Epidemiology in Miami in Healthy People 2020 Context

Introduction

Healthy People 2020 is a national government initiative spearheaded by the CDC to address the most critical issues and health improvement priorities in the United States. This was done by creating evidence-based 10-year projections and objectives that national, state, and local public health agencies and medical organizations seek to achieve to improve overall population health. With more than 1,300 various objectives in 42 topic areas, Healthy People 2020 attempts to be a universal tool, but cities may benefit from focusing on certain aspects based on local health patterns and epidemiology of conditions that affect specific regions (Centers for Disease Control and Prevention, 2019). In this assignment, the city of Miami (zip codes 33139-141) will be examined through the lens of Healthy People 2020 objectives and a plan of action will be presented to address them in the local public health context.

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Problem I

The primary health issue identified for Miami is inadequate access to health care, both in terms of physical access and the number of people uninsured or unable to afford treatment. The number of adults with a stable source of health care remains at 63.8% below the 89.4% HP 2020 target, while only 75.5% of adults are insured (Miami-Dade County, n.d.). While these seem like high percentages, those that lack stable health care or insurance are heavily impacted, particularly in communities where low socioeconomic or minority status can lead to significant discrepancies in overall health provision and access. The high cost of living and medical care in Miami results in population groups without stable access to healthcare to experience higher rates of health issues, disease, and potentially early death. Without appropriate health care access and utilization, public health benefits such as vaccinations or prevention of chronic or complex diseases cannot be fully successful. While the Affordable Care Act (ACA) has sought to eliminate these disparities, there are evident barriers presented, particularly in urban areas such as Miami and have a major impact on low-income communities for Latinos and African Americans (Chen, Vergas-Bustamante, Mortensen, & Ortega, 2016).

Problem II

One of the biggest problems affecting Miami is a consistently high rate of overweight and obesity for adults, lingering at 67.4% which although on par or slightly above national average, remains a prominent public health concern (Centers for Disease Control and Prevention, n.d.). Under the topic area nutrition and weight status for Healthy People 2020 there are numerous objectives such as reducing proportions of adults and children who are obese and increase the proportion of adults with a healthy weight (Office of Disease Prevention and Health Promotion, 2019a). Obesity results in prominent health issues due to risks of comorbidities and chronic disease such as diabetes, high blood pressure and stroke among others. This negatively impacts quality of life, life satisfaction, economic productivity, and healthy longevity of the population. In Miami, this leads to increased pressure on the health system and increased prevalence of chronic and acute conditions that also do not meet Healthy People 2020 goals.

Problem III

The third identified problem in Miami is a high rate of communicable diseases, particularly STIs, HIV, and Tuberculosis. The Miami statistics, particularly for HIV remains significantly higher than the national rate at 47 per 100,000 (Miami Jewish Health Systems, 2019). A number of objectives in Healthy People 2020 under the topic area sexually transmitted diseases and HIV focus on reducing rates of HIV/AIDS and various STIs (Office of Disease Prevention and Health Promotion, 2019b). High rates of infectious and communicable diseases can have prominent impacts on communities, particularly in those with low access to healthcare discussed in the first problem. Communicable disease result in higher morbidity and mortality rates that have profound impacts on local economy, including productivity, life expectancy, and other public health burdens (Cuningham et al., 2019). The rise of infectious diseases and STIs in Miami is an evidence of a struggling public health system, as well as indicators of poor sexual education and potentially promiscuous culture of unprotected sex. As a result, this influences negative STD stigma and teenage health education and status.

Identification and Plan of Action

The identified problems and subsequent objectives were identified based on local population health needs assessment conducted by one of the largest medical centers in the area as well as information and statistics provided by the Miami-Dade County health department (Miami Jewish Health Systems, 2019). Some elements of personal experience of living and working in Miami medical circles were also considered. The three identified problems are inherently interconnected, as limited access to healthcare leads to poor treatment of infectious diseases and poor long-term longevity of individuals with chronic disease.

Therefore, the plan of action must be a complex multi-factored response. Improving access to healthcare can be done by lowering the cost of healthcare and insurance as well as implementing affordable community health programs that provide timely access. On a local level, Miami can implement targeted health initiatives for vulnerable populations such as geriatric, mental health, and minority patients (Osborn, Squires, Doty, Sarnak, & Schneider, 2016). In combination, both infectious and chronic disease problems can be addressed through focused education and rehabilitation programs that eliminate stigmas around the issues and present viable tools people can implement in daily life. Community-focused health education on lifestyle behaviors can be efficient in the long-term (Alicea-Planas, Pose, & Smith, 2016).

References

Alicea-Planas, J., Pose, A., & Smith, L. (2015). Barriers to providing health education during primary care visits at community health centers: Clinical staff insights. Journal of Community Health, 41(2), 220–225. Web.

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Centers for Disease Control and Prevention. (n.d.). Miami-Dade County, Florida obesity prevention. Web.

Centers for Disease Control and Prevention. (2019). Healthy People 2020. Web.

Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical care, 54(2), 140-146. Web.

Cuningham, W., McVernon, J., Lydeamore, M. J., Andrews, R. M., Carapetis, J., Kearns, T., … Campbell, P. T. (2019). High burden of infectious disease and antibiotic use in early life in Australian Aboriginal communities. Australian and New Zealand Journal of Public Health, 43(2), 149-155. Web.

Miami Jewish Health Systems. (2019). Community health needs assessment. Web.

Miami-Dade County. (n.d.). Healthy People 2020 progress tracker. Web.

Office of Disease Prevention and Health Promotion. (2019a). Nutrition and weight status. Web.

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Office of Disease Prevention and Health Promotion. (2019b). Sexually transmitted diseases. Web.

Osborn, R., Squires, D., Doty, M. M., Sarnak, D. O., & Schneider, E. C. (2016). In new survey of eleven countries, US adults still struggle with access to and affordability of health care. Health Affairs, 35(12), 2327-2336. Web.

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