Running head: CARDIOVASCULAR DISEASE IN POLK COUNTY

Cardiovascular Disease in Polk County

Janelle Gosch
University of South Florida

Cardiovascular Disease in Polk County

Imagine a society in which all people live long and healthy lives. To accomplish this,
citizens must be informed of the determinants of health, disease, disability and the opportunities
for progress. Then a plan to engage multiple sectors to take actions to strengthen policies and

CARDIOVASCULAR DISEASE IN POLK COUNTY

improve practices that are driven by the best available evidence and knowledge should be put in
place (Healthy People, 2015). The purpose of this paper is to identify health needs or risk of Polk
County and evaluate how these needs or risk relate to leading health indicators and social
determinants of health. Also to examine the three levels of prevention as they relate to Polk
County and develop a policy to address the health needs of Polk County using current research,
data, and evidence-based guidelines.
Geographic Location, Population, Socioeconomic Factors
Named after James K. Polk, the 11th president of the United States, Polk County is
located in the heart of central Florida. It is approximately midway between Tampa and Orlando
along Interstate 4 and runs down US route 27 to the edge of Frostproof. With 2,010 square miles
of acreage and water, Polk is the fourth-larges county in the state of Florida and the largest
county north of the Everglades. It is bigger than the state of Rhode Island and equal in size to
Delaware (The Central Florida Scorecard, 2012). Polk Countys leading employers are Publix
Supermarkets with 10,249 jobs, Lakeland Regional Health formerly known as Lakeland
Regional Medical Center with 4,499 jobs, and GIECO with 2,139 jobs (Central Florida
Department Council of Polk County, Florida, 2015). Along with being one of the top employers
Lakeland Regional Health is also one of the major health care systems in Polk County.
Polk County has both urban and rural sectors throughout which 634,638 people live. Of
those people 79.7% are white, 19.6% Hispanic, and 15.7% are black, incorporating those of
multiple race (United States Census Bureau, 2014). In Polk County the percentage of a language
other than English spoken at home in people older than 5 is 19.2% significantly lower than the
state of Floridas 27.4%. 18.2% of Polks population live below the poverty level which is 1.9%

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higher than the state of Floridas 16.3%. Polk Countys citizens older than 25 with a high school
degree is 82.4% just shy of the state average of 86.1% (United States Census Bureau, 2014).
Strengths and Weaknesses
Based on the research conducted on the county health profile, Polk County has several
health indicators that can be analyzed as either a strength or weakness in the population.
Three Health Indicators that Demonstrate Strengths in Polk County
A great strength in Polk County would be the improved maternal and child health. Polk
County had less low birth weight and premature births compared to the state of Floridas rate for
low birth weight and premature birth. The county records showed 8.2% of the births were low
birth weight compared to Floridas average of 8.6%. Polks preterm birth percentage was 12.6 to
Floridas 13.9% (Florida Department of Health, 2013).
Immunizations are important in preventing serious diseases and in some cases death in
our country. Polk County was successful in having 96.2% of their kindergarteners fully
immunized before starting school. This was far greater then the state percentage of 92.6 (Florida
Department of Health, 2013).
Suicide, or the act of causing ones own death, is a major health concern in America. Polk
County has a lowered their rate of suicide related death to 12.3 per 100,000 compared to
Floridas average of 13.8 per 100,000 (Florida Department of Health, 2013). Thus being seen as
a strength in the health of Polk County.
Three Health Indicators that Need improvement in Polk County

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A health indicator that poses as a weakness for Polk County would be the increase in
gonorrhea and chlamydia cases being reported. Chlamydia being reported in 417.1 per 100,000
in Polk County compared to 409.8 in Florida (Florida Department of Health, 2013). Sexually
transmitted infections pose a greater threat to the population because they do not always cause
symptoms causing further spread of the diseases.
Polk County has also seen a rise in adults being diagnosed with diabetes and deaths
associated with diabetes. The rate of adults diagnosed with diabetes in Polk County was 14.2%
compared to the 10.4% of Florida (Florida Department of Health, 2013). An increase in diabetes
would be seen as a weakness in Polk County, diabetes has been known to cause other
complications including nerve damage, kidney disease, retinopathy, and cardiovascular disease.
As of 2013, Polk County has some of the highest rates of coronary heart disease, heart
failure, stroke, hypertension, and high blood cholesterol levels according to the Florida
Department of Health. The number of people per 100,000 who died from coronary heart disease
was 121.7 in Polk County compared to Floridas 102.5 (Florida Department of Health, 2013).
Hospitalization rate for coronary heart disease was 401.5 per 100,000 (Florida Department of
Health, 2013). The number of people who died from stroke was 35.5 per 100,000 in Polk
County compared to 31.3 in Florida (Florida Department of Health, 2013). 12.0 people per
100,000 who died from heart failure in Polk County compared to the states 9.7 (Florida
Department of Health, 2013). 36% of residents in Polk County were diagnosed with
hypertension, which is higher than Floridas average rate of 34.3% (Florida Department of
Health, 2013). There is no doubt that cardiovascular disease is a major issue in Polk County and
is a health issue that need to be focused on.
Priority Health Issue

CARDIOVASCULAR DISEASE IN POLK COUNTY

A major weakness reported in Polk County is the health indicator of cardiovascular

disease. As recorded above the rate of deaths and diagnoses of coronary heart disease, heart
failure, stroke, hypertension, and high blood cholesterol levels according to the Florida
Department of Health are higher than the state average. This is a priority health issue because is
effects the most amount people in the community. The county health profile also indicated that
obesity in Polk County is 37.6% that is more than 10% higher than the state of Floridas average
27.2% (Florida Department of Health, 2013). This being one of many risk factors for
cardiovascular disease that can be modified with education and support. Cardiovascular disease
in Polk County is a significance health concern and will be the focus of this paper.
Community Health Models
Determinants-of-Health Model
A determinants of health model can be used to assist a community health nurse become
informed on steps that can be taken to improve a populations well-being and quality of life.
Health services, physical environment, social environment, individual behavior, biology, and
genetics are all determinants of health. Changes to these determinants produce specific outcomes
that include positive behavior change, reduction in disease, condition, and risk factors, and
increased health equity and reduced health disparities.
Cardiovascular disease is a destructive disease that can be caused by increased
cholesterol levels, hypertension, and diabetes. However cardiovascular disease is also caused by
modifiable risk factors including poor diet and exercise, cigarette smoking, and obesity (Centers
for Disease Control and Prevention, 2015). Many lifestyle habits begin during childhood. Parents
and families should encourage their children to make heart healthy choices, such as following a
healthy diet and being physically active. Along with making following a healthy lifestyle a
family goal it should also be a community goal. The environment should encourage healthy

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behaviors and be able to provide affordable nutrition to citizens through farmers markets and
public gardens. Health Systems should be able to provide more information and support in the
prevention of cardiovascular disease. Health care offices could provide free blood pressure
screenings as well as teaching people to check at home.
Population Diagnosis
Although African Americans, Whites, and Hispanics all have cardiovascular disease
ranked as their leading cause of death (Centers for Disease Control and Prevention, 2015). This
population diagnosis will focus on African Americans in Polk County are at increasing risk of
cardiovascular disease due to lifestyle choices such as smoking and diet and lack of education
and compliance. 23.8% of all deaths of African Americans are caused by heart disease (Centers
for Disease Control and Prevention, 2015). Also death rates due to heart disease are highest in
the southeast of the United States (Centers for Disease Control and Prevention, 2015).
Community Based Intervention
Primary Level of Prevention
Primary prevention aims to prevent a disease or injury before it occurs (Institute for Work
& Health, 2015). The level of recipient for this level of prevention would be system-wide. For
cardiovascular disease, this can be done by preventing exposures to hazards that cause the
disease, such as smoking. Legislation and enforcement can ban the use of cigarettes inside and
around children. Primary prevention can also be done by altering unhealthy or unsafe behaviors
that can lead to heart disease, such as becoming more active and eating healthier foods. Public
parks can offer fitness programs to promote a more active and healthy lifestyles for community
residents. Education can be provided by the community nurse and health care providers to the
residents about the risk factors for heart disease and the benefits to living a healthier life.
Communities may set up farmers markets, which make getting fruits and vegetables more

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affordable and easier to access. The stakeholders toward whom the intervention is geared would
be community members, public officials, legislators, health care providers, and funding sources.
Secondary Level of Prevention
Reducing the impact of a disease or injury that has already occurred is the goal of
secondary level of prevention (Institute for Work & Health, 2015). In regards to cardiovascular
disease the level of recipient would be the individual. By detecting and treating heart disease as
soon as possible, health care providers may be able to halt or slow its progress. Management of
heart conditions such as atherosclerosis, heart failure, stroke, hypertension and atrial fibrillation
are frequently evolving and providing better outcome for those suffering from cardiovascular
disease. Through the use of pharmaceuticals including statins, antihypertensive agents,
anticoagulation therapies and thrombolytic, to the use of cardiac imaging and surgical
interventions, healthcare providers have been able to successfully accomplish secondary level of
prevention (Dizon et al., 2013). The stakeholders toward whom this secondary intervention is
geared is health care providers, community members, family members and friends for support.
The community health nurse should encouraging personal strategies to prevent recurrence of
cardiac events such as heart attack or stroke. The community health nurse can also implementing
programs to return community members to their original health and function to prevent longterm problems.
Tertiary Level of Prevention
Tertiary prevention involves alleviating the impact of an ongoing illness or injury that has
lasting effects (Institute for Work & Health, 2015). The level of recipient for this level of
prevention would be community. The community health nurse would implement this level of
prevention by helping people manage long-term care of cardiovascular problems in order to
improve their ability to function, their quality of life and their life expectancy. A cardiac

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rehabilitation program would be available to community members to help promote physical

activity, improve diet habits, and smoking cessation. As well as in person this intervention could
be incorporated in an online program for easier access. Brennan et al., (2011) used this
technology enhanced practice, the interactive technology tools on their website address many
topics like education about disease, medication, and dietary tools. A website can offer symptom
monitoring with symptom checklists, weight trackers, blood pressure trackers, or heart rate
trackers (Brennan et al., 2011). A website also offers an easier way of communication between
nurse and patient when deciding goals, writing journals, and updating bulletin boards. This
intervention would also offer support groups that allow members to share strategies for living
well. The community health nurses role throughout this intervention would be to ensure
compliance of the program by monitoring community members attendance and treatment
effects. The stakeholders geared toward this intervention are community members, public
officials, health care providers, and funding sources. Members participating in the rehabilitation
program should be able to prevent further negative impact on their health and be able to live
longer healthier lives.
Health Policy Proposal
Public health nurses dedicate themselves to the health and well being of the
communities they serve by educating them in beneficial health practices and disease prevention.
But those who have already been affected by disease often see further complications due to
problems with compliance and lack of education. Cardiovascular disease is a major issue in Polk
County and is a health issue that needs to be focused on. With a population diagnosis focusing on
African Americans in Polk County diagnosed and at risk of cardiovascular disease, this proposed
health policy would require attendance to a cardiac rehabilitation program after discharge from
hospital from cardiac related event. As well as offer an optional program to prevent

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cardiovascular disease open to the public but strongly encouraged for people at higher risk for
developing cardiac disease and family members related to anyone affected by cardiovascular
disease. The goals of this health policy would be to improve outcomes for community members
previously besieged with cardiovascular disease by either reducing occurrence of another cardiac
event, lowering cholesterol levels, maintaining weight within normal BMI level, controlling
hypertension, etc. Overall, improving community health and increasing access to care.
Stakeholders affected by proposed health policy community members, public
officials, health care providers, and funding sources. Supporters would be the community
members affected by cardiovascular disease and family, friends, and neighbors interested in
getting involved with program. Supporters can spread the word of the health policy and increase
support across the county and state. Opposing forces of the proposed health policy would be the
related to the funding of the program and facilities needed to run the program.
Advocacy and social marketing will also be used to influence the population of
interest and the first steps to policy development (Truglio-Londrigan & Lewenson, 2013). After,
identifiying a problem, goals, objectives, and rules must be formulated. The first steps toward
presenting the health policy is effective communication. The importance and potential of
preventing heart disease must be communicated effectively by the public health community to
people of the community, local policy makers, and other stakeholders. This will help gain
supporters and funding. Relevant organizational arrangements and an ample amount of support
are needed to achieve effective collaborations among all major partners and to implement the
plan. Public health agencies must develop the expertise to create and maintain strong
partnerships to advance the agenda for preventing heart disease. This health policy will impact
Polk County greatly by increasing compliance and access to care for members of the community

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dealing with cardiovascular disease. It will enhance population health by reducing hospitalization
and death due to heart disease as well as other comorbidities. The final steps are enforcing and
evaluating the success of the health policy (Truglio-Londrigan & Lewenson, 2013).
Conclusion
Cardiovascular disease is a broad term used to categorize many conditions including
heart failure, stroke, hypertension, arrhythmias and more. It has been the number one cause of
death in Polk County for several years. However many of these problems can are caused by poor
diet, lack of exercise, cigarette smoking, and obesity, which are all preventable. With this
information, cardiovascular disease is a priority health issue that needs to be addressed. With
interventions to prevent, reduce the impact, and alleviate the long-term effects of heart disease,
this health policy was established. A program designed to meet the need of the lower income
people and families dealing with cardiovascular disease. It was established in the hopes that a
reduction in the occurrence of another cardiac event, lowering cholesterol levels, maintaining
weight within normal BMI level, controlling hypertension, and so on would be evaluated.
Overall, improving the general community health, increasing access to care for the community,
and creating a society in which all people live long and healthy lives.

References

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Brennan, P. F., Casper, G. R., Burke, L. J., Johnson, K. A., Brown, R., Valdez, R. S., Sturgeon,
B. (2011). Technology enhanced practice for patients with chronic cardiac disease home
implementation and evaluation. Heart & Lung: The Journal of Critical Care, 39(6), 3446. http://doi.org/10.1016/j.hrtlng.2010.09.003.
Centers for Disease Control and Prevention. (2015). Heart disease. Retrieved from
http://www.cdc.gov/heartdisease/facts.htm.
Central Florida Development Council of Polk County, Florida. (2015). Top employers in polk
county, fL. Retrieved from http://cfdc.org/Data-Research/Top-Employers.aspx.
Dizon, L.A., Seo, D.Y., Kim, H.K., Kim, N., Ko, K.S.,Rhee, B.D., Han, J. (2013). Exercise
perspective on common cardiac medication. Integrative Medicine Research, 2(2), 49-55.
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Retrieved from http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=
1341&County=53&year=2013&tn=24.
Healthy People. (2015). Introducing healthy people 2020. Retrieved from
http://www.healthypeople.gov/2020/About-Healthy-People.
Institute for Work & Health. (2015). What researchers mean by primary, secondary, and tertiary
prevention. Retrieved from http://www.iwh.on.ca/wrmb/primary-secondary-and-tertiaryprevention.
Truglio-Londrigan, M. & Lewenson, S. (2013). Public health nursing: Practicing populationbased care. Burlington, MA: Jones & Bartlett Learning.
Mobilizing for Action through Planning and Partnership. (2012) Polk county, florida. Retrieved
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The Central Florida Scorecard. (2012). Fun facts. Retrieved from

http://www.myregion.org/index.php?
submenu=PolkCounty&src=gendocs&ref=PolkCounty&category=Collaboration.
United States Census Bureau (2014). Polk county, florida. Retrieved from
http://quickfacts.census.gov/qfd/states/12/12105.html.
Weisfeldt, M.L., & Zieman, S. J. (2007). Advances in the prevention and treatment of
cardiovascular disease. Health Affairs, 26(1), 25-37. doi: 10.1377/hlthaff.26.1.25.