Community and population assessment are vital aspects of public healthcare delivery and upkeep. By understanding the local environment, available public resources, and health behavior patterns, medical professionals can better treat individuals as well as deliver competent public health interventions. This community evaluation will focus on the urban Miami, Florida area in the Miami-Dade County to present a comprehensive assessment of the population and resources, determine any public health problems, and present a plan of action.
Miami was officially formed in 1896 as the only major U.S. city founded by a woman, a local citrus plantation owner Julia Tuttle. The city grew rapidly due to its citrus growing business as well as tourism. In the early 20th century, the population consisted of up to 40% of African Americans and migrants from the Bahamas who worked as laborers. Miami played a role in providing training bases for World War II soldiers and later became a refuge for half a million Cuban refugees fleeing the Cuban Revolution, further diversifying the population. In the latter half of the 20th century, Miami was a hub for illegal drug transit coming from Latin America, an issue continuing to the modern-day. However, in the 21st century, Miami has become a highly urbanized hub for business and tourism, offering its luxurious beaches, hotels, and harbors. The city has a wide variety of neighborhoods with a large diversity and rapidly developing urban environment along with some suburban areas as well (“Miami,” n.d.).
Physical Environment Considerations
Description and Boundaries
Miami is in a strategic location positioned on Biscayne Bay, at the entrance of the Miami River and both the Atlantic Ocean and the Everglades in close proximity, part of Florida’s Gold Coast (“Miami,” n.d.). The Miami area has an extremely flat topography, with most of the areas not extending beyond 5 feet above sea level, with the highest natural elevation being a limestone ridge in the south of the city at 12 feet (Romm, 2013). This makes Miami prone to flooding and potential devastation if sea levels continue to rise as projected. Miami maintains a tropical climate with warm winters and humid summers, with average temperatures ranging from 68 to 84 degrees Fahrenheit (“Climate – Miami,” n.d.). The total area for Miami is approximately 56 square miles (Miami Downtown Development Authority, 2018).
As an urban center, Miami has extensive sanitation systems in place, which encompass solid waste, garbage, and sewage utilization. The government attempts to maintain a clean and healthy environment by managing complex systems that ensure sustainability and strict sanitation code enforcement (the City of Miami, n.d.). Water quality exceeds federal and state drinking water standards and is tested regularly. Air quality in Miami falls within the good range on the EPA standard with a PM2.5 and clean color and odor, with rare instances of increased particulates where some groups such as the elderly or those with respiratory conditions may experience discomfort. The city and county government identify and track toxic pollutants in accordance with EPA regulations, but there are no immediate dangers (Miami-Dade County, 2016).
Miami has a stable food supply which is both imported and obtained locally through agriculture and fishing. Food preparation is regulated by government standards in appropriate facilities. The biggest threat of disaster for the population is hurricanes and storm surges which may lead to flooding and devastation. Miami maintains strong emergency management and disaster preparedness plan since the city often faces hurricane threats. The population can be considered to be educated regarding safety, evacuation, and recovery efforts for hurricanes (Miami-Dade County, n.d.a).
Miami has a mixture of public and private housing, although the exact correlation is unknown. Most of the housing in Miami is in good condition, enforced by minimum housing standards, which require safe and sanitary conditions. However, more impoverished neighborhoods have had issues with aspects such as lead and other safety concerns (Miami-Dade County, 2018). Owned housing makes up approximately 52% of the real estate, while rentals consist of approximately 48% (TownCharts, n.d.). Miami offers a wide range of public housing, including assisting living facilities for the elderly and those with disabilities. There are also public housing developments, reasonable accommodation, and specialty environments. Section 8 housing is available for the impoverished populations, including a housing choice voucher, rehabilitation rental, single room occupancy programs (Miami-Dade County, n.d.c). One of the issues that Miami faces is housing affordability, as even those with full-time jobs are cost-burdened by housing. It is a severe crisis that highlights income inequality, and even the government has been forced to raise caps for rent on affordable housing. Six out of ten adults spend more than 30% of their income on housing, one of the highest rates in the country, with racial minorities and impoverished neighborhoods being marginalized (Robertson, 2018).
Leading Industries and Occupation
The principal industry in Miami remains to be tourism, with a significant local population having occupations in local businesses and hospitality-related services such as hotels, restaurants, clubs, and others. As a strategic port, Miami has also diversified its economy by becoming a hub for international trade. Agriculture also strongly contributes to the economy and employs over 2 million people (“Miami: Economy,” n.d.).
The People of the Community
The Miami urban population is 441,007, with a density of 12,139 people per square mile. The Miami metro area, however, houses more than 5.56 million people. Population in Miami is gradually increasing with an average annual growth rate of 0.73% over the last decade and as high as 2.4% in 2017 (Open Data Network, 2017). Mobility data is not available; however, the area does continue to experience a high influx of both domestic and foreign migrants. Approximately 43.2% of households are married families, with 26.4% being single male or female. Of those families that have children, 61.9% are married, while 29.8% are single mothers and 8.3% are single fathers (Statistical Atlas, n.d.).
Biological Considerations and Vital Demographic Characteristics
The female to male ratio in Miami is 50.56% to 49.44%. The median age is 40 years old, with 22% being under the age of 19, 55% aged 20-60, and 21% aged 60 and older. The population is 13% white, 16% black, and 69% Hispanic (Census Reporter, 2017). The birth rate is 60.3 per 1000 women. The crude death rate is 325.6 per 1000 people. The infant mortality rate is 5.1 per 1000 live births. The maternal death rate is 16.5 per 100,000 live births (Miami Matters, 2017a). According to the Florida Department of Health (2017), the leading causes of death include:
- Heart Disease – 5,399 (26.24%);
- Cancer – 4,436 deaths (21.56%);
- Stroke– 1,587 (7.71%);
- Chronic lower respiratory disease – 1,074 (5.22%);
- Unintentional injury – 917 (4.46%).
No significant events or catastrophes affected Miami in recent years, except for the 2008 financial crisis, which heavily impacted the poorest populations in the city and raised the cost of living. Miami has a positive outlook for economic prospects as economic and business growth is expected along with rising incomes. Issues such as inequality, housing prices, and disparities are being focused on, which suggests potential relief for even the most marginalized groups. The Miami government and its departments maintain continuous official communication with residents, while informal networks are present as the city is known for its tightly knit communities, particularly among ethnic minorities. Miami-Dade has about 8.1 suicides per 100,000, with 247 in 2017. 9 out of 100,000 are white, while 4.1 out of 100,000 are black (Live Stories, 2017b). Approximately 211 homicides were registered in Miami in 2017, with 21.4 per 100,000 occurring among African Americans and 3.7 per 100,000 among whites (Live Stories, 2017a). The city offers extensive law enforcement and protective services ensuring public safety. Stress is a leading cause of illness and death in Miami, with some common causes including urban depression, housing affordability, traffic, flooding, and finances (Birch, 2015).
The median family income in Miami is $64,338. Major occupations are in the hospitality, trade, mining, manufacturing, and construction industries. The unemployment rate is at 2.9% (United States Department of Labor, 2019). The population living in poverty is at 21.3%. Approximately 16% of the population is aged 65 or older and can be considered retired (Miami Matters, 2017b). Approximately 34.7% of people are married, and 13.9% divorce. At least 29.76% attain a high school diploma, 16.29% a bachelor’s degree, and 10.05% a graduate degree. 23% of the Miami population speaks only English, while 70% speaks Spanish along with varying levels of English. 68% of the population is Christian, predominately Catholic, while non-Christian faiths compromise 10% (9% Jewish), and 21% of the population is unaffiliated with religion (World Population Review, 2019).
Government and Leadership
Miami maintains a mayor-commissioner form of government. The city also falls into the jurisdiction of Miami-Dade County, which has a mayor and board of commissioners. The county government is responsible for county-wide services, including public health, sanitation, and emergency services. Meanwhile, the city government runs services such as police and fire, as well as deals with zoning and legal issues (Chapple, 2019). Most of the offices are located in downtown Miami, easily accessible to everyone and running on standard working hours.
Education and Transportation
There are a number of public and private education institutions in Miami at all levels of academia. The city heavily invests in modern public education as well as the availability of community centers and libraries for extracurricular activities. Special education is available for all included groups, including pregnant teens, children, and adults with mental or physical disabilities, as well as adults requiring further schooling. The programs are funded and well-supported by local schools and care centers (Expat Arrivals, n.d.). Miami offers a developed public transportation system, including buses, Metrorail, and metro mover. These are efficient and affordable, offering routes to the most important locations in Miami. City busses have over 64 routes, which the Department of Health notes cover accessibility to health, community, and social facilities within a quarter to half-mile radius throughout the city. The public transportation system runs 365 days a year within reasonable hours (Miami-Dade County, n.d.b).
The general nutritional level of the population is abundant. In fact, similar to the rest of the country, the Miami population is experiencing unhealthy consumption patterns, which are leading to increased rates of obesity, with 64.9% of adults being at least overweight based on BMI (Miami-Dade County, n.d.b). Leisure is available in the city as Miami offers a great variety of parks, sports, beaches, and recreational activities. However, almost a third of adults report no dedicated leisure time. A troublesome health behavior noted in Miami is increased recreational or addiction drug use. Miami has one of the highest drug abuse and drug overdose deaths in the country, with patterns increasing with the national opioid epidemic (Hall, 2014).
Health System Considerations
The Miami health system consists of various medical facilities, including several large hospitals, local clinics, government-run facilities, and public health programs. The urban environment allows for practically any type of medical service, including specialized treatment. In cooperation with the government, public health programs focusing on community and elderly health, immunizations, wellness, and disease control are available (Florida Department of Health Miami-Dade County, 2014). Healthcare services are generally readily available, but most are costly, requiring payments or insurance in order to access. Lack of insurance coverage in impoverished and minority neighborhoods leads to health disparities. However, both public and private health organizations provide safety net services to the uninsured and charity care (Mount Sinai Medical Center, 2017).
Miami health services are of high quality, having leading healthcare institutions and research facilities in the area. Public health programs are comprehensive as well. Mental healthcare and drug rehabilitation programs remain a community health need that is not given enough attention. The health care services do face some overload, but it is not a severe crisis at the moment, potentially exacerbated in the future by the professional medical shortage (Mount Sinai Medical Center, 2017). The health system in Miami is financed through a combination of government funding based on a reimbursement system as well as private funding and business practices.
After a full environmental assessment, several issues were identified within the community, health systems, and population, which are all inherently intertwined and multifaceted. One significant issue is a lack of affordable housing, which leads to significant homelessness. Furthermore, there are not enough public health resources available, particularly for social and mental health. Exacerbating the issue is the fact that coordination between health providers remains lackluster, and there is no concrete healthcare policy guiding treatment for the homeless and uninsured (Florida Department of Health, 2018). As a result, there are vulnerable populations who are either homeless or in poverty, usually concentrated in neighborhoods predominantly inhabited by ethnic minorities. These communities experience public health issues such as the opioid epidemic, drug use, and gun violence that lead to injury and death, as well as negatively affecting the social structures of the Miami community.
Plan of Action
The response to the identified problems should also be multifaceted and encompass several interventions to address the issues. Although health workers cannot directly facilitate changes in housing and economics, nurses can engage in advocacy by gathering public support and bringing up these issues in government meetings. The focus is to modify policy in order to create greater availability of affordable housing. Studies show that permanent supportive housing and affordable housing are key to community health, improving wellbeing in older populations, as well as longitudinal general and mental health in diverse populations (Crisanti et al., 2017; Vega & Wallace, 2016).
Housing helps to increase the quality of life, increase access to healthcare and community resources, and decreases marginalization. In order to address drug use and the opioid epidemic, it is recommended to establish free public health programs which offer safe consumption sites, syringe exchange, and education or rehabilitation services. Although controversial, such programs have contributed to decreased drug usage and increase rehabilitation (McGinty et al., 2018). Overall, this plan of action can be implemented in multiple steps as a comprehensive measure to address identified public health and community problems affecting Miami.
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