Miami-Dade Community Needs Assessment

Overview

Description of the Community

History

Evidence of Native American settlement in the region dates back to 12,000 years ago. They are known to settle on the banks of Miami River with their villages towards the north. The Tequesta Indians were the first people of contact during the European invasion. They were hunters and gatherers (Parks, 1991). Dade County was created in 1836, named after Major Francis Dade who was killed in the Second Seminole War. After making changes to its boundaries, the Dade County excluded Palm Beach and Broward Counties. In 1997, the people of the county voted again for the name change to the current Miami-Dade County, thereby identifying it with the larger Miami city which is located within it (Muir, 1953).

Type of Community

As a place, the county has glaring health disparities, which need to be addressed. The population is largely urban. Under 20 percent of the population is considered middle class; it is one county with the highest poverty levels countrywide despite the fact that the county is among the top ten counties with the most millionaires. Data reveals that these disparities occur due to racial and ethnic differences. Up to 26 percent of black Americans live under the poverty line in comparison with 17 percent of Hispanics and 10 percent of white non-Hispanics. These disparities are also present for education, where 92 percent of white non-Hispanics have at least a high school degree. On the other hand, only 72 percent of African Americans and 73 percent of Hispanics have the same level of education.

Physical Environment Considerations

Description

The county is located in the southeastern part of the Florida state and is the southeastern-most county in the country. It bears a land area of 1946 sq. miles and the county seat is in Miami. The county hosts 34 incorporated cities and several other unincorporated areas (United States Census Bureau, 2011). Heavily urbanized areas line the north, central and eastern parts of the county culminating in the location of Miami. The southern part consists the Redland and Homestead area, making up the agricultural economic area sparsely populated. This is completely different from the densely populated areas in the northern part.

The county is 6 feet above sea level (United States Census Bureau, 2011). The plate is rather new and is on the eastern edge of the Florida platform. The Miami-Dade area is the last areas to be formed with most of its flora and fauna dating back to the Pleistocene period. The bay contains the Miami Beach and South Beach. Florida Keys is accessible through the county but is part of the neighboring Monroe County.

Boundaries

The county is bordered by Broward to the north, Monroe to the southwest and Collier to the northwest.

Environment

The county contains three protected areas, namely: Big Cypress, Biscayne and Everglades National Parks. It is also home to the Miami International Airport, and is one of the busiest airports in the world, catering to over 35 million passengers every year. This airport is the largest hub for the American Airlines, which is the biggest passenger carrier worldwide. This airport is the country’s third largest entry point for international air passengers and ranks seven in the world. Disaster management is keen in the area, noting the potentials for disaster in the entire state. Food quality and supply ensures that it is a county that is well-fed although there are high poverty levels.

Housing

With regards to housing, there were 2.2 million people living in the county as of 2000, with close to 550,000 families. The average population density was 1158 people per square mile. There were 852,278 housing units, bringing the density to 438 units per square mile (US Census Bureau, 2010).

Leading Industries and Occupations

In Miami, the largest part of the economy has been supported by tourism. In fact, this is an all-year round economic activity in this part of the world, as people from the colder northern regions move to Miami to enjoy the beaches even during winter. In the year 2003, over 10.4 million visitors spent the night in the greater Miami, boosting the local economy with over $9.9 billion in direct expenditure. Additionally, the city is host to hotels, restaurants, transportation to attractions, and shopping experiences. Moreover, other industries such as medicine, real estate and real estate are a great part of the county’s economy with the growth in tourism being ever-expanding (City Data, 2010).

The Beacon Council exists for the purpose of job creation in Miami. The Council is one of the local efforts put in place in the larger Miami area to recruit new business to the county by providing services such as site identification, the recruitment and training of labor, providing business research as well as provide localized inceentives to the intending businesses. As a result, many diverse forms of employment exist in the county based on the favorable conditions for setting up a business in the county, including favorable taxes and business incentive programs in place. For instance, the Grow Miami Fund is presently providing grants to qualified small businesses with low interests, with amounts of up to $2 million (US Census Bureau, 2010).

The People of the Community

Population Profile

Miami-Dade County consists the largest metropolitan area in Florida. It represents just over 13% of the state’s total population and is the eighth biggest county of the country. It is approximated that the county hosts just over 2.5 million as of 2012. There were just over 867,000 households. 30 percent of these had children who were minors, 43 percent were married couples living together whereas 18.7 percent were female single parent households. 30.4 percent were non-families. 8 percent of the families lived with someone over the age of 65 while the average household size was 2.83. Average family size was 3.3 people. Over 50 percent of the total population being foreign born, were from many countries with 47 percent of them being naturalized citizens (US Census Bureau, 2010). The most common countries of origin was Cuba, Nicaragua and Colombia, among other Latin American countries.

Biological Considerations

In this county, it is considered a minority-majority county, where the minority groups have a higher population than majority groups. As a result, the county hosts a 66% Hispanic population, 19% African American, non-Hispanic, whereas white non-Hispanic Americans are only 15% of the population. It is estimated that up to 52 percent of its population is born in foreign countries – thereby representing the greatest percentage in all of the American counties. Over 72 percent of residents older than five years old speak a language other than English when they are home, which is normally Spanish or Creole. The population is relatively young, with a majority of the population (86%) under 65 and 22 percent under 18 (Brown, et al., 2016).

As of 2011, the leading causes of morbidity among the population were cardiovascular diseases, cancer, stroke, chronic respiratory diseases and unintentional injuries. It was indicated that poverty and high disparities among different racial groups was responsible for the differences in healthcare services provided. Some individuals lacked insurance, access to healthcare or even experienced gaps in services due to poverty, thereby becoming victim to different health challenges including morbidity. Cardiovascular diseases were among the most prevalent health challenges among this population (Tracy, et al., 1997).

Psychological Considerations

The county experienced the third most costly natural disaster in the United States history – hurricane Andrew, which struck in 1992. Hitting from the south east, the larger part of the county was affected and damages accrued to over USD 25 billion in the county alone. In areas where there was greatest destruction, recovery was slow. It was the most costly natural disaster before Katrina in 2005.

The county also hosts a number of economic enterprises, which influence the earning patterns of the residents (City Data, 2010). Bright Star Corporation and Burger King are among some of the well-known brands which are present in this area, bringing about positive economic prospects to the city’s growth. American Airlines and the University of Miami are among the highest employers in the country, accounting for well over 25,000 employees. Common sources of stress could include the lack of employment and high poverty levels.

Sociocultural Considerations

The median household income for the county is $43,876 with a number of employees moving just over 1.26 million, representing a 1.72% growth from the previous year (Data USA, 2015). The following graphical presentation shows the distribution of occupations among the people of Dade:

It was noted that most people in the county are in administrative and sales occupations (27.5 percent), whereas the smallest percentage of the workforce are in technical professions such as engineering and architecture (just over 1 percent). In Miami-Dade county, the most common racial group living under poverty is white Americans, followed by Hispanic and thereafter, African American people (City Data, 2010). Where a family’s income is less than the threshold for that specific family, every person in such a family is considered to be living in poverty. In total, 20 percent of the entire population in the county live in poverty – a figure that is above the national average of 14 percent.

With regards to education, the following pictorial shows the enrollment from institutions of higher learning in the county:

General psychology and nursing were the highest enrollments in these institutions, gathering 8.6 percent and 6.6 percent respectively. Other distributions were set in other areas of concern (Data USA, 2015). With regards to religion, over 40 percent of the population in Miami is religious, that is they are affiliated with a religion (Sperling, 2010). 22 percent are catholic, and the rest are distributed between LDs, Jews, Islam and other Christian faiths. The language mostly spoken is English and Spanish. As seen above, the majority of Miami residents have Hispanic origin.

Government and Leadership

Miami-Dade operates a unique metropolitan government system consisting of two tiers, established in 1957. Florida voters approved a constitutional amendment in 1956 allowing the people of Dade to enact home rule charter. Home rule did not exist in Florida before this time and counties were limited to the regulations set out in its constitution and state laws. The second woman to be elected in the US, Mattie Belle Davis, was from Florida and served on the American Bar Foundation. Counties and municipalities remain separate entities in the county. There are therefore 34 municipalities and the one city, Miami (Data USA, 2015).

Education

For the state, every county is a school district. County public schools are run by school boards which are independently elected. A superintendent of schools manages daily operations in the district. They are appointed by the school board. The Miami-Dade County Public school district had almost 400,000 students in the 2007/08 year, making it the fourth largest public school district in the country. The county is also home to the public library, which has 42 branches and 8 others in construction. A number of universities and colleges are also available in the county, totaling to about twelve.

Transportation

As noted above, the major international connection from the county to the world is the Miami international Airport. Public transportation is also available in the country, serviced by its department of transportation and public works. There operates a heavy rail metro, a bus system and an elevated people mover. Toll roads are also available in the county, where violation leads to additional charges as per toll violation laws. The county has ten major expressways alongside one minor expressway passing through downtown Miami (Miami-Dade Government, 2016).

Behavioral Considerations

Dade County experiences all-year warm weather. While this should be a factor for better health, heat during summer and fall could pose serious challenges to outdoor activities. Walkable communities could possibly improve health through the provision of aesthetic and safe modes of transportation. Nevertheless, the county has experienced health concerns which are related to physical activity and weight concerns. There are both overweight and obese sections of the population, where the population has a greater height than what is healthy for their height. As a result, the majority of this group either have a BMI between 25 and 29.9, which is considered overweight, and higher than that, which is considered obese. As of 2007, 64 percent of all adults in the county were either obese or overweight (Brown, et al., 2016).

With regards to physical activity, it was estimated that 67 percent were inactive at work; 35 percent were sedentary; 23 percent consumed at least five servings of fruit per day; 29 percent meet moderate exercise and physical activity recommendations, while 23 percent met vigorous physical activity recommendations. This showed that a large population in the county experienced challenges with engaging physical activity opening themselves up to the challenges that arise with such a lifestyle, including becoming overweight and obese (Tracy, et al., 1997).

With regards to other forms of safety precautions, the county has made almost 40 miles of bike lanes and 30 miles paved paths since 2000. This is the result of planning endeavors, new funding sources and adopted policies which seek to enhance the county’s safe transportation objectives. This, therefore, increases the travel options for residents in the county, while improving their health outcomes.

Health System Considerations

Existing Health Services

The Miami-Dade County, being the home of Miami, hosts quite the variety of healthcare services. The wide variety of services include all manner of health concerns. In fact, the University of Miami is a pioneering health research institution, bringing about the introduction of innovation in the realm of healthcare and provision of quality care services (City Data, 2010). While this might be the case, the high prevalence of poverty in the county is the main deterrent to the access to healthcare, thereby reducing the chances that one gains access to these progressive healthcare services. Again, the lack of insurance among many members of the public in this part of the country limits their access. The unique population makeup of this county makes it difficult to obtain good quality healthcare for low morbidity.

Assessing Current Performance Levels

Moving to assess the current performance levels, the incidence of particular diseases among the population and their management could offer a picture into the processes offered for the healthcare industry. With regards to diabetes, for example, information available on the health needs could point to the performance of the industry. This is a disease that occurs as a result of the failure to regulate blood sugar. Environments that encourage healthy foods and physical activity are key to reducing diabetes incidence among the population. In fact, such activity enables residents to avoid pre-diabetes and type 2 diabetes. In Miami-Dade, up to 35 percent of the population reported to having no leisure time activity, thus accounting for the 64 percent of the population that was either overweight or obese. In the United States, diabetes is fifth on the deadly diseases list, with an increased death rate of 45 percent per 100,000 people compared to the previous 26.4 percent in 1987 (US Census Bureau, 2010). Miami-Dade County experienced a higher death rate for people suffering from Diabetes by three percentage points compared to Florida State. So in Miami-Dade, just over 180,000 people have diabetes and over 2,000 people were hospitalized in just 2007.

Again, one can look into this issue through the eyes of hypertension interventions. 25.3 percent of the population were registered to have hypertension, which is an increase by 1.7 percent since 2002. While this might be lower than the 28 percent state rate, it is certainly a high incidence rate. Some of the key components in curing hypertension is changed lifestyles, medical care and treatment as prescribed by a doctor (Ferguson, Shultz, & Bisno, 1991). Again, physical activity was one of the greatest requirements in reducing weight and subsequently pushing down blood pressure. Among other things, the populace would watch sodium intake, alcohol consumption and adequate potassium consumption to maintain healthy blood pressure. Approximately one in three American adults suffers from hypertension, making it a national health concern. The county rate for the number of deaths arising from hypertension was on the rise from 2006 and reached the state level by 2008. It is expected that this rise will continue with the prevailing tendencies towards avoiding physical activity.

For health needs lacking services, asthma is one such need. The disease is a serious respiratory disease, affecting a large number of Americans. The 23 million affected people control this disease through medical treatment and managing environmental triggers. Seven million of these are under the age of 18 years. 6.2 percent of the adult population in Florida has asthma. In Dade County specifically, 4.2 percent of adults have asthma, 4.9 percent of middle school children and 17 percent are high school children as of 2008.

Considering the use of healthcare services, therefore, there is gross overuse of these services. From the above assessment, the larger number of healthcare concerns arise from lifestyle choices that one makes. These could affect the health of an individual adversely, where the choices are made poorly (Miami Dade Government, 2007). For example, people in Miami-Dade have a learning towards minimal physical activity despite having the right weather to engage in these endeavors. Such inactivity results in the occurrence of obesity and being overweight, which in turn results in the development of lifestyle diseases. These have been highlighted above, with the exception of cardiovascular diseases. Interestingly, these are the top deadly diseases in the county. Be it as it may, they are avoidable.

Financing to healthcare should therefore include the proper campaigning for proper lifestyle choices that will reduce the instance of high-risk diseases among residents of the county (Miami Dade Government, 2007). Where a significant portion of county resources could be dedicated to the awareness of such challenges, the county would certainly have to worry less about increased morbidity and infection from these diseases. Specifically, lifestyle choices should be targeted by encouraging residents to engage in sufficient physical activity that will ensure their health and vitality. In this manner, the healthcare funding for the county will also move towards improving the livelihoods of residents in the face of widespread poverty. Conclusively, the county will be able to reduce the instance of its most pressing healthcare concerns.

References

Brown, S. C., Lombard, J., Wang, K., Byrne, M. M., Toro, M., Plater-Zyberk, E., & Pantin, H. M. (2016). Neighborhood greenness and chronic health conditions in Medicare beneficiaries. American journal of preventive medicine, 51(1) , 78-89.

City Data. (2010). Miami: Economy . Retrieved from City Data: http://www.city-data.com/us-cities/The-South/Miami-Economy.html

Data USA. (2015). Miami-Dade Florida . Retrieved from Data USA: https://datausa.io/profile/geo/miami-dade-county-fl/#category_occupations

Ferguson, G. W., Shultz, J. M., & Bisno, A. L. (1991). Epidemiology of acute rheumatic fever in a multiethnic, multiracial urban community: the Miami-Dade County experience. Journal of Infectious Diseases, 164(4) , 720-725.

Miami Dade Government. (2007). Health Assessment Area. Retrieved from Miami Dade Government: http://www.miamidade.gov/greenprint/planning/library/milestone_one/health.pdf

Miami-Dade Government. (2016). Miami-Dade County News . Retrieved from Miami-Dade Government: http://www.miamidade.gov/mayor/library/memos-and-reports/2016/02/02.01.16-Mayoral-Appointment-of-New-Department-Directors.pdf

Muir, H. (1953). Miami, U.S.A. Coconut Grove, Florida: Hurricane House Publishers.

Parks, A. M. (1991). Miami: The Magic City. Miami, FL: Centennial Press.

Sperling, B. (2010). Miami-Dade County, Florida: Religion . Retrieved from Sperlings Best Places: http://www.bestplaces.net/religion/county/florida/miami-dade

Tracy, R. P., Psaty, B. M., Macy, E., Bovill, E. G., Cushman, M., Cornell, E. S., & Kuller, L. H. (1997). Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arteriosclerosis, thrombosis, and vascular biology, 17(10) , 2167-2176.

United States Census Bureau. (2011). US Gazetteer files: 2010, 2000, and 1990 . Retrieved from United States Census Bureau: https://www.census.gov/geo/maps-data/data/gazetteer.html

US Census Bureau. (2010). Demographics of Miami-Dade County, FL . Retrieved from US Census Bureau: https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/POP060210