Running Head: HAMILTON COUNTY INTERVENTIONS

Hamilton County Interventions

Paige Stevens FHT/Fall 2014/UD
University of South Florida

Hamilton County Location Data

Hamilton County Interventions

Hamilton County is located in Central Indiana. Hamilton is technically urban, but it is

often considered suburban by the members that live within. The population is currently 302,623
people in Hamilton, making up 4.6% of Indiana (STATSIndiana, 2014). Three of the major
employers of Hamilton County consist of retail at 10.5%, health care and social services at 9.8%,
and professional technical services at 9.1%. These three employers make up the top 29.4% of
private employment. Private employers structure 92.3% of Hamilton Countys workforce
(STATSIndiana, 2014). The health care systems of Hamilton contain public health nursing, health
education programs, environmental health, and public health preparedness (Government of
Hamilton County Indiana, 2012). Indiana is also known for their top performing hospitals. Many
of the hospitals that have elevated profit and outcome are located in Hamilton County. Those
hospitals are Indiana Orthopedic Hospital, St. Vincent Carmel Hospital, and Indiana University
Health (Wall, 2014).
Population and socioeconomic factors
The poverty rate in Hamilton County is at 5.5% as of 2013 (STATSIndiana, 2014). The
Indiana average poverty rate is 15.8%, which is only 0.8% above the national average poverty
rate (STATSIndiana, 2014). The poverty rate among children under 18 is at 6.1% in Hamilton
with is substantially lower than the Indiana average of 21.9% (STATSIndiana, 2014). Hamilton
County only makes up 0.7% of the 11,711 citizens that receive Welfare in Indiana. This
concludes that the majority of the Hamilton population is financially sound. As the poverty and
welfare rate are fairly low in Hamilton County, the high school graduation rate is the opposite.
With a graduation rate of 96.3%, Hamilton County is 9% higher than the Indiana average
(STATSIndiana, 2014). The statistics for high education rate and low poverty rate seem to match
because the citizens have the chance to grow in the workforce provided that they already have an

Hamilton County Interventions

education. The rate of B.A. or higher is at 55.1% in Hamilton, as well (STATSIndiana, 2014).
Since citizens have the financial means to send their children to college, the cycle continues as

their children are able to graduate from college and afford health care and essentials perpetuating
the low poverty rate. With 88.5% of the Hamilton County population considered Caucasian, there
is very little diversity among race (STATSIndiana, 2014). The other top two races in Hamilton
are Asian at 5.4% and African American at 4.0% (STATSIndiana, 2014). The Caucasian
percentage for Hamilton is only 2 percent higher than the State average and the African
American percentage rises to 9.5% (STATSIndiana, 2014). With such a low percentage of other
races and nationalities in the county, ethnic disparities may often be an issue. Below will explain
the strengths and weaknesses of Hamilton County, Indiana. By identifying what can be done to
enhance the assets of Hamilton County, a policy will be stipulated to provide further
interventions to continue the increase in positive health care statistics.
Strength Analysis
Hamilton County has multiple health strengths and top performing categories. Low
premature death rate, low physical inactivity, and low preventable hospital stays are just a couple
of the categories that are considered beneficial to the community. Because health care is highly
accessible in Hamilton County, the premature death rate is very low, creating a higher life
expectancy. Hamilton County has 3,931 per 100,000 years of potential life lost before age 75
(County Health Rankings & Roadmaps, 2015). That is 3,597 years less than the Indiana average,
which is almost half the state average (County Health Rankings & Roadmaps, 2015). Along with
accessibility come financial means. Hamilton County has an average household income of
$84,022 and only 10% of Hamilton County citizens under the age of 65 are uninsured
(STATSIndiana, 2014). With these statistics, it is proven that most members of the community

Hamilton County Interventions

are able to receive and afford the health care needed. The low percentage of physical inactivity
age 20 and up is a strength in the community because the average percentage of U.S. citizens
who claim to partake in no leisure physical activity is 25%, 2 percent lower than Indianas
average (County Health Rankings & Roadmaps, 2015). At 18% of physical inactivity, Hamilton
County is considered one of the top performers in the nation (County Health Rankings &
Roadmaps, 2015). Physical inactivity can increase a clients chance of coronary artery disease,
obesity, and even depression (Centers for Disease Control and Prevention, 2015). With these
health risks in mind, increasing a populations activity can then decrease preventable hospital
stays. Another strength of the Hamilton County population is the number of preventable hospital
stays related to ambulatory-care sensitive conditions. At a number of 44 per 1,000 Medicare
enrolled clients, Hamilton ranks much lower than the national average of 60 per 1,000 clients

and the Indiana average of 70 per 1,000 (County Health Rankings & Roadmaps, 2015). As health
literacy is beginning to be acknowledged as a growing problem related to recurrent hospital
admissions in the United States, Hamilton Countys education rate continues to grow. With a
96.3% high school and/or college graduation rate, the Hamilton population has shown its value
of education (STATSIndiana, 2014). With a well-educated population comes a further
understanding of medical care and its importance.
Weakness Analysis
Though there are not as many weaknesses as strengths in the community, there are still a
couple significant weaknesses in Hamilton County. High alcohol-impaired driving deaths, high
average daily density of fine particulate matter, and high percent of workforce that drives alone
or far distances are the main three weaknesses of the county. The county percentage of alcoholimpaired driving deaths is 10 percent higher than the state average of 26% (County Health

Hamilton County Interventions

Rankings & Roadmaps, 2015). This is considerably higher than even the national average of
30.8% (County Health Rankings & Roadmaps, 2015). The availability of alcohol may not be as
much of a factor as the increased income rate. Since citizens are able to afford alcohol,
consumption rates often rise with salary. This is a definite weakness of the county because even
those under the age of 21 are at a higher risk for being involved in a vehicular accident if
someone on the road is driving under the influence. Since 85% of Hamilton workforce drivers
ride alone and 43% travel more than 30 minutes to work, this can contribute greatly to the high

average daily density of fine particulate matter in the air (County Health Rankings & Roadmaps,
2015). With an average of 13.5 micrograms per cubic meter, Hamilton is 2.5 PM2.5 greater than
the Indiana average (County Health Rankings & Roadmaps, 2015). These three statistics are
weaknesses because not only will air pollution create health issues, but with the increase of cars
on the road and mileage comes a decrease in our dwindling quantity of oil.
Priority Health Issue
Though the percentage of inactive citizens age 20 and up is at 18%, Hamilton County
should still continue to increase activity levels and create a more active environment (County
Health Rankings & Roadmaps, 2015). Hamilton County currently acts as a top performer in this
category and should continue their great achievement to show how small changes can better a
community. As mentioned before, physical activity can benefit a person beyond weight loss.
Exercise can decrease a clients chance of coronary artery disease, diabetes, hypertension,
asthma, and even depression (Centers for Disease Control and Prevention, 2015). By increasing
the overall activity of Hamilton County, hospital stays will in return decrease due to reduced
preventable stays related to ambulatory care.
Determinants-of-Health Model

Hamilton County Interventions

The Determinants-of-Health Model uses four different aspects that determine individual
and population based health care. Those factors include human biology, health system,
environment, and lifestyle. Most interventions that are successful use more than one of these
elements to reach beyond conventional health care (Office of Disease Prevention and Health
Promotion, 2015).
Human Biology
Beginning with human biology as the first factor to consider when addressing a
population based health issue. Genetics can affect any health topic including that of physical
activity. Since genetic make up is determined by family history, DNA regulates sex, ethnicity and
disorders or mutations (Office of Disease Prevention and Health Promotion, 2015). Human
biology affects physical activity because a person could be physically or mentally. Their physical
activity would be reduced to what they are able to do, even if it is limited to a chair or bed.
Physical activity would be beneficial to both cases, but may be moderated compared to a mid20s college student.
Health system
A health care system can strength or weaken an individuals outcome. Access and quality
are two major elements to consider when creating interventions regarding physical activity and
health care (Office of Disease Prevention and Health Promotion, 2015). Some clients may not be
able to reach their doctors office as often as they are scheduled because they lack the means of
travel. In this case, a clinic closer to the client should be offered. As far as quality goes, every
employee in the health care system should treat each client with respect and understanding.
Encouraging clients to continue to come to their appointments and keep up physical is necessary
to increase over all activity.

Hamilton County Interventions

Environment
Environmental determinants can affect a persons ability to stay active. Whether its the
weather, location, or social support, environment can play a key role in whether or not a client

decides to exercise (Office of Disease Prevention and Health Promotion, 2015). Maybe the client
is unable to reach a gym. The community nurse should then offer activities that can be done
within the home or near the home. Social support can make or break a persons drive to exercise.
If they are embarrassed or feel a burden to their family, they need encouragement to continue to
exercise to their ability.
Lifestyle
Lifestyle is the last factor in the Determinants-of-Health Model (Office of Disease
Prevention and Health Promotion, 2015). A persons lifestyle can limit if the client wants to
exercise or not. The community nurses job is to help the client change their lifestyle into an
active one. Giving ideas for easy workouts to start off with can help ease the client into this new
routine.
Population Diagnosis
The population of Hamilton County is at a decreased risk of obesity, diabetes, and
hypertension as evidenced by the low percentage of inactive citizens age 20 and above (Centers
for Disease Control and Prevention, 2015). Choosing the low percentage of physical inactivity as
a positive diagnosis will create interventions that advance the decrease in percentage of Hoosiers
that are inactive. The three levels of prevention will combine the factors of the Determinants-ofHealth Model to create interventions that will benefit the majority of the population and continue
to increase the activity level in Hamilton County.
Primary Prevention

Hamilton County Interventions

At the primary level of prevention it is essential to create interventions that prevent a

problem before any symptoms or signs are present. The key is to prevent it from happening in the
first place. Providing exercise units at workforce companies and employers using incentives in
the continuation of an active lifestyle are two interventions that are at the primary level of
prevention. These interventions are at a community level, providing for the workforce
community. Increasing physical activity has been proven to lower a clients chance of
cardiovascular disease, diabetes, and even strengthen bones (Centers for Disease Control and
Prevention, 2015). If companies were willing to invest in their employees health status, the
community could greatly gain from these assets.
By adding a gym or exercise center at large corporations, employees would have the
ability to stay active. Convenience is everything and many adults do not exercise due to lack of
time or accessibility. By installing the facility in-house, employees drop travel time. Employers
can also encourage physical activity by creating an online log of time-spent active. Employees
that are in the top percentile of physical activity at the company could be entered into a raffle for
a prize. Another option is to provide discount on equipment that promotes physical activity such
as a Fitbit or Life Tracker.
Though financially these seem like a lot to take on for a company, employee health can
make a huge change in outcome. Less sick days, less hospital stays, and lower health bills are
only a couple of the benefits of increasing physical activity. These interventions affect
community members in the workforce and funding sources. Funding sources would be crucial
because exercise equipment and space for a gym and locker rooms can be expensive.
Secondary Prevention

Hamilton County Interventions

The secondary level of prevention aims to lessen the impact of a disorder that has already
occurred (Institute for Work & Health, 2015). Prevention is done by treating and monitoring the
disorder. At this stage, it may still be possible to return the client to their original health by
implementing interventions (Institute for Work & Health, 2015). Physical inactivity as the
problem, implementing education programs and monitoring clients physical activity per week,
BMI, blood pressure, and blood glucose are secondary interventions that are community based.
Hamilton County can set up monthly community meetings were citizens are able to get
their BMI, blood pressure, and glucose monitored. Along with monitoring, an educational
presentation will be provided to the group on how to stay active and personal questions will be
answered after the presentation. The monitoring will require donation funds for blood pressure
and glucose machines. Nurses can also donate their time to perform the tasks of monitoring. If
the nurse were to find an outstanding number for any of the items being examined, they are to
explain to the patient the concerning number. The nurse is to then send the client to the hospital
for treatment. Community members, funding, and health care providers are all necessary for this
intervention to work. After the client is sent to the hospital for treatment, the community nurse
comes back into play. The nurse teaches the client on how to lower their number of BMI, blood
pressure, or glucose and provides assistance on lowering the number.
Tertiary Prevention
The tertiary level of prevention targets to lessen the impact of a chronic or ongoing
problem. These interventions are implemented in order to improve, as much as possible, the
clients ability to function, quality of life, and life expectancy (Institute for Work & Health,
2015). An intervention that is pertinent to this category includes teaching clients how to work
around obstacles. Obstacles incorporate such things as wheelchairs or mental disabilities. Clients

10

Hamilton County Interventions

that are wheelchair bound or mentally impaired are prone to gain weight due to their limitation of
activity. This intervention is received through a group process but is specific to individual.
Activity groups can be created that are open to physically and/or mentally disabled clients to
teach them how to exercise around obstacles such as a wheelchair or dementia. Mentally disabled
clients may not be aware their level of physical activity is insufficient; so starting slow on
activity level and building up strength is key to these clients. Rehabilitation is also an option, if
applicable. All of these clients are to remain attending their physicians regularly. The doctor
should monitor treatment effects or consequences. With the interventions comes involvement of
community members, health care providers, and donations or funding.
Policy Proposal
For the Hamilton County population, the secondary intervention would be most
beneficial as a health policy for the current population. This proposal will contain a policy in
which Hamilton County will set up a monthly community drive were citizens are able to get their
BMI, blood pressure, and glucose monitored, along with educational services related to physical
activity. By providing this sort of health service, the population physical inactivity percentage
should decrease by at least 2 to 3%. By increasing physical activity, the population in return
decreases the rate of coronary artery disease, obesity, and diabetes (Centers for Disease Control
and Prevention, 2015). For this proposal, community members, public officials, health providers,
and funding sources will all be required. Community members will partake in the event by being
screened and offering donations to continue the event in the future. Health care providers will
either donate their time to assist with screening or education the member of the community.
Funding will provide mobile services, equipment, and health officials that make the event

11

Hamilton County Interventions

possible. Public officials will view this proposed policy and source available funding in the
community budget.
Supports of the policy are community members, health officials, and teachers. These
members influence the decision because the health providers are able to find mobile equipment
for screening, as well as donate time. Community members can vote for the public official that
has similar viewpoints, hopefully voting in favor of this policy. Opposing forces include those
who have to financially support the policy and public officials in charge of budgeting. These
members can play a great role against the policy because more money out of the pocket often
gets declined. The policy plan will start with taking a poll of the general population if they
believe the policy is beneficial and if they would participate. Then, finding companies or
businesses to donate to the cause will help due to less money needing to be spent. Finally,
contacting hospitals in the area if they have available equipment or members who are able to

donate time will be a good start. This policy will address all members of the population because
it is a mobile event that can change venue every month, giving everyone a chance to be screened
and educated.
Conclusion
Targeting physical inactivity as a strength and positive diagnosis for Hamilton County
provides the community with multiple interventions using the Determinants-of-Health Model.
Focusing on the secondary prevention, the community will have the option of creating a mobile
clinic that provides BMI, blood pressure, and glucose monitoring. Funding and volunteers are
necessary for this policy, but this health proposal will help reduce physical inactivity and
multiple diseases that are often associated with minimal exercise.
Resources

Hamilton County Interventions

12

Centers for Disease Control and Prevention. (2015). Physical Activity and Health. Retrieved June
20, 2015, from http://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
County Health Rankings & Roadmaps. (2015). Indiana: Hamilton. Retrieved June 23, 2015 from
http://www.countyhealthrankings.org/app/indiana/2015/rankings/hamilton/county/factors/
overall/snapshot
Government of Hamilton County Indiana. (2012). Health Department. Retrieved June 20, 2015
from https://www.hamiltoncounty.in.gov/department/index.php?structureid=17
Institute for Work & Health. (2015). What Researchers Mean ByPrimary, Secondary and
Tertiary Prevention. Retrieved June 24, 2015, from http://www.iwh.on.ca/wrmb/primarysecondary-and-tertiary-prevention
Office of Disease Prevention and Health Promotion. (2015). Determinants of Health. Retrieved
June 23, 2015, from http://www.healthypeople.gov/2020/about/foundation-healthmeasures/Determinants-of-Health
STATSIndiana: Indianas Public Data Utility. (2014). Hamilton County, Indiana. Retrieved June
20, 2015 from http://www.stats.indiana.edu/profiles/profiles.asp?
scope_choice=a&county_changer=18057&button1=Get+Profile&id=2&page_path=Area
+Profiles&path_id=11&menu_level=smenu1&panel_number=1
Wall, J.K. (2014). Top 10 most profitable hospitals around Indianapolis. Indianapolis Business
Journal. Retrieved June 20, 2015, from http://www.ibj.com/blogs/12-thedose/post/46756-top-10-most-profitable-hospitals-around-indianapolis