of Florida at 26%, and Polk County having a higher average at 34% (CHR&R, 2014).

Obesity predispose individuals to other serious health disease and conditions such as stroke,

coronary heart disease, type two diabetes, and hypertension (CDC, 2015).

Identification of a Priority Health Issue

Safe sex practices are very important to be educated upon, but also to put into practice.

From the previous data, in Polk County the teen birth rate and the rate of newly diagnosed cases

of chlamydia are significantly higher than that of the State and National average. The priority

health issue that will be focused on is STI’s but specifically, the rate of newly diagnosed cases of

chlamydia in Polk County. Chlamydia is a common bacterial infection that can be easily treated,

but if left untreated can lead to serious health issues. Untreated chlamydia can lead to a women

having pelvic inflammatory disease (PID) which cause infertility in women, (CDC, 2014). It is

important for both men and women to get tested for STI’s and to use protection during all forms

of sex. Early detection of STI’s helps prevent longer term complications related to undiagnosed

and untreated STI’s as well as condom use helps prevent the transmission of STI’s.

Discussion and Application of Community Health Models

Social determinates of health must be addressed in order to improve ones’ health and

provide an environment to promote good health for all. There are five main components to the

social determinants of health and they are: economic stability, education, social and community

context, health and health care, and neighborhood and build environment (Healthy People 2020,

2019). Economic stability, education, and health and health care are three determinates that relate

to sexually transmitted infections (STIs). Most STIs can be prevented by the proper use of
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condoms. If one doesn’t know how to properly use condoms or cannot afford condoms then STIs

can easily be transmitted to many (CDC, 2013). Most STIs can also be easily treated but with a

lack of accessibility or insurance to see a doctor, STIs can be left untreated for months and can

cause further complications (Healthy People 2020, 2019). These factors need to be addressed in

order for change in health to occur.

Population Diagnosis

Adolescents and adults, especially those ranging from 15-24 years of age are at higher

risk of contracting chlamydia due to increased risk factors such as unprotected sex, multiple sex

partners, and new sexual partners.

Population-based Interventions

In Polk County, the rate of newly diagnosed cases of chlamydia is worse than the national

average, and is trending upwards (CHR&R, 2015). Chlamydia is a sexually transmitted infection

(STI) that can be prevented through condoms and safe-sex practices, and can also be easily

detected and treated (CDC, 2016). Primary prevention is focused on preventing disease,

secondary prevention is focused on screening and treatment of disease and tertiary is focused on

preventing further complications of the disease.

Primary Level of Prevention

One way to prevent from getting a STI, specifically chlamydia is the use of condoms

during all forms of sexually activity. In New York City, the Department of Health and Mental

Hygiene (DOHMH) launched The Free Condom Initiative with the goal of increasing condom

acquisition and use within their community (Renaud et al., 2009). This program was launched in

2005 and from 2004 to 2006 the DOHMH increases their distribution of condoms from

approximately six million to approximately 18 million. This program was designed so that
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organizations order condoms online and then received the condom shipment directly from the

manufacturer to distribute out to the community at their respective business or organization. This

program cost the DOHMH slightly above one million dollars but this program was estimated to

save millions of dollars due to infections averted. (Renaud et al., 2009). How this program could

be applied to Polk County would be the implementation of a similar program under the direction

and supervision of the County Health Department. According to CDC, in 2016 individuals

ranging from 15-24 years of age had the highest rate of chlamydia (CDC, 2017). Organizations

and businesses such as County Health Clinics, Polk County School Board, and colleges located

within Polk County would be the focus of marketing for this program. Nurses located at the

organizations and businesses would be responsible for ordering the condoms and distributing

them out, as well as providing education on proper condom technique by demonstration on a

penis and vagina model. The teach-back method should be employed so that individuals can

properly demonstrate condom technique on either a penis or vagina model depending on the

condom used (Calsyn et al., 2010).

Secondary Level of Prevention

Chlamydia is the most commonly reported sexually transmitted infection and is typically

asymptotic in women (LeFevre, 2014). With chlamydia often being asymptomatic it can go

undiagnosed and untreated for a while. Untreated chlamydia can lead to serious complications

later in life such as pelvic inflammatory disease, infertility, and chronic pelvic pain, (CDC,

2014). The USPSTF highly recommends that sexually active women under the age of 24 get

screened and women who are older but at an increased risk get screened as well (LeFevre, 2014).

The USPSTF found adequate evidence that screening tests accurately detect chlamydia and helps

reduce complications of chlamydial infection (LeFevre, 2014). It is important that individuals get
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screened to help prevent further complications of the disease. In Polk County, individuals should

have the opportunity to get screened at regular doctor’s appointments, gynecological

appointments, and at schools. It is important that individuals are educated about risk factors for

chlamydia such as a new sexual partner, multiple sex partners, or engaging in unprotected sex.

Since chlamydia can go undetected it is important that nurses and physicians evaluate patients

for these risk factors. Chlamydia is diagnosed by using nucleic acid amplification tests (NAATs)

and the sensitivity and specificity of this test is very high, creating very accurate test results

(LeFevre, 2014). A program that has been successful in other states is a school-based sexually

transmitted disease screening (SBSS) which provides education, screening, testing, and

counseling to students at their school (Lewis, Dittus, Salmon, & Nsumai, 2016). This program

was estimated to cost approximately $130.00 per student tested. It was mentioned that this is a

cost-effective program as a whole but requires a substantial investment of time and resources

from the provider of such program. (Lewis et al, 2016). A program like this could be very

beneficial to students in Polk County. Polk County Health Department and Medicaid could be

utilized for funding and resources. School nurses could take on the lead role of providing

education to students about safe sex practices and risk factors for chlamydia as well as what to

expect with testing and providing the students with the testing kit. If the students choice to

partake in the screening and test positive, they would then be provided in-school treatment,

counseling, and re-screening.

Tertiary Level of Prevention

In relation to STI’s prevention of re-infection is the aim for tertiary prevention. It is

important that individuals who are diagnosed with chlamydia notify their sexual partners about

their potential exposure and get tested as well (LeFevre, 2014). Those diagnosed with chlamydia
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should follow the treatment regimen prescribed to them and get re-screened. It is important that

re-screening occurs to make sure that the individual is free from infection. If left untreated, or not

completing treatment in its entirety can leave an susceptible to reproductive complications. The

SBSS program offers re-screening in schools, which would be beneficial to this vulnerable

population (Lewis et al., 2016).

Development of Health Policy

Primary level interventions in regards to sexual education are very important and there

are laws mandating sexual education, but there is controversy over what should be taught in

schools: abstinence versus safe sex practices. The Florida Department of Education (FDOE)

requires sexual education be taught in schools with a focus of sexual abstinence as the expected

standard in accordance with Florida State Statute Section 1003.46 (FDOE, 2018). The United

States (U.S.) federal government provides funding to abstinence-only-until-marriage (AOUM)

programs (Santelli et al., 2017). AOUM programs have been found to be ineffective at delaying

the onset of sexual activity, ineffective at changing other sexual risk factors as well as

scientifically and ethically problematic (Santelli et al., 2017).

Acknowledging that adolescents will have pre-marital sex is the first step in changing the

policy in regards to sexual education teaching in schools. A shift from abstinence only education

to prevent unwanted outcomes from sexual activity to education on safe-sex practices can be

beneficial in the prevention of STI’s and unintended pregnancies (Pound, Langford, & Campbell,

2016). Sexual education should still be required to be taught in public schools but with a focus

on safe-sex practices. This would include the implementation of a Free Condom Initiative in

Polk County schools as well as proper education to students on how to effectively use condoms

to prevent the transmission of STI’s and prevent unintended pregnancies. Chlamydia rates are of
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concern amongst adolescents in Polk County, and so is the incident rate of teen births.

Implementing the Free Condom Initiative and proper education has multiple goals with the focus

on improving the sexual health practices and knowledge in adolescents residing in Polk County.

These goals include reducing the number of newly diagnosed chlamydia cases, decreasing the

number of teenage births and the complications that are associated with teenage births such as

low birth weights and pre-term births. Need another sentence

The FDOE should be reached out to first to make a change to their police. Since the

FDOE already has a policy in place in regards to requiring sexual education in public schools an

addendum to that policy stating the transition from abstinence only education to safe-sex

practices could be implemented. The next step would to be contacting the Polk County Health

Department. Since the Free Condom Initiative would provide free condoms to students it is

important to find funding to support this initiative and the goal would be that the funding would

come from the health department. Polk County Health Department would also be in charge of

coordinating with condom companies and distributing the condoms to the schools in the county.

The health department is also in charge of evaluating the effectiveness of the program. This can

be done by collecting and evaluating data in regards to the newly diagnosed cases of chlamydia

as well as the number of teen births after the implementation of this program. The next

population to address would be the nurses and teachers at the public schools. The nurses and

teachers would be the ones in charge of distributing the condoms and providing education on the

proper usage of condoms. It is important the educators present this material and demonstrations

in a safe environment due to the sensitivity of this subject. Condoms should be available in

public spaces such as the nurses office, and specific classrooms and bathrooms so that students
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can have access and don’t have to feel awkward asking for them since that could be a potential

limitation for students using condoms.

Major associations of physicians and public health workers as well as many health

professionals have supported and endorsed comprehensive sexual education (Santelli et al.,

2017). This policy is focused on providing comprehensive sexual education so the hope would

be that these healthcare workers would support the change from abstinence to comprehensive

sexual education in schools as proposed. A group that could possible oppose the proposed change

in policy would be certain religious groups such as Roman Catholics and Muslims. These

religious groups do not condone pre-martial sexual activities and are big supporters of abstinence

until marriage.

Conclusion

Addressing major health issues is important because it relates to health outcomes of the

population. Chlamydia is a health issue that is prevalent in Polk County, Florida so thinking as a

community health nurse it is important to address why it is so prevalent and how to prevent

further infections. Chlamydia can be easily prevented by the proper use of condoms and can be

easily detected and treated, and it is important to get tested frequently due to this infection

typically being asymptomatic and having a high rate of re-infection. Education is a key

component in disease prevention.

While doing my preceptorship in the emergency room (E.R.) at Lakeland Regional

Health in Polk County, at least once a week I was helping take care of a patient who came in due

to either pelvic pain, vaginal or penial discharge or discomfort during sexual activity. It was very

common for the patient to be treated prophylactically for gonorrhea and chlamydia in the E.R.

due to lab results taking a couple of days for diagnosis. One thing that I found that was common
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amongst those visiting the E.R. is a lack of a primary doctor or not being able to get an

appointment soon enough. Something so little like providing teaching about safe sex and free

condoms can make a big impact. For me as a future E.R. nurse, this proposed plan would

hopefully reduce the number of patients who have chlamydia which would then reduce the

number of patients coming to the E.R. for treatment therefore saving time and money as well as

allowing nurses to be able to treat truly emergent patients.

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