Introduction
The national initiative Healthy People is a research-based project that outlines goals for the United States’ health improvement for the next decade. With the start of the year 2020, the latest plan, Healthy People 2020, is coming to its conclusion, and many programs and strategies are being reviewed for the future. Thus, it is also possible to see what local healthcare providers and activists were able to achieve and which problems remain prominent in the community.
In Miami (ZIP 33101), in particular, and Miami-Dade County and the State of Florida, in general, many problems were addressed using the Healthy People 2020 objectives. However, some of the concerns are still relevant to the local population, and they need to be analyzed further. This paper looks at such community-based problems in Miami-Dade County as obesity, low rates of immunization against the human papillomavirus, and the lack of awareness and preparation for the 2017 hepatitis A outbreak.
Problem 1: Nutrition and Sedentary Lifestyle
The problem of obesity has reached national levels, with many states struggling to provide people with healthy food options and nutrition knowledge. Healthy People 2020 (2020b) recognizes this issue in one of its current goals – the nutrition and weight of Americans. Here, the main proposed goal is to make sure that people have a healthful diet, which leads to a lower risk of chronic diseases and other health problems.
In Miami-Dade County, the rate of obesity is high; according to the Centers for Disease Control and Prevention (CDC, n.d.), more than 67% of all adult residents are obese. Moreover, more than 10% of all high school students are overweight, and among them, only about 10% exercise daily (CDC, n.d.). In contrast, the state average for daily physical education classes is at 44% (CDC, n.d.). Another contributor to this problem is the residents’ poor diet.
A sedentary lifestyle occurs due to people’s job conditions, the use of cars as the primary means of transportation, and the lack of physical activity. Similarly, poor nutrition can be explained by people’s limited access to healthy foods as well as information about meals. The combination of these factors leads not only to obesity but many health-related problems, including malnutrition, anemia, hypertension, heart disease, diabetes type 2, and others (Healthy People 2020, 2020b).
Thus, this is a critical topic for the US as a whole, and Miami-Dade County in particular. Healthy People 2020 (2020b) suggests increasing food access for children and adults, teaching physicians to address this problem in their workplace, and eliminating food insecurity for low-income communities. Most objectives target the issue on a systemic level, ensuring that people are provided with opportunities to maintain or improve their health.
In Miami-Dade County, this particular concern was tackled by the Communities Putting Prevention to Work (CPPW), a local initiative funded by the CDC. The county’s activists developed a strategy based on the Healthy People 2020 goals of increased access and information. As a result, staff members in child care organizations were trained to advocate for healthier meals, physical activity classes, and screen time. Next, childcare centers and programs were contacted to discuss possible revisions to menus to make them more nutritious. The county’s government installed new bicycle racks to promote alternative means of transportation. Finally, the Sports, Play, and Active Recreation for Kids (SPARK) curriculum was added to more elementary schools (CDC, n.d.).
Overall, one can see that the county implemented a variety of programs to meet the goals created by Healthy People 2020. However, it is vital to note that not all advice was followed. For example, one of the primary objectives that the national project introduced is the reduction of food insecurity through local programs. Thus, the government was urged to help local low-income families to overcome such problems as food deserts and the lack of fresh fruit and vegetables in the diet. According to the latest data, the number of households with food insecurity has decreased in Florida (“Households with food insecurity,” 2018). Nonetheless, it is still an issue that has to be considered by the government.
Problem 2: Immunization for Human Papillomavirus
The rates of immunization differ significantly among the states due to the local policies about vaccination exemptions, people’s perceptions, and the availability of the vaccine. The goal of Healthy People 2020 is to increase these numbers, arguing that it would lead to a reduction in preventable cases of infection. Two of the objectives outlined in the project are to vaccinate more female and male adolescents against human papillomavirus (HPV) (Healthy People 2020, 2020a). The main risk of HPV is that it increases one’s risk of developing a variety of cancers and other diseases. For example,
As it is a common virus, immunization appears to be a necessary step in preventing it from spreading. According to Gowing and Atwell (2020), current legislation in Florida does not make the HPV vaccine mandatory, and the state’s Department of Health does not officially recommend it. The researchers also find that male patients are much less likely to get or know about the vaccine than women. Moreover, uninsured people’s rate of being immunized is substantially lower than that of people with insurance (Gowing & Atwell, 2020). Acknowledging that Miami-Dade has a high percentage of uninsured residents, one may see that issue that pertains to vaccination.
In the objectives of Healthy People 2020, vaccination rates are increased through awareness and education. People learning about the benefits of the vaccine (decreasing the risk of cancer) are expected to view this program positively. The CDC suggests an AFIX approach (Assessment, Feedback, Incentives, and eXchange of information) for physicians and nurses (Kasting et al., 2018).
However, Kasting et al. (2018) find that the use of this strategy is low in Florida, and less than half of all providers engage in these activities in the state. Arguably, this result shows that Miami-Dade County, along with other parts of the state, does not pay enough attention to this particular goal. In the strategic plan for the county’s health initiatives, vaccination is mentioned briefly as a necessary step in preventing infectious diseases (Florida Department of Health in Miami-Dade County, 2019). The lack of detail, nonetheless, reveals an insufficient focus on this specific issue.
Currently, Florida falls behind many states in Healthy People 2020 goal of increasing the rates of immunization. While the national target for male adolescents is set at 80% of immunized patients, the state’s numbers are as low as 38% (“Male adolescents receiving,” 2018). This significant discrepancy between numbers is indicative of the state not following the plan outlined by the national initiative.
Therefore, one may argue that strategies currently used by physicians are implemented based on their motivation rather than state- or county-wide recognition of the problem. As a result of the low rates of HPV immunization, the incidence of oropharyngeal cancer is higher in Florida than in the US overall (Khan & Tomar, 2020). Coinciding with men’s lack of awareness and young boys’ low rate of vaccination, white non-Hispanic men have the highest number of cases in the state (Khan & Tomar, 2020). The absence of official recommendations is considered to be the primary reason for such poor outcomes.
Problem 3: Hepatitis A Outbreak
Finally, the outbreak of hepatitis A that is currently happening across the US can be considered. Florida is among the states with the highest number of cases of hepatitis A. More than 3,300 incidents were reported in 2019, and more than 300 cases have been confirmed since the beginning of 2020 (Florida Health, 2020). According to the official data, in 2019, the number of cases saw a 500% increase, which is indicative of a massive outbreak. Miami-Dade County has relatively low rates of infected persons, but it had some of the most recent reports. This may suggest that the infection is spreading and can reach a higher number if it is not contained in time. The officials are tracking self-reported cases weekly.
Hepatitis A is an infectious disease that is most often spread from person to person in the US. While for some persons, the condition may result in mild symptoms that pass quickly, for others, this disease can last for months. Although the majority of cases do not lead to long-term liver damage, liver failure is a risk for persons with a weak immune system (CDC, 2020). Thus, prevention and vaccination are crucial not only for personal but also for community well-being.
The most efficient way to prevent it is vaccination, and it should be administered quickly to control the outbreak. Healthy People 2020 includes the objective of increasing the rate of immunization for hepatitis A among young children as well as reducing the causes of the infection. Furthermore, the project emphasizes the need to educate and vaccinate people to fight this infection. Currently, Miami-Dade County is adjusting its vaccination plans to adhere to these suggestions.
The official recommendation is to use a VEST approach – “Vaccinate, Educate yourself, practice basic Sanitation by washing your hands, and know that FDOH and our health partners are Tracking the virus” (Florida Health, 2020, para. 1). These activities align with the suggestions made by Healthy People 2020 since they are focused on education and preventive measures. County health departments are also administering the vaccine for hepatitis A to young adults. Overall, the plan should help the state to control the outbreak in the following years.
Conclusion
The initiative of Healthy People 2020 includes a variety of goals for population health, ranging from vaccination to proper nutrition. Most objectives are founded on prevention and education, and they urge local governments to consider the underlying reasons for outbreaks and community-wide issues. In Miami-Dade County, some of the significant concerns are poor nutrition and a sedentary lifestyle that lead to obesity.
The country is working according to the strategy outlined by Healthy People, although it does not implement all suggestions. Another issue is related to the low vaccination rates, which can be explained by Florida’s lack of official recommendations. Here, the county’s government does not follow the advice of Healthy People, which has led to a high rate of HPV-related cancer diagnoses. Finally, the outbreak of hepatitis A can be mentioned as a current problem that the county is combating. The plan falls in line with the national goals that should help control the situation and lower the number of cases.
References
Centers for Disease and Control Prevention. (2020). Viral hepatitis: Widespread outbreaks of hepatitis A across the United States.
Centers for Disease and Control Prevention. (n.d.). Communities Putting Prevention to Work.
Florida Department of Health in Miami-Dade County. (2019). Consortium for a Healthier Miami-Dade: Strategic plan 2019-2024.
Florida Health. (2020). Hepatitis A in Florida.
Gowing, L., & Atwell, L. (2020). The human papillomavirus (HPV) vaccination in Florida.
Healthy People 2020. (2020a). Immunization and infectious diseases.
Healthy People 2020. (2020b). Nutrition and weight status.
Households with food insecurity in the past 12 months (percent). (2018). Web.
Kasting, M. L., Christy, S. M., Sutton, S. K., Lake, P., Malo, T. L., Roetzheim, R. G.,… Kahn, J. A. (2018). Florida physicians’ reported use of AFIX-based strategies for human papillomavirus vaccination. Preventive Medicine, 116, 143-149.
Khan, N., & Tomar, S. L. (2020). The incidence of oropharyngeal cancer and rate of human papillomavirus vaccination coverage in Florida, 2011 through 2015. The Journal of the American Dental Association, 151(1), 51-58.
Male adolescents receiving 2 or 3 doses of HPV vaccine by age 13–15 years (percent). (2018). Web.