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Health Policy Paper Final Draft
Health Policy Paper Final Draft
Courtney P. Whyte
It is important to address major health outcomes in order to help improve the health of the
people. For Polk County one of the major health issues is the number of newly diagnosed cases
of chlamydia. This paper will give an overview of Polk County, strengths and weaknesses in
regards to health outcomes in Polk County, the three levels of prevention in relation to
chlamydia, as well as a proposed healthy policy to address the rising number of newly diagnosed
chlamydia cases.
Polk County is located in the central part of Florida, and is the fourth largest county by
size, with Polk County accounting for approximately 1,800 square miles of Florida’s total size of
around 53,600 square miles (United States Census Bureau [USCB], 2010). Polk County is home
to approximately 666,000 residents, and around 13.5 percent of those residents live in a rural
area (County Health Rankings & Roadmaps [CHR&R], 2018). In Polk County the top three
employers are Polk County School Board, Publix Super Markets, and Lakeland Regional Health
(Central Florida Development Council [CFDC], 2018). Polk County School Board employs
13,000 individuals, Publix employs 11,721 individuals, and Lakeland Regional Health employs
5,605 individuals. (CFDC, 2018). Polk County has five major medical centers, Lakeland
Regional, Watson Clinic, and Winter Haven hospital being the three largest; Lakeland Regional
Health is the fifth largest hospital in Florida, and has the busiest emergency room in Florida.
(CFDC, 2019).
In Polk County, approximately 16 percent of the residents are living in poverty, which is
two percent higher than that of Florida’s average of 14 percent (USCB, 2017).When comparing
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the percent of the population of those 25 years and older who have graduated high school, the
state percent is approximately 88 percent compared to Polk County’s 84 percent. In Polk County,
around 21 percent of the population ages five years and older speak a different language than
English at home, whereas for Florida that percent is higher, at nearly 29 percent. (USCB, 2017).
In Polk County, there are a total of 318 primary care physicians for the county, as of data
published in 2015 (CHR&R, 2015). The ratio of population to primary care physicians in Polk
County is 2,040:1 (CHR&R, 2015). In Florida the ratio of population to primary care physicians
Every county in the United States has strengths and weaknesses when it comes to health
outcomes and health factors for those living in that county. This information can be found on the
County Health Rankings & Roadmaps. This next section will analysis the strengths and
weakness of the health outcomes and health factors in Polk County as well as the impact that the
Identified Strengths
When comparing statistics in Polk County to those of the state average and in some cases
the national average, three areas where Polk County is better or is showing improvement is, the
percent of women who receive mammography screenings, the incidence rate of motor vehicle
crashes, and the percent of the population who report being excessive drinkers. Polk County’s
average for those who receive mammography screenings is higher than the state average but less
than the Top U.S. Performers; the average for Top U.S. Performers is 71%, followed by Polk
County at 69%, and then the average for the state of Florida at 68% (CHR&R, 2014). Polk
County has a lower incidence rate of motor vehicle crashes compared to the state of Florida. For
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Polk County the rate per 100,000 population is 1,523.3, whereas for Florida it is 1,955 per
100,000 (Florida Department of Health [FLDH], 2016). In comparison to the state of Florida,
Polk County’s percent of those who reported being excessive drinker is lower that the state
average. Excessive drinking is considered binge drinking or heavy drinking (Centers for Disease
Control and Prevention [CDC], 2018). Binge drinking for women is considered as drinking 4 or
more drinks on occasion and for men it is drinking 5 or more (CDC, 2018). Heavy drinking for
men is considered drinking 15 or more drinks per week for and for women it is drinking 8 or
more drinks per week (CDC, 2018). For Polk County, 15% of the population report being
excessive drinkers, whereas for Florida the average is 18%, and the Top U.S. Performers is 13%,
(CHR&R, 2016).
Identified Weaknesses
In comparison to state and national data, Polk County definitely has some areas for
improvement when it comes to health outcomes. Three of these areas are: teen birth rate,
sexually transmitted infections (STI’s), specifically the number of newly diagnosed cases of
chlamydia, and the percent of adults that are obese. The teen birth rate in Polk County is worse
than the state average and the Top U.S. Performers average. The number of births per 1,000
females ages 15-19 is 36 in Polk County, 25 for the state of Florida and 15 for the Top U.S.
Performers (CHR&R, 2016). Adolescents have a higher rate of poor birth outcomes such as
premature births and low birth weights (McCracken & Loveless, 2014). The number of newly
diagnosed cases of chlamydia per 100,000 population is substantially higher in the state of
Florida, especially in Polk County. In Florida the rate is 454.8 per 100,000, in Polk it is 482.3 per
100,000 compared to the Top U.S. Performers average of 145.1 per 100,000, (CHR&R, 2015).
Repeat infections are in common in those who have had chlamydia before and for women repeat
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infections increases a women’s risk for ectopic pregnancies and pelvic inflammatory disease
(CDC, 2016). Obesity is an issue nationwide, with that Top U.S. Performers averaging at 26%,
the state of Florida at 26%, and Polk County having a higher average at 34% (CHR&R, 2014).
Obesity predispose individuals to other serious health disease and conditions such as stroke,
coronary heart disease, type two diabetes, and hypertension (CDC, 2015).
Safe sex practices are very important to be educated upon, but also to put into practice.
From the previous data, in Polk County the teen birth rate and the rate of newly diagnosed cases
of chlamydia are significantly higher than that of the State and National average. The priority
health issue that will be focused on is STI’s but specifically, the rate of newly diagnosed cases of
chlamydia in Polk County. Chlamydia is a common bacterial infection that can be easily treated,
but if left untreated can lead to serious health issues. Untreated chlamydia can lead to a women
having pelvic inflammatory disease (PID) which cause infertility in women, (CDC, 2014). It is
important for both men and women to get tested for STI’s and to use protection during all forms
of sex. Early detection of STI’s helps prevent longer term complications related to undiagnosed
and untreated STI’s as well as condom use helps prevent the transmission of STI’s.
Social determinates of health must be addressed in order to improve ones’ health and
provide an environment to promote good health for all. There are five main components to the
social determinants of health and they are: economic stability, education, social and community
context, health and health care, and neighborhood and build environment (Healthy People 2020,
2019). Economic stability, education, and health and health care are three determinates that relate
to sexually transmitted infections (STIs). Most STIs can be prevented by the proper use of
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condoms. If one doesn’t know how to properly use condoms or cannot afford condoms then STIs
can easily be transmitted to many (CDC, 2013). Most STIs can also be easily treated but with a
lack of accessibility or insurance to see a doctor, STIs can be left untreated for months and can
cause further complications (Healthy People 2020, 2019). These factors need to be addressed in
Population Diagnosis
Adolescents and adults, especially those ranging from 15-24 years of age are at higher
risk of contracting chlamydia due to increased risk factors such as unprotected sex, multiple sex
Population-based Interventions
In Polk County, the rate of newly diagnosed cases of chlamydia is worse than the national
average, and is trending upwards (CHR&R, 2015). Chlamydia is a sexually transmitted infection
(STI) that can be prevented through condoms and safe-sex practices, and can also be easily
detected and treated (CDC, 2016). Primary prevention is focused on preventing disease,
secondary prevention is focused on screening and treatment of disease and tertiary is focused on
One way to prevent from getting a STI, specifically chlamydia is the use of condoms
during all forms of sexually activity. In New York City, the Department of Health and Mental
Hygiene (DOHMH) launched The Free Condom Initiative with the goal of increasing condom
acquisition and use within their community (Renaud et al., 2009). This program was launched in
2005 and from 2004 to 2006 the DOHMH increases their distribution of condoms from
approximately six million to approximately 18 million. This program was designed so that
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organizations order condoms online and then received the condom shipment directly from the
manufacturer to distribute out to the community at their respective business or organization. This
program cost the DOHMH slightly above one million dollars but this program was estimated to
save millions of dollars due to infections averted. (Renaud et al., 2009). How this program could
be applied to Polk County would be the implementation of a similar program under the direction
and supervision of the County Health Department. According to CDC, in 2016 individuals
ranging from 15-24 years of age had the highest rate of chlamydia (CDC, 2017). Organizations
and businesses such as County Health Clinics, Polk County School Board, and colleges located
within Polk County would be the focus of marketing for this program. Nurses located at the
organizations and businesses would be responsible for ordering the condoms and distributing
penis and vagina model. The teach-back method should be employed so that individuals can
properly demonstrate condom technique on either a penis or vagina model depending on the
Chlamydia is the most commonly reported sexually transmitted infection and is typically
asymptotic in women (LeFevre, 2014). With chlamydia often being asymptomatic it can go
undiagnosed and untreated for a while. Untreated chlamydia can lead to serious complications
later in life such as pelvic inflammatory disease, infertility, and chronic pelvic pain, (CDC,
2014). The USPSTF highly recommends that sexually active women under the age of 24 get
screened and women who are older but at an increased risk get screened as well (LeFevre, 2014).
The USPSTF found adequate evidence that screening tests accurately detect chlamydia and helps
reduce complications of chlamydial infection (LeFevre, 2014). It is important that individuals get
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screened to help prevent further complications of the disease. In Polk County, individuals should
appointments, and at schools. It is important that individuals are educated about risk factors for
chlamydia such as a new sexual partner, multiple sex partners, or engaging in unprotected sex.
Since chlamydia can go undetected it is important that nurses and physicians evaluate patients
for these risk factors. Chlamydia is diagnosed by using nucleic acid amplification tests (NAATs)
and the sensitivity and specificity of this test is very high, creating very accurate test results
(LeFevre, 2014). A program that has been successful in other states is a school-based sexually
transmitted disease screening (SBSS) which provides education, screening, testing, and
counseling to students at their school (Lewis, Dittus, Salmon, & Nsumai, 2016). This program
was estimated to cost approximately $130.00 per student tested. It was mentioned that this is a
cost-effective program as a whole but requires a substantial investment of time and resources
from the provider of such program. (Lewis et al, 2016). A program like this could be very
beneficial to students in Polk County. Polk County Health Department and Medicaid could be
utilized for funding and resources. School nurses could take on the lead role of providing
education to students about safe sex practices and risk factors for chlamydia as well as what to
expect with testing and providing the students with the testing kit. If the students choice to
partake in the screening and test positive, they would then be provided in-school treatment,
important that individuals who are diagnosed with chlamydia notify their sexual partners about
their potential exposure and get tested as well (LeFevre, 2014). Those diagnosed with chlamydia
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should follow the treatment regimen prescribed to them and get re-screened. It is important that
re-screening occurs to make sure that the individual is free from infection. If left untreated, or not
completing treatment in its entirety can leave an susceptible to reproductive complications. The
SBSS program offers re-screening in schools, which would be beneficial to this vulnerable
Primary level interventions in regards to sexual education are very important and there
are laws mandating sexual education, but there is controversy over what should be taught in
schools: abstinence versus safe sex practices. The Florida Department of Education (FDOE)
requires sexual education be taught in schools with a focus of sexual abstinence as the expected
standard in accordance with Florida State Statute Section 1003.46 (FDOE, 2018). The United
programs (Santelli et al., 2017). AOUM programs have been found to be ineffective at delaying
the onset of sexual activity, ineffective at changing other sexual risk factors as well as
Acknowledging that adolescents will have pre-marital sex is the first step in changing the
policy in regards to sexual education teaching in schools. A shift from abstinence only education
to prevent unwanted outcomes from sexual activity to education on safe-sex practices can be
beneficial in the prevention of STI’s and unintended pregnancies (Pound, Langford, & Campbell,
2016). Sexual education should still be required to be taught in public schools but with a focus
on safe-sex practices. This would include the implementation of a Free Condom Initiative in
Polk County schools as well as proper education to students on how to effectively use condoms
to prevent the transmission of STI’s and prevent unintended pregnancies. Chlamydia rates are of
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concern amongst adolescents in Polk County, and so is the incident rate of teen births.
Implementing the Free Condom Initiative and proper education has multiple goals with the focus
on improving the sexual health practices and knowledge in adolescents residing in Polk County.
These goals include reducing the number of newly diagnosed chlamydia cases, decreasing the
number of teenage births and the complications that are associated with teenage births such as
The FDOE should be reached out to first to make a change to their police. Since the
FDOE already has a policy in place in regards to requiring sexual education in public schools an
addendum to that policy stating the transition from abstinence only education to safe-sex
practices could be implemented. The next step would to be contacting the Polk County Health
Department. Since the Free Condom Initiative would provide free condoms to students it is
important to find funding to support this initiative and the goal would be that the funding would
come from the health department. Polk County Health Department would also be in charge of
coordinating with condom companies and distributing the condoms to the schools in the county.
The health department is also in charge of evaluating the effectiveness of the program. This can
be done by collecting and evaluating data in regards to the newly diagnosed cases of chlamydia
as well as the number of teen births after the implementation of this program. The next
population to address would be the nurses and teachers at the public schools. The nurses and
teachers would be the ones in charge of distributing the condoms and providing education on the
proper usage of condoms. It is important the educators present this material and demonstrations
in a safe environment due to the sensitivity of this subject. Condoms should be available in
public spaces such as the nurses office, and specific classrooms and bathrooms so that students
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can have access and don’t have to feel awkward asking for them since that could be a potential
Major associations of physicians and public health workers as well as many health
professionals have supported and endorsed comprehensive sexual education (Santelli et al.,
2017). This policy is focused on providing comprehensive sexual education so the hope would
be that these healthcare workers would support the change from abstinence to comprehensive
sexual education in schools as proposed. A group that could possible oppose the proposed change
in policy would be certain religious groups such as Roman Catholics and Muslims. These
religious groups do not condone pre-martial sexual activities and are big supporters of abstinence
until marriage.
Conclusion
Addressing major health issues is important because it relates to health outcomes of the
population. Chlamydia is a health issue that is prevalent in Polk County, Florida so thinking as a
community health nurse it is important to address why it is so prevalent and how to prevent
further infections. Chlamydia can be easily prevented by the proper use of condoms and can be
easily detected and treated, and it is important to get tested frequently due to this infection
typically being asymptomatic and having a high rate of re-infection. Education is a key
Health in Polk County, at least once a week I was helping take care of a patient who came in due
to either pelvic pain, vaginal or penial discharge or discomfort during sexual activity. It was very
common for the patient to be treated prophylactically for gonorrhea and chlamydia in the E.R.
due to lab results taking a couple of days for diagnosis. One thing that I found that was common
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amongst those visiting the E.R. is a lack of a primary doctor or not being able to get an
appointment soon enough. Something so little like providing teaching about safe sex and free
condoms can make a big impact. For me as a future E.R. nurse, this proposed plan would
hopefully reduce the number of patients who have chlamydia which would then reduce the
number of patients coming to the E.R. for treatment therefore saving time and money as well as
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