Running head: HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

Health Policy Proposal: Hillsborough County, FL

Evidence-based Community Interventions
Shadik Day
University of South Florida

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

Introduction
On analysis of Hillsborough County, is it necessary to identify specific strengths and
needs in order to work towards developing an evidenced based community intervention and
implementing a health policy plan. An understanding of community needs can only be obtained
from an evaluation of local, state and national data surrounding health issues and demographics.
The community needs can then lead to identifying a priority health issue. Once the issue is
identified models like the Determinants-of-Health can then be utilized to develop interventions
surrounding the issue and factors that may contribute to the issue. This model will provide the
foundation to then isolate a priority population diagnosis. Dissecting the problem at hand and
identifying primary, secondary and tertiary level prevention interventions will then lead to the
synthesis of a health policy proposal.
Local, state and national data
As of 2010, Hillsborough County has a population of 1,229,226, with a population
density of 1,082 persons per square mile. In terms of age and gender, 25% are age 18-34 years
and 12% are ages 65 years and older. Of these percentages, 49% of the population is male and
51% of the population. In terms of race and ethnicity 17% of the persons identified as black and
71% white, 3% Asian, 5% some other race and 3% two or more races. The average per capita
income is $27, 282 as of 2011. The poverty status as identified by the federal government is that
85% of persons live at or above the poverty level and 15% live below that level. As of 2014,
137,872 persons receive food stamps and 6,563 persons received cash benefits, this can be
compared to the statistics in 2010 with 127,142 persons and 6,563 persons respectfully
(Hillsborough Community Atlas, 2012). These local statistics can illustrate where Hillsborough
Country measures up in comparison to state and national data. The state of Florida has a

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

population of 18,801,310 and the United States (US) has a population of 308.7 million people
(United States Census, 2010). In terms of age and gender in the state of Florida, 21% are age 1834 years and 17% are ages 65 years and older and for the US, 36.5% and 13% respectfully
(United States Census, 2010). The percentages of the population in terms of sex are 49% are
male and 51% are female, this holds true on a state level as well as a national level. In terms of
race and ethnicity on a state level, 16% of the persons identified as black and 75% white, 2%
Asian, 4% some other race and 3% two or more races (Hillsborough Community Atlas, 2012).
On a national level, 13% of the persons identified as black and 77% white, 5% Asian, and 3%
two or more races (United States Census Bureau, 2014). The average per capita income is $26,
733 on a state level and $54, 629 on a national level (The World Bank, 2015). The state of
Florida poverty status as identified by the federal government is the same as the local
percentages. Persons that receive household assistance as of 2012 are 163,237 statewide and
3,341,535 nationally (U.S. Census Bureau, 2015). In 2010, 19% of Floridians and 23% of
Hillsborough County did not have health insurance. Hillsborough County also implemented
Hillsborough County Health Care Plan (HCHCP), which is a comprehensive managed care
program for Hillsborough County residents with limited income and assets who do not qualify
for other health care coverage, including Medicare and Medicaid. The program is funded by a
special sales tax and administered by the Hillsborough County government and Health Care
Services. (Hillsborough County Government Florida, 2014). Hillsborough Countys death rate is
higher than Floridas (727.7 vs. 656.2 per 100,000). In Hillsborough County, the top 3 diseaserelated leading causes of death in 2009 were cancer, heart disease, and chronic lower respiratory
disease (Florida Health, 2011). In Hillsborough County, 39% of the population is overweight,
and 25% is obese. Interestingly, more men than women were overweight (45% vs. 34%), and

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

more women than men were obese (26% vs. 23%), this is the trend that is most concerning.
People who are overweight/obese are at increased risk for type 2 diabetes, high blood pressure,
coronary heart disease which encompasses the top 3 leading causes of death (Florida Health,
2011)
Hillsborough County Strengths
The availability of health resources is higher in Hillsborough County than it is in the state
Florida. Health providers per 100,000 are all higher in Hillsborough County than the state,
besides total licensed dentists and total licensed family practice physicians, which the amount is
almost the same (Florida Charts, 2014). Hillsborough County has 316.2 hospital beds, 266.6
acute care beds, 49.5 specialty beds and 301.8 nursing home beds, which ranks closely with the
availability in the state of Florida (Florida Charts, 2014). Hillsborough County has enough
resources to assure a proper quality healthcare system. Health care access and quality of life of
Hillsborough County exceeds that of the state of Florida.
In terms of Crime indicators, the statistics show that Hillsborough County is in good
standing when compared to the state of Florida. Larceny, burglary, aggravated assault and
murder are all higher in the state of Florida compared to Hillsborough County. Total domestic
violence offenses, robbery, forcible sex offences, and suicide are all equal in incidence for the
state of Florida and Hillsborough County. An alcohol related motor vehicle crash death is the
only crime indicator that is higher in incidence in Hillsborough County than the state of Florida
(Florida Charts, 2015). These statistics were collected over 2008-2010 and shows that
Hillsborough County has a lower prevalence of crime indicators when compared to the state of
Florida.

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

Hillsborough County Public Schools have implemented an efficient program through

Student Nutrition Services (SNS). SNS operates as a self-supporting, $125 million dollar
enterprise. Each day, more than 1,400 dedicated employees serve over 214,000 nutritious meals
to students (Hillsborough County Public Schools, 2015). Some of aspects of this program are
free meal benefits, reduced meals, free breakfast program for all students, fresh fruit and
vegetable program and after-school and dinner program. One of the aspects of SNS is assuring
that every student obtains a balanced diet, and this is a mandated program. Each student uses a
tray that has the different food groups they must have at least three of the five categories in order
for there meal to be processed and charged to their account. This program aims to create an
innovative, efficient, and cost effective student nutrition program that is nationally regarded as
the best (Hillsborough County Public Schools, 2015).
Hillsborough County Needs
Infant Mortality rates have been linked to prenatal care in specific trimesters,
breastfeeding, longer hospital stays and the ethnicity and race of the mother. When comparing
the infant mortality rates of Hillsborough County to that of the state of Florida, since 1993, the
incidence has always been higher in Hillsborough County. As of 2012-2014, Hillsborough
continues to be above Florida with a rate of 7.3 infant deaths per 1000 live births as compared to
6.1 infant deaths for the state (Florida Charts, 2014). Assuring that mothers have access to
resources to have early detection, proper breastfeeding teaching and access to proper nutrition
and vitamins would have to alleviate the high rates of frequency in Hillsborough.
Behavioral risk factors that may influence health outcomes in the future, coupled with
increase in chronic diseases and lack of education and/or literacy are detrimental to any county.
As of 2013, Hillsborough County has 67.4% adults who are overweight or obese which can be

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

compared to Florida with 62.8% (Florida Charts, 2014). Education coupled with socioeconomic
status plays a huge role in behavioral risk factors. According to Florida Charts, within
Hillsborough County, 87.9% of adults have less than high school education, 63.8% high
school/GED and 65% more than high school level (Florida Charts). Other indicators that should
be considered in the County that have a higher occurrence than Florida are hypertension
awareness, cholesterol awareness, immunizations, tobacco use and exposure and diabetes.
There is a considerably high incidence of reportable and infectious diseases in
Hillsborough County versus the state of Florida. Per 100,000 residents the rates of total Sexually
Transmitted Diseases (STDs) was found to be 728.6 in Hillsborough County and 506.8 in the
state of Florida (Florida Charts, 2014). This is an alarming issue and something that has been a
problem for many years. This is also the case with vaccine preventable diseases in the
community with a total rate of 5.8 for Hillsborough County and 3.9 for the state of Florida per
100,000 people. Without a change in the community approach to these statistics there will
constantly be a noticeable gap between Hillsborough County and Florida.
Priority Health Issue
From the needs outlined, a priority health issue for Hillsborough County is the high
incidence of obesity and overweight people. Genetics, environment, diet and exercise are all
contributing factors to a persons weight. People who are overweight or obese are at increased
risk for type 2 diabetes, high blood pressure, coronary heart disease, gallbladder disease, stroke,
sleep apnea, respiratory problems, osteoarthritis, and some types of cancer. In Hillsborough
County, 39% of the population is overweight, and 25% is obese (Community Health Profile
Report 2010/2011, p40). This is a priority health issue that can affect or lead to other problems
for Hillsborough County.

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

Community Health Models

The range of personal, social, economic, and environmental factors that influence health status
are known as determinants of health, this is what makes up what is known as the determinantsof-health model (Determinants of Health, 2015). The determinants-of-health model can help
nurses to prioritize factors that influence obesity and being overweight and begin the synthesis of
a health policy proposal. Some of the factors that influence obesity and being overweight: diet,
exercise and socioeconomic status specifically, access to resources and access to knowledge.
Behavioral risk factors that may influence obesity and being overweight are lifestyle choices,
improper diet, lack of exercise, alcohol, drugs, and cigarettes (Determinants of Health, 2015).
Population Diagnosis
There is an increase of obese and overweight population in the Hillsborough County, related to
diet, exercise and knowledge deficit.
Primary Level of Prevention
For the primary level of prevention a focus should be placed on the system-wide interventions
surrounding obesity and being overweight in the community. This can begin with the implication
of healthy advertisements on mass media that educate the public on a large scale. Community
health advocators should have a marketing initiative surrounding obesity and overweight
education. The initiative should focus on what the signs of early onset of obesity and being
overweight are and how to prevent and work towards a healthy weight is possible. In this model,
the social rick factors should be addressed, diet and exercise and resources should be established
if someone feels like they need to seek help. The community at large should know that there is
support and that people are willing to work with them if they do want to change. The community

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

nurses role in this system-wide intervention is to assure that the proper information is given
through mass media and assure that resources are intact when people pursue help.
Secondary Level of Prevention
For the secondary level of prevention, a focus on community resources should be taken.
Assuring that the resources that are recommended by the mass media is able to really provide the
support that individuals need. This is the level where more in depth education is obtained. In this
level, patients can be screened in clinics to establish a baseline BMI and possible meal plans and
exercise regimens. Patients should be able to come in to community centers for little or no cost
and access these resources. The nurse can assure that the screenings, recommendations for diet
and exercise, teaching on obesity and overweight, BMI education and evaluation of progress is
possible for the patient. Assuring that this is something that is financially feasible is crucial, as
this obesity and being overweight is directly proportional to an individuals socioeconomic
status. The community nurse must advocate for the patient and community for funding to assure
that these resources can continue to be self-sustained. Possible supporters at this level would be
the state and private community supporters. The community nurse would assure that patients had
a care plan for their specific BMI and goals that were discussed. With all these things being
considered, people at lower levels of income that may not be able to afford gym memberships or
personal trainers have access to a system that may be able to implement healthy change.
Tertiary Level of Prevention
The tertiary level of prevention would be focused on an individual plan of action. The
individual would use the primary and secondary prevention levels and then gain some level of
autonomy in the tertiary level. The individual will then maintain compliance to regimens and
plans set by them and the community nurse. They would record their daily/weekly weights,

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

assess their blood sugar if needed and keep track of counting calories and maintaining a balanced
diet. The community nurse would be there to assure that the individual has all the resources
necessary to make this autonomy possible. The role of the nurse as the supporter is to implement
follow-up sessions and recommend specialists that may be able to further help them with diet
and exercise planning. By scheduling a follow-up meeting the client has motivation to work
towards a date and this may improve compliance and prevent further negative impact on heath
and the spread of obesity.
Health Policy Proposal
Every health care proposal has a goal to work towards improvement in a particular area,
which is usually directed towards a certain population. The health proposal for Hillsborough
County would be to decrease the number of obese and overweight people by implementing
balanced diet, exercise and education. The most crucial level of prevention discussed is the
secondary level of prevention. This is where the efforts of the public officials and funding
sources meet the community members and the health care providers. The goal is simply to
improve access to a health care in the community that is affordable and able to have plans for
exercise, diet and education on obesity and being overweight. Hillsborough County could have
monthly health awareness fairs in a well-known park. The fair could incorporate vendors, local
farmers, local recreational options, local dietitians who would be able to engage with the public.
The fair can also have an interactive portion, which could be live screenings and planning
follow-up visits at a nearby community center. The suspected outcome is that the local
community members are able to form a connection to their resources to then further be educated
and aided into maintain/achieving health goals. This plan would affect local businesses because
if they participated in the fair they would then gain business in turn and this can be used as a

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

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marketing strategy for the fair to be self-sustained. Through word of mouth, marketing through
flyers, billboards and television, and permission from Florida Parks and Recreation to stage a
monthly fair this health policy would be lifted into a reality. The ultimate goal would be for this
initiative to reduce obesity and the number of persons that are overweight. This health policy
would serve to promote a healthier Hillsborough County by educating them about diet and
exercise and connecting them to resources to do so.
Conclusion
In Hillsborough County, 39% of the population is overweight, and 25% is obese
(Community Health Profile Report 2010/2011, p40). Every county in the state of Florida has its
strengths and weaknesses. The proposal is to decrease the rates of obesity and being obese in
Hillsborough county so that is less than when compared to the state of Florida. After careful
consideration for the demographic makeup of Hillsborough County the best approach was to
have a monthly county fair where individuals of the community could then be connected to
community resources. This initiative also takes into consideration the importance for compliance
as the screening phase of the plan in implemented in this proposal. The goal is to reduce the
levels of obesity and being obese and work towards a healthier Hillsborough County.

HEALTH POLICY PROPOSAL: HILLSBOROUGH COUNTY, FL

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References
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Florida Health. (2011). Hillsborough County Health Department 2010/2011 Community Health
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Hillsborough Community Atlas. (2012). Retrieved October 27, 2015, from
http://www.hillsborough.communityatlas.usf.edu/demographics/default.asp?
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