Running head: CAPSTONE PAPER

Capstone Paper: The Health of Pinellas County

Sean Briceno
University of South Florida College of Nursing

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Introduction

Pinellas Countys population is estimated to have over 900,000 people since 2014 and is
steadily increasing. Two major cities located in Pinellas are St. Petersburg and Clearwater. The
county spans 273 square miles, with over 3,000 people per square mile (United States Census,
2014). Pinellas largest company is Raymond James Financial, a securities brokerage
corporation located in St. Petersburg employing a workforce of roughly 3,500 employees.
Another corporation worth mentioning in St. Petersburg is Bright House Networks. They are a
television broadcasting network employing approximately 2,000 employees. A major company
located in the city of Clearwater is called Tech Data Corp. They are a computer and software
corporation employing roughly 1,500 employees (Pinellas County Economic Development, n.d.).
Pinellas Countys overall health rank is 33 out of the 67 counties in Florida. Only 14 percent of
the countys population is in poor or fair health compared to the state average of 16 percent.
Interestingly, 14 percent of the people in Pinellas are below the poverty level compared to
Floridas 16 percent. The percentage of the population in Florida that are 25+ years old and have
high school diploma is 86 percent, whereas Pinellas County percentage is higher at 88.9 percent.
Thirteen percent of Pinellas population over the age of 5 speak a language other than English in
contrast to the 27 percent at the state level (Health Ranking, 2015). Pinellas is one of the most
influential counties in Florida due to its size and workforce. The county has strengths and
weaknesses related to the health of the community. One weakness in particular is the number of
people who are overweight and obese. This number is too high and needs to decrease.
Strengths and Weaknesses of Pinellas County
Pinellas County has some strengths regarding the health of the community. Pinellas
County excels with low annual particle pollution, high health care provider to person ratio and

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low percentage of people hospitalized due to dehydration. The American Lung Association
grade county particle pollution on a scale of A to F, with A being the highest grade and F being
the lowest grade. The grade is based on the number of days particles pollution exceeded US
standards during a three year measurement period (American Lung Association, 2015). The
inhalation of pollution in excessive quantities can adversely affect the health of a county through
illnesses such as asthma, cardiovascular complications, or premature death. From 2011-2013
Pinellas County has received the top score of A for annual particle pollution (Healthy Tampa
Bay, 2015). Another strength of the county is its high health care provider to population ratio. In
2012 there were 87 health care providers to every 100,000 people. This ratio is important
because more access to primary care providers will increase the likelihood that community
members will have routine checkups and screening. In addition, people in acute situations with
easy access to primary care will be more knowledgeable in choosing where to obtain treatment.
According to Healthy Tampa Bay, Communities that lack a sufficient number of primary care
providers typically have members who delay necessary care when sick and conditions can
become more severe and complicated. (Healthy Tampa Bay, 2015). Pinellas Countys
population suffers low from dehydration. Dehydration is the excessive loss of water from the
body. It can be caused from diabetes, fever, burns and heat exposure. Infants are more
susceptible to dehydration than adults because they can lose fluid faster. Severe dehydration can
become life-threatening if left untreated. In 2011-2013 only four people out of every 10,000 in
the county were hospitalized for dehydration. This is a substantial decrease from 2007-2009
were the hospitalization rate was at 7.3 people out of 10,000 (Healthy Tampa Bay, 2015).
With all of Pinellas Countys strengths there are some weaknesses that the county can
make significant efforts to improve. A few of these weaknesses include the percent of residents

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with health insurance, hospitalization rate of people with short-term complications associated
with diabetes, and the high number of people who are overweight or obese. In 2013, only 74
percent of Pinellas residents had some form of health insurance compared to the 2008 statistic
where 76 percent of Pinellas Countys population had health insurance (Healthy Tampa Bay,
2015). The Healthy People 2020 national goal is to increase the percentage of people with health
insurance to 100 percent (Healthy People 2020, 2015). According to Healthy Tampa Bay,
Medical cost in the United States are extremely high, so people without health insurance may
not be able to afford medical treatment or prescription drugs (Healthy Tampa Bay, 2015).
People without medical insurance are also less likely to complete routine checkups and
screenings due to their high cost. Because of the lack of checkups people are more likely to not
seek treatment until their condition is more advanced and therefore it will be more difficult and
expensive to treat. Another health issue plaguing the county is the hospitalization rate of people
with short-term complications of diabetes such as hyperglycemia, hypoglycemia and diabetic
ketoacidosis. From 2011 to 2013 there were 8.4 hospitalizations per 10,000 people over the age
of 18. This statistic is on the rise because from 2007 to 2009 there were only 5.8 hospitalizations
per 10,000 people. Risk factors such as obesity and physical inactivity play a role in the increase
of hospitalization due to complications of diabetes (Healthy Tampa Bay, 2015). The Healthy
People 2020 goals are to reduce the disease and economic burden of diabetes and improve the
quality of life for all persons who have or are at risk for diabetes. Healthy People 2020 wants to
improve diabetes education, improve screening procedures and reduce the rate of complications
such as foot ulcers (Healthy People 2020, 2015). One additional weakness of the county is the
excessive number of people who are overweight or obese. According to the Center for Disease
Control and Prevention (CDC), More than 63% of Pinellas County adults are overweight or

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obese. The CDC estimates that 29.5% to 33.5% of children ages two to four and 25%-29.9%
of high school students in Pinellas County are overweight or obese. Being overweight or obesity
can lead to numerous health problems (Center for Disease Control, 2013). Increased weight can
put a person at risk for certain illnesses such as: coronary heart disease, hypertension, stroke,
type 2 diabetes and gallstone (National Heart, Lung, and Blood Institute, 2012).
Pinellas Countys healthcare priority should be lowering the amount of people who are
overweight and obese. The goal of Health People 2020 is to increase the national percentage of
persons aged 20 and older who are at a healthy weight to 33.9% by the year 2020 (Healthy
people 2020, 2015). To reach this goal Pinellas needs to lower their percentage of people who
are overweight or obese. This reduction will not only increase the health of the county but also
decrease the amount of money people have to pay for medical services.
Determinates of Health Model and Population Diagnosis
The Determinate of Health Model is the framework for reaching Healthy People 2020
goals. The model is useful to the community health nurse because it helps the nurse develop
interventions that address a populations health issues. The health model is used to produce
interventions based on the determinate of health categories. The Determinate of Health Model
categories include: policymaking, social factors, health services, individual behaviors, biological
factors and genetic factors. These interventions are used to produce outcomes that will typically
target more than one category and will produce outcomes that positively affect a population
(Healthy People 2020, 2015). One Determinate of Health that affects obese people is their
individual behavior. People who are overweight or obese have trouble managing their eating
habits and weight. A study published by Elsevier, researchers evaluated obese adults eating
behavior and motivation to lose weight. The participants were selected at random into a three-

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year lifestyle intervention group and control group. The researchers found that weight decreased
more in the intervention group than in the control group. Cognitive restraint increased in the
participants who lost weight and the successful dieters show a long-term improvement of
uncontrolled eating. This study demonstrates that with the right help and determination people
that are obese can manage their weight (Nurkkala M. et al, 2015). Another Determinate of
Health is unsupportive social interactions that influence emotional eating behaviors. A study
published by Elsevier researchers found that unsupportive social interactions serve as a powerful
predictor of health outcomes. Unsupportive social interactions seem to act as a stressor and was
associated with the adoption of ineffective coping styles such as over eating (Raspopw K.,
Matheson K., Abizaid A., & Anisman H., 2013). The Pinellas County community is at risk for
obesity related to individuals behavior and unhealthy coping mechanism as evidence by 63% of
Pinellas County residents are overweight or obese.
Community Based Interventions
The primary level of prevention is prevention before the disease or injury occurs. The
primary prevention goal of obesity is to prevent weight gain. The interventions in the primary
level of prevention are focused on promoting individuals ability to maintain a healthy weight.
According to the National Heart, Lung, and Blood Institute following a healthy lifestyle can help
prevent overweight and obesity. Individuals will want to prevent any unhealthy weight gain by
making healthy food choices and keeping a balance between calories consumed and calories
expended. Regular physical activity and limiting the amount of sedentary time will help to
maintain a healthy weight (National Heart, Lung, and Blood Institute, 2012). The community
health nurses role in primary level of prevention is to assess for any unhealthy weight gain and
promote healthy lifestyle patterns such as physical activity and balanced calorie consumption.

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Once an individual is overweight or obese the person is in the secondary level of

prevention. The goal of the secondary level of prevention is to reduce the effect of the disease or
injury that has already occurred. Obesity is diagnosed in adults when their body mass index
(BMI) is at an obese level for their height and age. The interventions for the secondary level of
prevention focus on lifestyle modifications for obese individuals. Focusing on balancing the
number of calories consumed and the number of calories expended will help to reduced weight.
According to the National Heart, Lung, and Blood Institute consuming 1,000 to 1,200 calories in
women and 1,200 to 1,600 calories in men will help individuals lose weight. Eating foods low in
fat can help reduce the risk of cardiovascular disease associated with obesity. Regular physical
activity will help to increase the number of calories expended which in turn will aid in losing
weight (National Heart, Lung, and Blood Institute, 2012). The community health nurses role
during the secondary level of prevention is to monitor weight, provide support and
encouragement to the individual as they lose weight.
The tertiary prevention aims to reduce the impact of an ongoing illness or illness that has
lasting effects. The tertiary level intervention for obesity focus on preventing further weight
gain. To maintain a healthy weight the individual needs to preserve their healthy eating habits
and stay physically active. Health experts from the national Heart, Lung, and Blood Institute
recommends tracking weight, body mass index, and waist circumference (National, Heart, Lung,
and Blood Institute, 2012). The community health nurses role during the tertiary level of
prevention is to monitor the individuals weight, promote healthy lifestyle patterns such as
physical activity and a balanced calorie consumption.
Development of Health Policy Proposal

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Health policies in general are actions undertaken to achieve a specific health goal. One
crisis facing Pinellas County is the risk for increased obesity related to individuals behavior and
unhealthy coping mechanisms. The secondary level of prevention focuses on reducing
individuals weight and promoting lifestyle changes that will help an individual to maintain a
healthy weight. One proposal that can lower the overweight and obese rate in Pinellas County is
to provide incentives to food retailers for them to offer healthier food and beverage choices.
Food retailers can be incentivized with money to offer foods with better portion size, low in
calorie, sugar, fat and sodium. The goal of the proposal is to see a decrease in the number of
obese individuals in Pinellas County. The people that will be affected by the proposed health
policy is the community as a whole. Healthy weight and unhealthy weight individuals will have
healthier food options available for purchase. Supporters of the proposal are healthcare
organizations such as the National Heart, Lung, and Blood Institute and the Centers for Disease
Control. These health organizations will also be able to help fund the proposal. People who
opposed the proposal are large fast food restaurant chains. They are opposed to the proposal
because their competition will be receiving benefits and they will not receive any benefits. The
first step towards putting the policy into action is to gain the support and funding from health
organizations. This proposal will benefit the health of the community in Pinellas County by
lowering the amount of overweight and obese individuals in the county.
Conclusion
In conclusion, Pinellas County has strengths and weaknesses when it come to the health
of the countys community. Some strengths of Pinellas County are low annual particle pollution,
high health care provider to population ratio, and low hospitalization rate of people due to
dehydration. Some weaknesses associated with the health of Pinellas County residents are low

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percentage of residents with health insurance, hospitalization rate of people with short-term
complications of diabetes, and the high number of people who are overweight or obese. With the
right health policies Pinellas County can reduce the amount of overweight or obese individuals in
the community.
Word Count: 2,272

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