Running head: PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 1

Proposed Health Policy for Gilchrist County

Jaime Umpleby

University of South Florida

PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 2

Proposed Health Policy for Gilchrist County

Gilchrist County is a small, rural county in north central Florida. In this paper, Gilchrist

County will be explored to find multiple levels of health prevention for adult obesity. Obesity

has become a major issue in the United States and an important issue to investigate for Gilchrist

County. Through primary, secondary, and tertiary interventions, as well as a potential health

policy proposal, Gilchrist County has an opportunity to further enhance the health of the

community.

Overview of Gilchrist County

The small, rural community of Gilchrist County accounts for 0.1% of Florida’s

population and is Florida’s 57th most populous county with a population of about 16,900 people

(North Florida Economic Development Partnership, 2017). Out of Gilchrist County’s small

population, the majority ethnicity is 91% white, with 94% of the population being non-Hispanic

or Latino (North Florida Economic Development Partnership, 2017).

The top three industries in the county and their respective percentages of employment

within the population include trade, transportation, and utilities 23.3%, construction 16.1%, and

professional and business services 11.8% (North Florida Economic Development Partnership,

2017). Some major employers in the county include Ayers Health and Rehabilitation, CCDA

Waters, and Alliance Dairy (Florida Department of Transportation [FDOT], 2013). In regards to

healthcare, the two major providers in the county are Ayers Health and Rehabilitation and the

Tri-County Health Center (FDOT, 2013).

Comparison of Local vs. State Populations

In comparing Gilchrist County to the state of Florida, the percentage of families below

the poverty level in Gilchrist County is 25%, compared to Florida’s rate of 21% (County Health
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 3

Rankings & Roadmaps [CHR&R], 2018). Gilchrist County’s population greater than or equal to

age 25 with a high school diploma is 93%, which is significantly higher than Florida’s rate of

78% (CHR&R, 2018). The ratio of primary care providers to residents of Gilchrist County is

2,870: 1 compared to Florida’s ratio of 1,380:1 (CHR&R, 2018). Additionally, only five percent

of Gilchrist County’s population greater than or equal to age five does not speak English, which

is significantly lower than Florida’s rate of 28% (North Florida Economic Development

Partnership, 2017).

Analysis and Interpretation of Data

Gilchrist County shows many unique strengths and weaknesses compared to the state of

Florida. Analyzing the county’s strengths and weaknesses is necessary to explore in order to

advance the wellness of the state as a whole.

Identified Strengths

One of Gilchrist County’s strengths compared to the state of Florida is the number of

children in single-parent households (CHR&R, 2018). The county has a rate of 27% while the

state has an increased rate of 38% (CHR&R, 2018). A lowered rate of children in single-parent

households is beneficial for the county because studies show that children in single-parent

households have an increased risk for performing poorly academically (Amato, Patterson, &

Beattie, 2015).

Another strength for Gilchrist County is its lower violent crime rate compared to the

state’s rate (CHR&R, 2018). The county has a violent crime rate of 243 per year while the state

has a rate of 500 per year (CHR&R, 2018).

A third strength for Gilchrist County is its decreased air pollution rate (CHR&R, 2018).

Gilchrist County has an air pollution rate of 7.4 micrograms per cubic meter, which is currently
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 4

equal to Florida’s air pollution rate (CHR&R, 2018). However, Gilchrist County has decreased

its air pollution rate each year since 2007 when the county had a rate of 11 micrograms per cubic

meter (CHR&R, 2018). The county and the state both have a lower air pollution rate than the

United States, with an air pollution rate of 9 micrograms per cubic meter (CHR&R, 2018). A

decreased air pollution rate is positive for the county because research has shown that air

pollution has negative effects on cardiopulmonary health (Pope & Dockery, 2006).

Identified Weaknesses

One weakness for Gilchrist County is its high physical inactivity rate compared to the

state level (CHR&R, 2018). The county has a physical inactivity rate of 31% while Florida has a

lowered physical inactivity rate of 23% (CHR&R, 2018). Physical activity is important for the

county because physical activity is helpful in reversing bone loss, treating symptoms of

depression, preventing pregnancy associated medical conditions such as preeclampsia and

gestational diabetes, and is overall beneficial in promoting positive health outcomes (Booth,

Roberts, & Laye, 2012).

Another weakness of Gilchrist County is its low access to exercise opportunities

compared to the state (CHR&R, 2018). Gilchrist County’s access to exercise opportunities rate

is 21% while Florida’s rate is significantly higher at 87% (CHR&R, 2018). Lack of exercise in

the county could lead to negative health outcomes such as type two diabetes, cardiovascular

disease, and premature mortality (Booth et al., 2012).

Lastly, Gilchrist County could improve on the adult obesity rate compared to the state

level (CHR&R, 2018). The county has an increased adult obesity rate of 32% compared to

Florida’s rate of 26% (CHR&R, 2018). Gilchrist County’s adult obesity rate has been increasing

since 2004 when the rate was 24% (CHR&R, 2018). Aside from the negative health effects from
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 5

obesity, financially, obesity costs the county over 270 billion dollars a year when including

medical care and loss of economic productivity (Booth et al., 2012).

Identification of a Priority Health Issue

Gilchrist County has a priority health issue of adult obesity. This is a priority health issue

for the county because as previously stated, the county has an adult obesity rate of 32%

compared to the state’s adult obesity rate of 26% (CHR&R, 2018). This rate has become

increasingly higher since 2004 when the county’s adult obesity rate was 24% and the state’s rate

was 22% (CHR&R, 2018).

This is an important risk factor to address for the county because adult obesity in

residents increases their risk for cardiovascular disease and metabolic issues such as type two

diabetes and metabolic syndrome (Palmer & Toth, 2019). Cardiovascular Disease is the top

cause of death worldwide, so lowering the risk factors for cardiovascular disease is important for

any community’s overall health and quality of life (Palmer & Toth, 2019).

Discussion and Application of Community Health Models

The Social Determinants of Health Model (SDOH) incorporates the social conditions that

factor into a person’s life and overall health, including socioeconomic factors and physical

factors (United States Department of Health and Human Services [HHS], Healthy People 2020,

2014). The SDOH model is useful in developing population based health interventions because

it factors in all of the social and physical determinants of a specific population’s health and

health issues (HHS, Healthy People 2020, 2014). There are five key areas included in the SDOH

model: economic stability, education, social and community context, health and health care, and

the neighborhood and build environment (HHS, Healthy People 2020, 2014).
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The SDOH factors that influence Gilchrist County’s priority health issue of obesity

include economic stability, education, health and health care, and the neighborhood and build

environment. In the area of economic stability, it is important to factor in Gilchrist County’s

unemployment rate of 5.1% (CHR&R, 2018). In the area of education, Gilchrist County has a

non-English speaking population of 5% and a high school education rate of 93% (CHR&R,

2018). In the area of health and health care, the county has an uninsured rate of 19% and a

2,870:1 primary care physician to patient ratio (CHR&R, 2018). In the area of the neighborhood

and build environment, Gilchrist County has a 17% food insecurity rate and a 16% rate of severe

housing problems (CHR&R, 2018).

Population Diagnosis

Adults in Gilchrist County are at risk for obesity due to limited access to exercise

opportunities and lower physical activity (CHR&R, 2018).

Community/Population-based Interventions

With Gilchrist County’s health issue of adult obesity, there are three levels of prevention

that can be explored to promote improved health outcomes for the community. These levels of

prevention are primary, secondary, and tertiary levels of prevention. These three levels of

prevention will be explored further to promote positive health outcomes for the community.

Primary Level of Prevention

Primary prevention includes promoting positive health and preventing negative health

outcomes (Minnesota Department of Health, 2001). Health teaching is a primary prevention tool

that can be used to communicate facts and skills that have the power to change attitudes and

health practices (Minnesota Department of Health, 2001). Health teaching for increased physical

activity to decrease the likelihood of adult obesity can be done at the community-wide scale and
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 7

can be shared through social media, television, and other methods of media campaigns (Center

for Disease Control (CDC), 2011). The CDC has already established an evidence-based program

with data based off of a previous established program, Wheeling Walks from Wheeling, West

Virginia where they founded a community-wide program to provide adults aged 50 to 65 years

old with at least 30 minutes of activity each day (CDC, 2011). Community-wide campaigns for

health teaching on physical activity increased four percent of the community’s population

participating in physical activity (CDC, 2011). This primary prevention method includes public

officials to assist in community involvement, message development, and funding, as well as

community members and healthcare providers to implement and support the physical activity

teaching campaign (CDC, 2011). A concern with this campaign is that it will take up a lot of

resources and funding to carry out across to all areas of the community (CDC, 2011). As a

community health nurse, it would be important to conduct research and planning into this

intervention to make sure the community will respond positively to the campaign (CDC, 2011).

Secondary Level of Prevention

Secondary prevention includes finding health problems early on and treating them before

the problems become too serious (Minnesota Department of Health, 2001). Screening is a

secondary level of prevention that can be used to identify citizens of the county with risk factors

for obesity (Minnesota Department of Health, 2001). The United States Preventative Services

Task Force recommends screening to be done when visiting a healthcare professional by

calculating a body mass index (BMI) from the patient’s height and weight, and measuring waist

circumference to test for risk factors for adult obesity (U.S. Preventative Services Task Force,

2012). Evidence shows that a BMI of 30 or greater and increased fat around the increases the

risk for not only obesity, but also for heart disease and diabetes (U.S. Preventative Services Task
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 8

Force, 2012). Screening involves the individual as the recipient as individuals will be screened

during healthcare visits (U.S. Preventative Services Task Force, 2012). The stakeholders

included in this intervention include community members and healthcare providers, as

community members should all be screened to identify risk factors for obesity and healthcare

providers should be conducting the screenings for their patients (U.S. Preventative Services Task

Force, 2012). Funding should not be a concern for screening since it will done in the healthcare

setting and the community health nurse would be needed to discuss the plan with healthcare

providers and implement the screening with their patients. Following up with the screening, it

would be important for the community health nurse to carry out resources for the people that

screen risk factors for adult obesity, leading to tertiary prevention.

Tertiary Level of Prevention

Tertiary prevention limits the damage by an occurring problem and it is implemented

after a negative health outcome has already occurred (Minnesota Department of Health, 2001).

A tertiary level of prevention that can be used in the community involves preventing further

negative impact on health and preventing an increase in weight through behavioral and lifestyle

changes (Felix & West, 2013). Included in behavioral and lifestyle changes is a reduced-calorie,

low-fat diet paired with physical activity (Felix & West, 2013). This is an individual

intervention and includes the stakeholders of community members to carry out the intervention

and healthcare providers to educate and monitor the intervention’s effectiveness. There are no

funding concerns for this intervention since it is carried out with the individual. The community

health nurse can be helpful with healthcare providers by educating obese patients about dietary

restrictions and the importance of physical activity. Community health nurses can also follow up

with the community residents on the effectiveness of this intervention.

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Development of Health Policy

The focus of this health policy will be limiting the adult obesity rate in Gilchrist County.

The proposed health policy is obesity screening for all adult residents visiting primary care

providers. To identify patients with obesity, healthcare providers will measure patient’s BMI

and waist circumferences and will provide follow-up care and resources to those identified as

obese (U.S. Preventative Services Task Force, 2012).

This health policy proposal is primarily focused on secondary intervention. The health

policy will impact the county by screening all adult individuals for risk factors of obesity,

including increased BMI and waist circumference (U.S. Preventative Services Task Force,

2012). By health care providers screening adults in the county during every healthcare visit,

adults at risk for obesity can be informed and can follow up on primary and tertiary interventions

to either prevent obesity from occurring or decrease their BMI and waist circumference to

decrease their risk for other comorbidities like cardiovascular disease, type two diabetes, and

metabolic syndrome (U.S. Preventative Services Task Force, 2012). By health care providers

conducting this screening, it will enhance the overall health of the population by giving all

residents access to this screening and proper knowledge on health, nutrition, and exercise

education when residents visit their healthcare providers (U.S. Preventative Services Task Force,

2012).

The desired outcome of this proposal is to decrease the rate of adults with obesity in

Gilchrist County through screening adults for obesity and referring adults with obesity to weight

management programs (U.S. Preventative Services Task Force, 2012). The first step towards

presenting the health policy proposal includes first communicating with the healthcare providers

who will be conducting the obesity screenings (U.S. Preventative Services Task Force, 2012).
PROPOSED HEALTH POLICY FOR GILCHRIST COUNTY 10

By communicating with the local healthcare providers, all healthcare providers in the county will

be on the same guidelines for conducting screenings, such as the BMI and waist circumference

that is considered to be obese (U.S. Preventative Services Task Force, 2012). After

communicating this information between healthcare providers in Gilchrist County, there will

need to be anonymous data collection on patients being screened for obesity to determine if this

proposal reaches the desired outcome of decreasing the adult obesity rate in Gilchrist County, or

if the proposed health policy effects the adult obesity rate in a negative way (U.S. Preventative

Services Task Force, 2012).

The stakeholders included in this intervention include community members and

healthcare providers, as community members should all be screened to identify risk factors for

obesity and healthcare providers should be conducting the screenings for their patients (U.S.

Preventative Services Task Force, 2012). Funding should not be a concern for screening since

the obesity screening will conducted in the healthcare setting. The community health nurse

would be needed to discuss the plan and general guidelines with healthcare providers in the

county and to gather data regarding the proposed health policy and the effect it has on the adult

obesity rate in the county.

The U.S. Preventative Services Task Force supports screening of obesity in adults (U.S.

Preventative Services Task Force, 2012). Based off of reviewed research studies, they have

issued a final recommendation for obesity screening in adults 18 years of age or older (U.S.

Preventative Services Task Force, 2012). There is currently no evidence-based research in

opposition for this proposed health policy.

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Conclusion

While Gilchrist County only accounts for a small portion of Florida, the county can make

a big impact on the state’s overall health and wellness. Through exploring the county’s strengths

and weaknesses compared to the state, better health outcomes can hopefully be achieved by the

county and the state. As evident in the paper, there are multiple options to tackle the health issue

of obesity in Gilchrist County. Through primary prevention, health teaching on the importance

of physical activity can be shared community-wide through a media campaign. With secondary

prevention, healthcare providers can screen patients to look for risk factors of obesity, such as a

high BMI and a large waist circumference. Then through tertiary prevention, the harmful effects

of obesity can be decreased through dietary modification for those diagnosed with obesity.

Finally, through the proposed health policy of obesity screening through healthcare providers,

the desired outcome of decreasing the adult obesity rate in Gilchrist County will hopefully be

attainable for the county.

This paper is extremely relevant to my nursing career as adult obesity has been a

common finding throughout my clinical experience as a student nurse. I have seen how obesity

is associated with comorbidities and can cause extremely negative health outcomes for patients.

Through my experience I have found that many people with obesity have a lack of knowledge

regarding nutrition, physical activity, and health overall. After conducting research on this topic

all semester, I am confident that I will be able to properly educate my patients on the importance

of diet and exercise to prevent or decrease obesity. I think screening in the primary care settings

can hopefully identify people with obesity early on before it becomes out of control. With the

right resources and education directed towards the patient, I am hopeful that the rate of obesity
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will decrease and along with it decrease the amount of comorbidities frequently seen in

healthcare.
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