Running head: ANALYSIS OF MIAMI-DADE 1

Analysis of Miami-Dade County Health Characteristics

Jennifer Carter

University of South Florida

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Analysis of Miami-Dade County Health Characteristics

With the mention of Miami-Dade County, individuals often first think of the beautiful

beaches and the vacation like qualities associated with the city. However, as a result of living in

Miami-Dade County for upwards of two decades, individuals will realize that the community has

more to offer to its citizens than its scenic assets. Miami-Dade County is a multi-cultural

community that strategizes and uses multiple approaches to analysis the strengths and weakness

of the area; and thus provide appropriate resources and safety to the families that inhabit the

areas between its broad borders. Through an analysis of the county, state, and national data, the

impact of environmental factors, individual health characteristics, and individual, family or

population based values, beliefs, attitudes, and behaviors that contribute to the overall health of

the community was identified. Therefore, through the utilization of the data collected and health

models, this purpose of this paper is to develop a health policy to address the priority health

problem in Miami-Dade County.

Overview of Miami- Dade County

The county of Miami- Dade encompasses more than 2,000 square miles and

approximately 2,712,945 individuals (Miami-Dade County, 2017). The county is surrounded by

Biscayne Bay and the Atlantic Ocean on the Eastern surface, the Everglades National Park to the

West, the Florida Keys on the South, and Broward County on the Northern extremity. Miami-

Dade County is composed of 34 municipalities, with Hialeah, Miami Gardens, Miami Beach,

North Miami, and Coral Gables being the largest (Miami-Dade County, 2017). In addition to

these municipalities, there is an unincorporated municipal service area, which is an area of the

county that does not fall within the defined borders of the municipalities.
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A board of thirteen county commissioners and a mayor governs the county and has the

ability to create and inforce policies and operations for Miami-Dade County services. The

mayor has the additional abilities, including a veto right, for providing for the county. This

checks and balances system sets policies and establishes laws for the county that is 63.1%

Hispanic and 18.8% African American (Statistical Atlas, 2015). In Miami Dade County, the top

employers are Baptist Health South Florida, The University of Miami, and American Airlines

(The Beacon Council, 2015). Additionally, the top healthcare systems are Jackson Memorial

Hospital, Baptist Hospital of Miami, and Mount Sinai Medical Center (The Beacon Council,

2013). The ordinances of the commissioner’s office, top employment chains, and accessible

healthcare systems sets the climate for the population and socioeconomic factors of that in

Miami-Dade County.

Comparison of Local vs. State Populations

In lieu of the population being 63.1% Hispanic, it is not a surprise to notice that 51.5% of

Miami-Dade County’s inhabitants are foreign born (Miami-Dade County, 2017). Furthermore,

this finding supports information from the United States Census Bureau (2015a) that indicates

that 74.4% of the age five and older population in Miami-Dade County does not speak English.

This percentage compares to 28.8% of the five and older population in Florida that does not

speak English (United States Census Bureau, 2015a).

With language and cultural barriers proving to be a prevalent issue in society and Miami-

Dade County unofficially serving as a melting pot of cultures, the United States Census Bureau

(2016b) indicates that 28.9% of the population older than the age of 25 in Miami-Dade County

has earned a high school diploma or equivalent. Unfortunately, the census bureau reports a
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slightly lower percentage of 28.2% of the Florida population older than the age of 25 earning a

high school diploma or equivalent (United States Census Bureau, 2016b).

In Miami-Dade County, the median household income in the year 2015 was $43,129

(United States Census Bureau, 2015b). Therefore, The United States Census Bureau (2016a)

reports the percent of families living under poverty in Miami-Dade County is 18.3%.

Alternatively, the United States Census Bureau (2016a) reports that the percent of families living

under poverty 14.7% in Florida.

According to the Census Bureau, 52.3% of individuals in Miami-Dade County have

private health insurance compared to 62.4% of individuals in Florida using a private health

insurance (United States Census Bureau, 2016b). In Miami-Dade County, 35% of the population

access public coverage, compared to 37.6% in the state of Florida (United States Census Bureau,

2016b). Lastly, in Miami-Dade County, 16.8% of the population does not have health insurance

coverage, compared to 12.5% in the state of Florida (United States Census Bureau, 2016b). In

terms of accessibility to health care, the Florida Department of Health enables Miami-Dade

County to allow individuals without insurance and ability to pay for healthcare services to obtain

care without the burden of payment prohibiting individuals from seeking assistance.

Analysis and Interpretation of Data

An analysis of the Miami-Dade County community was conducted and three strengths

and weaknesses were interpreted through an assessment and comparison on county statistics and

rankings.

Identified Strengths

With non-communicable diseases, such as cardiovascular diseases, cancer, respiratory

diseases, and diabetes, being on the upward spiral in society, it is important for communities to
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adapt the type of resources that they make accessible to the individuals in the community.

Miami-Dade County reports 99% of the population has adequate access to locations for physical

activity, compared to 92% overall in Florida (Health Rankings, n.d.). According to Long-Term

Health Benefits of Physical Activity – A Systematic Review of Longitudinal Studies (2013),

moderate to vigorous physical activity, that burns approximately 2,000 to 3,000 calories per

week, appear to reduce the occurrence of stroke, hypertension, and chronic heart disease.

Accessible resources that are conducive in alleviating chronic diseases, such as the ones

mentioned, are proactive in prolonging the community.

Another identified strength of Miami-Dade County is that 17% of alcohol impaired

driving deaths occurred in the county, compared to 28% overall in Florida (Health Ranking,

n.d.). This is important because there is strong evidence that supports the effectiveness of

random driving under the influence checkpoints in the efforts of reducing harm and fatalities

associated with impaired driving (Florida Department of Law Enforcement, 2017). Since 2008,

Miami-Dade County reports reducing arrests made due to driving under the influence from

upward of 200 arrests per 100,000 population to 71.6 arrests per population (Florida Department

of Law Enforcement, 2017).

Miami-Dade County reports a food environment index of 8.4, with 8.4 being the top

U.S. performer, and the State of Florida reporting a food index of 7.1 (Health Rankings, n.d.).

The food environment index is described as an index of factors that contribute to a healthy food

environment, with zero being the lowest and ten being the highest. These index of factors

includes two equally weighed indicators, an estimate of the percentage of the population that is

low income and does not live in a specified proximity to a food market and an estimate of the
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percentage of the population that did not have access to a reliable source of food during the past

year (Health Rankings, n.d.).

Identified Weaknesses

Despite the many strengths of Miami-Dade County, this paper also analyzed the

weaknesses of the county with one of them being 409.8 newly diagnosed sexually transmitted

infections (STI’s), compared to the top U.S. performer reporting 145.5 newly diagnosed STI’s

(Health Rankings, n.d.). Miami-Dade County faces an interesting challenge when it comes to the

escalating rates of new cases of STI’s. Over the last four years, the rates continued to grow with

an average of 15 cases of an STI diagnosed every day among 20 to 25 year olds (Moore, 2016).

In the year 2015, Miami-Dade County was number one in the state for reported STI cases

(Moore, 2016).

In addition to the high incidences of STI cases, Miami-Dade County reports 74

preventable hospital stays (number of hospital stays for ambulatory care sensitive conditions per

1,000 Medicare enrollee’s), compared to top U.S. performers reporting 36 preventable hospital

stays (Health Rankings, n.d.). Ambulatory care sensitive conditions are described as

convulsions, chronic obstructive pulmonary disease, bacterial pneumonia, asthma, dehydration,

hypertension, kidney/urinary infections, amongst many more. According to County Health

Rankings and Roadmaps, hospitalizations for the diagnoses mentioned are often preventable and

usually result from a lack of sufficient quality of outpatient care (Health Ranking, n.d.). This

statistic also reflects the tendency of individuals in the community overusing hospitals as a main

source of care which can be related to the great percentage of individuals that struggle with

access to healthcare due to a lack of insurance coverage.

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Lastly, Miami-Dade County reports 57% of female Medicare enrollee’s ages 67-69 that

receive mammography screenings, compared to top U.S. performers reporting 71%

mammography screenings (Health Rankings, n.d). As a secondary level of intervention,

mammography screenings can be useful in detecting and implementing early treatment of breast

cancer. These mammograms are useful in detecting lumps before they can be felt and reduce the

risk of premature death and costs associated with breast cancer.

Identification of a Priority Health Issue

The priority health issue of Miami-Dade County is the prevalence of newly diagnosed

sexually transmitted infections. As mentioned previously, Miami-Dade County reports 409.8

newly diagnosed sexually transmitted infections (STI’s), compared to the top U.S. performer

reporting 145.5 newly diagnosed STI’s. This issue is of high importance because STI’s result in

a large global burden. Although STI’s effect individuals on every spectrum of life, the Center of

Disease Control and Prevention reports that individuals aged between 15 and 24 account for half

of the 20 million new STI cases that occur each year (Centers for Disease Control and

Prevention, 2017). STI’s negatively impact infected individuals sexually, reproductively,

psychologically, socially, and financially. Additionally, STI’s can be associated with cancer,

infertility, and enhanced HIV transmission (Gottlieb, et al., 2014). Furthermore, with the

societal stigma associated with STI’s, many individuals are resistant to seeking care. Resistance

to seeking care may be a prime factor contributing to the increasing prevalence proportion and

the development of other associated pathologies.

Discussion and Application of Community Health Models

Community health models are important because it supports the goal of promoting health

and preventing diseases. Furthermore, community health models are used to help programs
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understand heath risks and behavior amongst the community and anticipate necessary health

promotion and disease prevention programs. Similarly, the Healthy People 2020 describes the

Determinants of Health as the range of personal, social, economic, and environmental factors

that influence health status (Office of Disease Prevention and Health Promotion, n.d.).

Determinants of health fall under a variety of broad categories that include: policymaking, social

factors, health services, individual behavior, and biology and genetics (Office of Disease

Prevention and Health Promotion, n.d). Integration and analyzing factors from the multiple

categories lead to the development of the most effective population-based interventions.

The factors that affect the priority health issue in Miami-Dade County include: health

services and individual behavior. Healthy People 2020 attests that the lack of availability, high

costs, lack of insurance coverage, and language barriers can negatively impact health by

preventing individuals from seeking preventative care and delaying treatment (Office of Disease

Prevention and Health Promotion, n.d). This is in turn is the cause of many STI’s advancing and

resulting in preventable hospital stays. Individual behavior plays a role in Miami-Dade County

in the prevalence of STI cases when the amount of individuals engaging in unprotected sexual

activities is investigated. Furthermore, integration of these components illustrate the disparities

that individuals in Miami-Dade County are subjected to, thus influencing the priority health

issue.

Population Diagnosis

Young People aged between 15 and 24 in Miami-Dade County are at risk for acquiring a

sexually transmitted infection due to risky behaviors, including unprotected sexual activity.

Community/Population-based Interventions
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Primary Level of Prevention

A primary level of prevention seeks to promote health and reduce the risk of exposure to

a disease (Benedictine, n.d.). In the past, legislation provided funds for abstinence-only

programs and prohibited discussion about safer sex practices, such as condom use (Carter, 2012).

However, this only resulted in more teenage pregnancy and higher incidences of sexually

transmitted infections (Carter, 2012). Therefore, on a community level, primary prevention of

the increasing prevalence of STI’s will include the education on safer sex practices, transmission

mode for the various infections, and condom use for penetrative acts. Stakeholders to which this

intervention is geared toward include: community members that are considering sexual activity,

health care providers, and public officials. Community members are considered stakeholders

because in order to decrease the transmission rates in the community, resident participation is

required. Additionally, health care providers and public officials are considered stakeholders

because they will need to interact with the community in attempt to promote prevention.

However, funding for the necessary educational resources is a concern as Miami-Dade County

encompasses a wide geographic area with a wide array of cultures and languages. Providing an

adequate, succinct educational program to such a diverse population may pose a financial

conflict. As a community nurse, initiation of this prevention will require arrangement of all the

necessary information and determining a method to clearly express the material in a format that

can be easily understood.

Secondary Level of Prevention

Secondary prevention focuses on slowing the progression of the disease (Benedictine,

n.d.). In a retrospective study conducted in 2014, it was indicated that routine screenings

increased the amount of women screened and opened doors for early identification, treatment,
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and decreased infection rates (Ouden, Derouin, Silva, Khan, 2014). Therefore, the secondary

level of prevention for Miami-Dade County is to offer screening and diagnosis of STI’s.

Stakeholders to whom this intervention is geared toward include: community members and

health care providers. Community members are stakeholders as this is the group of individuals

that are designated to receive the screening and diagnosis portion of this level of prevention.

Furthermore, health care providers are equally stakeholder because it is this group that will

conduct the screenings and diagnosis the community members. Concerns following this

intervention include funding. With Miami-Dade County being a large county, it will be

particularly complex for the community to fund screening devices for each individual. This level

of prevention will call for the community nurse to conduct the health screening with the goal of

dramatically decreasing the development of illness.

Tertiary Level of Prevention

Tertiary prevention has the goal of managing, rehabilitating, and improving the quality

of life in individuals that are diagnosed with diseases (Benedictine, n.d.). For the community of

Miami-Dade County, tertiary level of prevention will include monitoring patient compliance to

newly diagnosed health regimens, monitoring potentially adverse effects of treatment, preventing

negative impacts on health, and preventing the further spread of STI’s. Additionally, the goal of

this level of prevention will seek to assist community members with coping with their diagnosis.

Stakeholders to whom this intervention is geared toward include: community members,

legislators, and health care providers. Community members are considered stakeholders in this

level of prevention because the results of the secondary level will have either a positive or

negative impact on their life. Additionally, legislators are considered a stakeholder because they

are responsible for creating and administering policies and programs to deliver health insurance
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and services. Thus, health care providers are a stakeholder because they are responsible for

delivering health care to the affected community members. As a community nurse, the goal is to

create plans of care and assist the members of the community with making necessary lifestyle

modifications.

Development of Health Policy

Reducing the risk of sexually transmitted infections in individuals aged between 15 and

24 residing in Miami-Dade County will be the focus of this health policy. The desire and goal

of this primary prevention is to provide education about the transmission method of sexual

transmitted infections and safer sex practices with the use of barrier methods during penetrative

sexual activities. Stakeholders to which this health policy is geared towards include: community

members, health care providers, public officials, and funding sources. These stakeholders

present as supporters of the health policy because they all possess a general interest in preventing

transmission rates of STI’s before disease progression poses a negative impact on the individuals

life, presents as burden to the wellbeing of the community for public officials, and progresses

into a financial crisis for health agencies that provide funding. Additionally, health care

providers possess a general interest in the development of this health policy because this is the

group that will provide education and awareness to the community.

However, according to the article: Experiences, Perceptions, an Attitudes of Religious

Leaders and Parents Regarding Condom Promotion for HIV Infection and Prevention: A

Qualitative Study from Tanzania, groups in opposition of the development of this policy may

include religious leaders and faith adherents (Mubyazi et al., 2016). The article reports that a

very small amount of religious leaders and non-Catholic parents supported condom promotion

strategies. However, the mass majority did not agree with health education on the basis that
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young children would be exposed to the thought of sexual activity and desire to engage in

premature sex, and that adult people would become promiscuous (Mubyazi et al., 2016). This

opposing thought process may influence other parents and individuals to adopt a similar

ideology. However, this can be combatted by maintaining dialogue with opposing factors in

hopes of arriving at a mutual understanding of the benefits of condom use.

The general plan to put this policy into effect will include developing a lesson plan and

reaching out to community health clinics in the county. Health care providers in the community

will be approached first in an attempt to cover all areas that need to be discussed in the policy.

Additionally, public officials and funding sources will be approached to receive funding for the

necessary resources and to get the educational tool active in the community centers. The policy

will begin as an educational resource that will be utilized in the waiting rooms of various

community health centers.

This health policy will impact the county under study by addressing the needs of

protective sexual activity. The needs will be addressed by use of a succinct and comprehensive

educational tool at community health centers that seek to reduce transmission rates of sexually

acquired infections and improve the wellbeing and longevity of the community. Due to stigma

associated with these types of infections, an overarching, well developed educational resource

will help to enhance the population health by serving as a preventative tool.

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Conclusion

The lack of adequate clinical preventative services is a health issue that is most

concerning in Miami-Dade County. Of the weaknesses indicated, associated statistics, and the

rationales provided, they may all be rectified with revisions, possible education, and adherence

on Miami-Dade County’s primary and secondary level of interventions. Therefore, the priority

health issue is the prevalence of sexually transmitted infection in the county. Attention must be

paid to this issue because it can possibly reduce the incidence proportion of preventable diseases

that occur in the county and the amount of chronic illnesses that occur as a result of late

detection. Revisions and stressed importance on primary and secondary interventions may also

reduce the proportion of individuals that are forced to depend on the tertiary means of

prevention, which in some instances may be too late in restoring individuals of the community

back to their prior health status. Thus, a health policy that focuses on primary prevention via the

use of an educational tool in community health centers is the focus of the health policy for this

community. This policy seeks to serve as a preventative tool in reducing STI transmission rates,

financial burdens associated with prevailing STI rates, and physical and psychological impacts

on individuals due to diagnosis.

This paper is relevant to my nursing career because it discusses health issues that are

prevalent in the community I plan to work in. Analysis of health characteristics of the

community and prior planning of interventions is necessary for providing specialized quality care

to not only the individual, but also to the population.

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