Obesity Among Minority Hispanic And Black Populations In Orange County

Background

Describe about the  Community Field Report for Government and Relevant Stakeholders.

Background

Despite the fact that there have been a lot of attention on obesity, the prevalence and incidence rates of this disorder are continually increasing. According to State of Obesity (2016), the prevalence rate for obesity in Florida has increased by 18.4% from 2000 yet 11.4% increase is noted from 11.4%. Merely based on these statistics, it is apparent that there have been a tremendous change in the demographics of Orange County since 2010 in contrast to previous years, but generally, the general population has increased by an average that is more than twice fold that of the national average (TownCharts, 2016). Stokes (2013) suggests that obesity will become a continuous cycle that will persist if the adult population does not adopt the right living strategies to lay an example for their juniors. Orange County is among the counties in Florida gravely affected by high rates of obesity, which are associated with poor socio-economic status, poor education, and lack of exercise. Yet, individuals in Orange County have a 97.8% access to exercise opportunities (Robert Wood Johnson Foundation cited in “Health behaviors,” 2016). Thereby, this report discusses obesity among the minority Hispanic and Blacks populations by identifying and addressing factors that potentially predispose them to obesity.

Community Description, Orange County                                                                  

Orange County is at the heart of Florida County at the midpoint between Jacksonville and Miami. It consists of 13 municipalities and covers an area of 1,004 square miles. On the north, Orange County is bordered by Seminole County and Osceola County on the south. Lake County borders it on the west while Brevard County is on the east (Orange County Government Florida, 2016).-

In comparison to other counties in Florida, the demographics data that was released in 2015 indicated that Orange county had the highest population at 1,200, 240 as indicated in appendix 1. This population has exponentially grown by 12.4% since 2010 and is largely attributed to migration. The whites make up the largest portion of the population at 69% while the African American account for 22.2% of this population, and the Hispanic/Latinos make up 29.2%. The Blacks and Hispanics are a minority group that does not have adequate resources at its disposable to support good health; thence, this report aims to focus on these two groups of people. The Hispanics, also referred to as the Latinos make up 26.9% of the population in Orange County while Non-Hispanic Blacks make up 19.5% as shown in the figure below (Orange County Government Florida, 2016). 

Community Description, Orange County

Adapted from Orange County (2016)

Population Affected

Since the Hispanics and the blacks are three times poorer than the whites, it is also likely that they are not able to access health care facilities; hence, high rates of poor health including high obesity rates. According to the Community Health Needs Assessment (2013) report, there has been an increase in vegetable and fruit consumption in all population groups of Orange County as well as a stability vis-à-vis a reduction in sedentary lifestyles, binge drinking, and smoking in the previous three years from the time the report was prepared. Nonetheless, the prevalence of obesity in Orange County as part of the tri-county region in Florida increased since 2010.

According to a report by Community Commons (2015), 23.5% of adults from the age of 20 years had a BMI of more than 30.0 as shown below.

Despite the fact that obesity continues to be an issue in Orange County, based on the map below, the initiatives that have been set up within the country have helped to maintain it at levels of less than 26.1%.

In reference to this report by Community Commons (2015), the report area helps to give a tentative picture of the situation in Orange County. Based on this report area as shown below, the decline in obesity is evident and more males than female seem to be affected by obesity.

Health Inequity

Stratton (2013) indicates that there is economic misery among the minority populations by indicating a study that reveals variation in distribution of resources among the various races within Orange County, Florida. Whereas the blacks and Hispanics wallow in high poverty levels and unemployment, the whites sail in riches and occupy the wealthiest areas of the county. Despite the fact that there has been documentation of the strikingly wide gap in income, education, and living standards among the different ethnic groups, interventions have not adequately addressed this issue. Thereby, I intend to bridge this gap by offering mobile health promotion services as outlined in my action plan later in this paper. This will help to increase accessibility to health care because lack of health insurance is an inhibiting factor to accessing health care despite the Healthy People recommendation for 100% health care insurance coverage (Community health needs assessment, 2013).

According to State of Obesity (2014), less nutritious and calorie-dense foods are cheaper and affordable to low-income and poverty stricken populations. In addition low-income households are food insecure and less likely to access the healthier and expensive foods. In the article, “Bill can shower food deserts with nutrition” (2015), low-income populations at the national and county levels have the same fate. Based on this information, the low-income neighborhoods are clustered in areas where supermarkets and fresh produce groceries and related stores are not available. In one study, only 8% of the African Americans lived in areas that had a supermarket in close proximity (State of Obesity, 2014). Also, most of the advertisements in these low-income neighborhoods are of high-calorie foods that are low nutritional value.

Population Affected

The inequities in prevalence and influencing factors of obesity matter because of the associated effects of obesity. According to the State of Obesity (2014), the medical costs associated with preventable diseases, such as heart diseases, high blood pressure, stroke, diabetes, and renal disease, could be avoided if measures to promote equitable distribution of resources were put in place. On an annual basis, the health care system is burdened with $23.9 billion, which could otherwise be reduced or avoided if healthy strategies to attain the recommended weights in relation to height are set in place.

Health Concern

Obesity is a predominant risk factor for cardiovascular diseases, especially coronary heart disease due to the close link between obesity and hypercholesterolemia and high blood pressure (Obesity, 2005). According to Healthy People 2020 (2016), good nutrition, healthy body weight, and physical activity are predecessors of obesity, which is an essential element of an individual’s overall health. The Health People 2020 (2016) note that a large percentage of the American population, and especially those from lower-income households, minority population groups, and neighborhoods referred to as food deserts as described below are not able to maintain a healthy lifestyle through good nutrition and an active lifestyle.

Measures Underway

In 2012, a Mobilizing for Action through Planning and Partnership (MAPP) model was used as part of a Community Health Improvement Plan in Orange County (CHIP) (2012-2015 Orange County, 2012). Whereas this plan is meant to determine the Community needs of the community on a general perspective, there are limited specific strategies or interventions used to address specific issues. In reference to obesity as indicated in this report, objectives were laid down that were to be achieved by the end of last year, but data in this is not available. Since one of the objectives was to determine the barriers of engaging in physical activity despite the availability of recreational facilities noted in “Central Florida” (2016) where individuals can exercise, I will review these barriers and engage the community in resolving them. I intend to use the community groups to encourage engagement in physical activity.

The Florida Department of Health (2014) indicates a myriad of initiatives that the department of health within the country have formulated and engaged in to improve the health status of the people in Orange County. The various models used to improve health status have an impact on obesity in one way or another since it is highlighted as one of the major risk factors for chronic diseases. Since education on nutrition is conducted among the individuals in Orange County, I will gather information on the topics that have been covered in my target population and focus on what has not been taught.

Health Inequity

In an annual report by Florida Department of Health (2014), documentation of the 12 domains of public health accreditation (PHA) health within Orange County was formulated. All the twelve domains of health that were prepared during this time are relevant to obesity, but in reference to this 2013 report, much of the focus was on communicable issues unlike non-communicable ones like obesity. Since the platform in reference to the 12 domains has already being laid down, I will develop an action plan that seeks to utilize the current data on assessment and disparity in resources to develop a health promotion program aimed to educate and encourage the adoption of a healthy lifestyle while integrating evidence-based practices. In this way, I will help to attain the objectives linked to the 12 domains of PHA.

Orange County is part of the Central Florida Community Benefit Collaboration as a move to aid in the implementation of the Patient Protection and Affordable Care Act (PPACA) that stipulates the need for a Community Health Needs Assessment once in three years (“Community Health Needs Assessment,” 2013). The DOH in Orange County appreciates evidence-based interventions through continuous clinical trials and research that helps to improve health service delivery, increase access to health, contain cost, and enhance the sustainability of relevant programs (Florida Department of Health, 2015). This 2015 report indicates that the DOH is aimed at improving the quality of foods accessed by all individuals through reduction of artificial fats and added sugars in the foods. Some entrepreneurs have thought of mobile food markets to increase the availability of the less nutritious foods like fruits and vegetables in neighborhoods that have limited access to groceries and supermarkets (see appendix 2). Breen (2015) gives the example of the Lynx bus, which instead of ferrying individuals and goods, has been transformed into a mobile grocery store that increases availability of these fruits and vegetables. Whereas the move was not linked to nutrition, it will be integrated in my action plan as noted below.

Outcome Identification

The program aims to achieve the benefits associated obesity reduction as described by Ross and Bradshaw (2009). Successful outcomes will include weight loss by at least 5%, reduced waistlines and visceral fat, which are preceding risk factors for cardio-metabolic disorders, by more than 10% and consumption of healthy balanced meals with the recommended portions of the different nutrients.

Planning

Population Focused Objectives

To increase the knowledge level of the Hispanics and the blacks regarding the constituents of a healthy lifestyle

Health Concern

To steer the formation of community support groups through which members can mobilize resources and use them for their benefit, for example, raising money to buy vegetables in bulk at a cheaper price and equally distributing them among the members.

Nurse Focused Objectives

Provide 2-hour education for two weeks on pertinent topics on obesity by liaising with the department of health

Use community groups to indulge in healthy living practices

I will form partnerships right from beginning after formulating my objectives, activities to be accrued out and the indicators of success, as I will prepare a presentation. This presentation will be my ticket for lobbying for funds from the different stakeholders that I will target to be involved in my program. These stakeholders will include, but not limited to community organizations, the department of health, institutions of health within the area, and NGOs since they have been involved in similar programs as noted by “Building a healthy Parramore” (2011), as an example. I will liaise with the main suppliers so that they can supply fresh vegetables and fruits to the individuals at friendlier prices compared to prices of retailer stores. The individuals will make the purchases in bulk through the support groups, and each member will make a fair contribution for this cause. Nonetheless, the buses will continue to supply to individuals within the neighborhoods. Just like Beatty, Harris, and Barnes (2010) note, working with these partners is critical to the project.

Activity	Time	Activity	Indicators
1/9/2016-15/9/2016 excluding weekends		Enrollment of individuals and households into the program	-Number of participants in the register database
17/9/2016 – 30/9/2016	4.00 pm to 6.00 pm	Education by nutritionists, doctors, and psychologists	Knowledge levels using questionnaires Attendance rates Attrition rates
1/10/2016-15/10/2016		Formation of Community support groups	Number of community support groups
16/10/2016-30/10/2016		MOU between the mobile market vendors and community support groups	-Servings of vegetables in the households
1/11/2016	8.00 am to 5.00 pm	Walk to mark the end of the program	Number of participants

Evaluation

Using the planning objectives and the timeline as guides, I will formulate a questionnaire to help me evaluate my action plan in relation to progress and outcomes as recommended by Taylor, Purdue, Wilson, and Wilde (2015). I will periodically conduct surveys to obtain data, which I will analyze and using a pre-post design at different intervals, determine the effects of the program at different time intervals, as noted in the Community Tool Box (2016).

After advertising the program and delineation of participation criteria, followed by enrolment, I will carry out a baseline survey from the people who will take part in the program (Chappelle, 2014). I will leave enrolment open so that individuals wishing to join the program as it progresses can do so after a short assessment. I will monitor the progress of the program by determining the number of participants in relation to the entire population in a neighborhood. Increase in the number of participants will mean that the program has a positive effect on the community; thus, they are ready to give their time to achieve success and sustainability of the program. Attrition rates will indicate a converse scenario, and a need to modify the program. I will determine the success of the program by determining the knowledge levels, weight loss, taking waist line measurement, and assessing the quality of meals in relation to balance and proportions of the different foods.

Measures Underway

Conclusion

Often, people tend to think that the government and relevant stakeholders do not give adequate attention to their plight. In reference to Orange County where there are no grocery stores and deemed as a food desert, the government is trying to develop ideas. The major challenge is usually in its implementation phase due to the availability of several recommendations made on how to address issues, but which are met with little or no groundwork. By addressing the gaps in the interventions that are already underway in Hispanic and Black neighborhoods, I aim to contribute towards alleviating the obesity issue among the minority populations in Orange County, FL. 

References

Beatty, K., Harris, J K., & Barnes, P. A. (2010). The role of interorganizational partnerships          in health services provision among rural, suburban, and urban local health        departments. The Journal of Rural Health, 26(3), 248-258.

Bill can shower food deserts with nutrition. (2015). Retrieved from https://www.orlandosentinel.com/opinion/os-ed-food-deserts-legislation-20150422-    story.html.

Breen, D. (2015). This famers market’s on wheels, bringing produce to ‘food deserts’.        Retrieved from https://www.orlandosentinel.com/news/breaking-news/os-orange-     rolling-farmers-market-20150110-story.html.

Building a healthy Parramore: A call to action to reduce childhood obesity. (2011).            Retrieved from https://www.rockfl.org/sites/default/files/documents/ROCK-            Building_a_Healthy_Parramore.pdf.

Central Florida celebrates 2016 healthiest weight community champions. (2016). Retrieved           from https://www.cityoforlando.net/news/2016/02/central-florida-celebrates-2016-          healthiest-weight-community-champions/.

Chappelle, E. (2014). Establishing a baseline as part of your evaluation. Retrieved from             https://www.cdc.gov/dhdsp/pubs/docs/cb_jan2014.pdf.

Community Commons. (2015). Community health needs assessment: Advancing community          health and well being. Retrieved from             https://assessment.communitycommons.org/UserContents/CHNA_Contents/CHNA330            29RPT_11.pdf.

Community Health Needs Assessment. (2013). Retrieved from             https://www.floridahospital.com/sites/default/files/pdf/chna_with_interactive_toc.pdf.

Community Tool Box. (2016). A framework for program evaluation: A gateway to tools.   Retrieved from https://ctb.ku.edu/en/table-of-contents/evaluate/evaluation/framework-         for-evaluation/main.

Florida Department of Health-Orange County. (2014). Annual report-2014: Putting the     pieces together. Retrieved from https://orange.floridahealth.gov/programs-and-  services/community-health-planning-and-statistics/_documents/annual-report-  2014.pdf.

Florida Department of Health, Orange County. (2015). 2015 Annual report. Retrieved from             https://issuu.com/floridahealth/docs/2015_annual_report.

Health behaviors. (2016). Retrieved from      https://www.opendatanetwork.com/region/0500000US12031-            0500000US12095/Duval_County_FL-          Orange_County_FL/health/adult_obesity_rate/2015?.

Health People 2020. (2016). Nutrition, physical activity, and obesity. Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-     topics/Nutrition-Physical-Activity-and-Obesity.

Obesity: Health crisis in Orange County. (2005) Retrieved from https://www.proindependence.org/documents/obesity_health_crisis_in_orange_county.      pdf.

2012-2015 Orange County Community Health Improvement Plan (CHIP). (2012). Retrieved        from    https://assets.thehcn.net/content/sites/healthymeasures/Project___OCHD___Communit            y_Health_Improvement_Plan_2012_2015.pdf.

Orange County Government Florida. (2016). 2016 Head start: Community assessment      update. Retrieved fromhttps://www.orangecountyfl.net/Portals/0/resource%20library/families%20-  %20health%20-%20social%20svcs/Community%20Assessment.pdf.

Orange County, Florida. (2016). Retrieved from https://www.city-   data.com/county/Orange_County-FL.html.

Ross, R., & Bradshaw, A. J. (2009). The future of obesity reduction: Beyond weight loss. Nature Reviews Endocrinology, 5, 319-325. doi:10.1038/nrendo.2009.78.

State of Obesity. (2014). Obesity prevention in Black communities. Retrieved from  https://stateofobesity.org/disparities/blacks/.

State of Obesity. (2016). Adult Obesity. Retrieved from https://stateofobesity.org/states/fl/.

Stokes, M. (2013). Obesity still high in Orange, Seminole. Seminole Voice. Retrieved from https://www.seminolevoice.com/news/2013/apr/17/obesity-still-high-orange-            seminole/.

Stratton, J. (2013). Study finds economic misery in minority neighborhoods. Retrieved from https://articles.orlandosentinel.com/2013-06-23/business/os-cfb-cover-poverty-         clustering-20130623_1_unemployment-rates-poverty-rates-census.

Taylor, M., Purdue, D., Wilson, M., & Wilde, P. (2015). Evaluating community projects: A  practical guide. 40 Water End, York: Joseph Rowntree Foundation.

TownCharts. (2016). Orange County, Florida demographics data. Retrieved from https://www.towncharts.com/Florida/Demographics/Orange-County-FL-     Demographics-data.html#Figure19.