Running head: DEVELOPMENT OF HEALTH POLICIES

Development of Health Policies Based on Population Statistics: Domestic Violence Incidence in

Escambia County
Patricia Korovich
University of South Florida
Community/Public Health Nursing

Development of Health Policies Based on Population Statistics: Domestic Violence Incidence in

Escambia County
The development and utilization of health policies by those in professions such as public
health and different levels of government can have a vital impact on the wellbeing of
communities that are targeted by them. With information compiled by government and/or
private organizations, one can assess the specific needs of a population. For the purposes of this
assignment, Escambia County, Florida and its healthcare needs compared to statewide statistics
will be the focus, and a policy will be created reflecting these.
Geographic and Socioeconomic Data
Escambia County is the 19th most populated county in Florida; in 2015, the countys
density was 467.6 persons/square mile versus the states average of 369.5 (Florida Legislature
Office of Economic and Demographic Research, 2015). The Office of Management and Budget
considers Escambia a metro county and as per census information, an Urban area, especially
Pensacola (Florida Legislature Office of Economic and Demographic Research [EDR], n.d.).
Three major employers in the county include Baptist Healthcare, Gulf Power Company
and Medical Center Clinic (Pensacola Chamber, 2015). Major health care systems include
Baptist Healthcare, Sacred Heart Health System and Medical Center Clinic.
According to an assessment done by the Florida Department of Health in Escambia
County in 2013, with respect to poverty, Escambia County has higher percentages of poverty
than the state of Florida in all ages, under age 18 and ages 5-17 in families, and the county fares
worse than the state averages of per capita personal income, median household income, and
average weekly wage (Florida Department of Health in Escambia County [Florida DOH], 2013,
Chapter 2). Only 7.9% of persons over the age of 5 speak a language other than English,

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

significantly lower than 27.8% in the state and in 2014 the percentage of adults over 25 years of
age who have their high school diploma or higher was 88.5%, greater than the state average of
86.5% (EDR, 2015).
Analysis, Interpretation and Prioritization of Data
Data for the analysis Escambia will be retrieved from the Florida Department of Health
Division of Public Health Statistics & Performance Management, which provides yearly county
health profiles for all counties in Florida.
Indicators of Strength
HIV/AIDS. One area in which Escambia County fared better statistically than the state
is in reported AIDS cases as well as HIV/AIDS deaths. The state has a death rate of 4.4 caused
by HIV/AIDS and a rate of 14.8 AIDS cases, where Escambia has 3.9 and 12.1, respectively.
This could potentially be due to the higher incidence adults who have ever been tested for HIV
(5.6% higher) and of adults less than 65 years of age who have had an HIV test in the past 12
months (7% higher).
Colorectal cancer screening. Escambia County shows strength in colorectal screening
processes. Statistics show that adults aged 50-75 in the area were more frequently screened for
colorectal cancer based on the most recent clinical guidelines (14% greater than state) and had
higher rates of colonoscopies and sigmoidoscopies received by those over the age of 50.
Immunizations. Finally, another health strength is that adults more frequently receive
influenza and pneumococcal vaccines in the county, especially in those over the age of 65 (7.5
and 9.7%). The county also has better rates of getting tetanus shots since 2005 (13.7%).
Indicators of Need

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

Sexually transmitted diseases. Escambia County has had a steadily increasing problem
with gonorrhea, chlamydia and infectious syphilis rates. In 2014 rates reached 799.71 per
100,000, making it the 6th highest county in the state with the issue (Florida Department of
Health, Division of Public Health Statistics and Performance Management, 2014c).
Diabetes. In Escambia County, diabetes is the fifth highest cause of death having a rate
28.5 compared to Floridas 19.6 (45% higher). This goes in hand with the countys high rate of
obesity and low rate of meeting both aerobic needs or consuming five or more servings of fruit
and vegetables a day. However, it is interesting to note that an individual with diabetes in
Escambia is more likely to receive self-management education than others in Florida (50%
greater) (Florida Department of Health Division of Public Health, 2014a).
Domestic violence. One of the most jarring statics for Escambia is that of domestic
violence. At a frequency of 1090.5 per 100,000 of the population, this county has the highest
rate in all of the counties in Florida; these statistics equate to roughly 11 people in every 1,000
experiencing some form of domestic violence. While the statewide average has been gradually
decreasing over the last ten years (Florida Department of Health, Division of Public Health
Statistics and Performance Management, 2014b), the area in question has continually increased
and Escambias proportion of domestic crime is currently almost double the rate of Floridas.
Priority Health Issue
The priority health concern that will be the focus of this paper is domestic violence.
While some may not perceive this issue to be of a medical nature, the long-term effects of
violence can be extensive, both mentally and physically, and not just for the victim. Healthy
people 2020 notes the effects of injuries and violence extend beyond the injured person or
victim of violence to family members, friends, coworkers, employers and communities (Office

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

of Disease Prevention and Health Promotion, n.d., para. 2). Medically, aside from the
physiological effects of a bodily assault one can experience with domestic violence, a person can
also encounter health issues related to high stress, depression, and possibly PTSD.
Community Health Models
The Public Health Nursing Assessment Tool (PHNAT) is a tool that allows a public
health nurse treating a spectrum of clients to evaluate and shift focus between individual,
community, population and system (Truglio-Londrigan & Lewenson, 2013, p. 55). The
Determinants of Health Model is an assessment (as part of a PHNAT) that gathers data on
aspects of health such as biological, social, individual contributing factors to health of
individuals, populations and communities (Truglio-Londrigan & Lewenson, 2013, p. 58).
Application of the Determinants of Health Model
Social. Some social factors that are associated with rates of domestic violence include
unemployment and poverty, as well as relationship dissatisfaction (Capaldi, Knoble, Wu Shortt,
& Kim, 2012). As stated earlier, Escambia County has a high rate of poverty compared to the
states averages; in addition, the countys unemployment rate has been steadily increasing since
2007 when it was 3.9 to 2014 where it was 10.9 (Florida Department of Health, Division of
Public Health Statistics and Performance Management, 2014d). Also, high-stress living
situations can contribute to the incidence of domestic violence, which can be exaggerated by
cramped living quarters, as may be seen in urban areas such as Escambia. Two other factors that
may have an affect on the occurrence of domestic violence include childhood abuse and the
presence or accessibility of a support system for the abuser and/or the victim (Capaldi et al.,
2012).

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

As a whole, it appears that Escambia County has a predisposition for both violent and
sexual crimes. County statistics show in addition to a great deal of domestic violence that, in
comparison to the state, there is a greater rate of aggravated assault (65% higher), forcible sex
offenses (83% higher) and rape, as well (Florida Department of Health, Division of Public
Health, 2014a).
Lifestyle. Several other risk factors associated with the incidence of domestic violence
include drug and alcohol use. Unfortunately, no straightforward statistics could be found
detailing the rates of drug and/or alcohol use in Escambia County. However, it is relevant that
Escambia County ranks number 8 in the state of motor vehicle accidents that are suspected to
have involved alcohol and is 39% higher than the state averages (Florida Department of Health,
Divison of Public Health Statistics and Performance Management, 2014e).
Population Diagnosis
Female residents of Escambia County Florida have an increased risk of being victims of
domestic violence as evidenced by state statistics; this population is at a higher risk of
developing mental and physical side effects including injury, depression, altered body image
and/or PTSD (Weaver, Griffin, & Mitchell, 2014).
Community and Population-Based Interventions
Primary Level of Prevention
In primary levels of prevention, the aim is to prevent the occurrence of an issue before it
occurs. For primary prevention, it would be beneficial during routine visits for providers and
nurses to educate patients on risk factors that can contribute to domestic violence and to assist
with problem solving and interaction skills. This in agreement with a suggestion made by
Capaldi, Knoble, Wu Shortt and Kim in a survey of research conducted on the subject that public

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

awareness might decrease occurrences (2012). This prevention would be best implemented at
either a system-wide level or, if more research becomes available pinpointing the areas within
the county that have the highest incidence of domestic violence, more of a community level.
Stakeholders that may have interest in such a program could include healthcare providers,
as well as hospital systems and local government due to the cost that is incurred both directly
(for example, hospital visits) and indirectly (for example, days taken off work) as a result of
domestic violence. It is estimated that the cost of domestic violence has been in excess of 8.3
billion, not including the costs incurred in the judicial system (Centers for Disease Control and
Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention,
2015).
The production, compilation and dissemination of information, possibly in the form of a
flyer, would be a task that a community health could tackle well; however, there would be a
concern of low compliance on the part of medical staff to educate all patients at risk and a low
interest on the part of the patients.
Secondary Level of Prevention
Secondary levels of prevention involve treating problems in early stages before they
cause irreparable damage, and prevention of escalation. A secondary method of prevention that
would improve domestic violence screening, reporting and treatment that has been suggested by
the Family Violence Prevention Fund is the removal of laws requiring mandatory reporting of
domestic violence to law enforcement. According to a compendium compiled by the fund, these
laws are most often not helpful to domestic violence victims, that the revision of these
mandates may allow patients to be more candid about their injuries leaving providers more
capable of assisting them (Family Violence Prevention Fund, 2010, p. 2-3). Clearly, an issue

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

with the implementation of this system-wide intervention would be the worry on the part of
providers of liability in the event of severe injury or loss of life of a domestic violence victim.
Additionally, government and non-government agencies may find difficulty with this method due
to the lack of data that would be collected on the issue as a result; this would cause issues with
funding.
Tertiary Level of Prevention
A tertiary level of prevention seeks to reduce the damage incurred when an issue has
already occurred; it focuses on restoring normal function, and minimizing complications. For
the issue of domestic violence, the application of treatment programs that focus on established
perpetrators of domestic violence could potentially help end the cycle of abuse; it would also
prevent further negative impacts on health, allow for monitoring of compliance and enable
comprehensive management of domestic violence cases.
This method of prevention should incorporate all levels of intervention: individual,
community and system-wide; Individuals should be contacted directly to participate in the
programs, organizations in the community that focus on domestic violence prevention should
develop and offer them. System-wide, different levels of government should become involved
using their resources to ensure that the programs are in fact productive and constructive. In
addition, all of the aforementioned are stakeholders in such an intervention. For government, it
would be of interest due to the exorbitant costs related to domestic violence and potential for
decline in repeat offenders. Individuals could be potential stakeholders in the event that
participation may grant leniency and help repair damaged familial relationships. Some nongovernment agencies already offer help for offenders, such as FavorHouse of Northwest Florida

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

in Pensacola, in the hopes that repeated violence can be avoided through learning healthy
alternatives (FavorHouse of Northwest Florida, Inc., 2016).
Issues may arise in terms of funding due to the sensitive nature of the topic; aiding
offenders may seem contrary to the goal of helping victims of violence. However, all
interventions have the same end-goal: to decrease the likelihood that an individual will become
the target of domestic violence, much less repeatedly. At the moment, these preventions are
largely funded by non-government groups such as FavorHouse and some are mandated for
offenders by courts. There is a lack of scientific evidence supporting the effectiveness of
programs aiming to reduce criminal recidivism, as shown in a Swedish study (Haggard, Freij,
Danielsson, Wenander, & Langstrom, 2015). However, this does not mean such efforts should be
abandoned; it simply means that more work needs to be put in to their development.
More individualized-care consideration is needed, as evidenced by studies conducted at
the University of Nebraska. According to this study, individuals in courses aiming to prevent
domestic violence criminal recidivism, whether court-mandated or voluntary, dropped out at a
nearly equal rate to each other; however, those that completed the courses had a lower rate of reincarceration related to violent crimes (Sartin, Hansen, & Huss, 2006). Also, it appears that
individual characteristics of offenders have an effect on the likelihood that one will complete
treatments including age, education and history of drug use (Sartin, Hansen, & Huss, 2006).
A community health nurse in this scenario could be helpful in developing and delivering
education made available to the offenders. Additionally, he or she can garner support, funding,
and conduct research to ascertain its success and any revisions that may be necessary.
Health Policy Proposal
Impact of Health Policy on Healthcare

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

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Health policies put into action have a great deal of impact on healthcare. Through careful
assessment, one can tailor a plan to help improve the quality of life and health of target
communities. Interventions put forth by health policies made to help site-specific issues can
have a compounded effect on all levels of healthcare and potential health complications that may
have been generated by such issues may be reduced.
Proposal
The policy will focus on the reduction of domestic violence in Escambia County. The
goal is to reduce rates of such violence, as well as repeat offenses, focusing on the use tertiary
prevention programs. There are many stakeholders who can be affected by the proposed policy:
individual citizens who are at a risk for violence, public officials in Escambia that surely would
prefer not to be leading in domestic violence in Florida, legislators that are entrusted with
maintaining public safety as well as managing the overwhelming cost of domestic violence and
healthcare providers that strive to support their patients wellbeing.
For funding, there are a great deal of domestic violence victim advocacy groups that may
have an interest in backing such programs. Additionally, due to the billions of dollars of expenses
such crimes incur, and the very real public health emergency taking place in Escambia,
legislation needs to advance funding to address the domestic violence crisis in the county. As of
2010, according to the compendium compiled by the Family Violence Prevention Fund, Florida
State had not received any public funding grants from the Violence Against Women Act
(VAWA), which it would benefit from (Family Violence Prevention Fund, 2010); this act aims to
help law enforcement and health professionals in assisting victims of domestic violence, but also
allocates 5% of funding to prevention and education (Distric Attorneys Council, n.d.).

DOMESTIC VIOLENCE INCIDENCE IN ESCAMBIA COUNTY

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This policy should have the utmost support from non-government agencies, government
bodies, medical professionals and victims, alike. The only foreseeable individuals who would
oppose a policy that simply aims to reduce domestic violence would be those who see no issue
with such battery. Thankfully, law, justice and society do not typically side with these people.
Initial Implementation
The general plan to put the policy into action is to compile plain statistics on domestic
violence in Escambia and present them to local lawmakers such as councilmen. It would be
important to first have support of local advocacy groups in attempting to raise funding to
generate research and programming to bring down the rate of domestic violence in the county,
potentially through VAWA grants. This addresses the very real need for residents to have an
intervention on their behalf in order to avoid the risk of injury and/or threat of death involved
with domestic violence.
Conclusion
As evidenced by the detailed data provided, domestic violence is an issue that is in dire
need of intervention on the part of lawmakers and healthcare providers in Escambia County.
There are many methods in which this can be addressed and several possibilities for the funding
of such interventions; however, in order for this to happen, advocacy groups and individuals such
as community health nurses need to insist upon government involvement in order to see widespread success through the use of their resources and financial support. This is a topic that the
author feels determined to find a viable, comprehensive resolution for, as she has experienced it
both indirectly in her personal life and has seen the results of it in patients during her nursing
education.

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