The black cloud over the Sunshine State: health disparities in south Florida

Journal of Cultural Diversity, Summer, 2003 by Janyce G. Dyer

Abstract: Florida, the "Sunshine State", is paradise for international tourists and has been adopted as seasonal or permanent home by many wealthy individuals and celebrities. However, Florida is not paradise for the growing number of residents who suffer from poverty, health problems, and a lack of access to health care and social services. The purpose of this paper is to present data on health care problems and disparities throughout the state of Florida and in select south Florida counties. Flaskerud and Winslow (1998) have provided a framework which can be used to analyze disparities in resource availability, relative risk, and health status indicators and suggests areas in which nursing and other health professionals can ethically intervene through research, practice, and political action.

Key Words: Health Disparities in South Florida

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Florida, the "Sunshine State", is paradise for international tourists and has been adopted as seasonal or permanent home by many, wealthy individuals and celebrities (e.g., Rosie O'Donnell, Madonna, and the late Jackie Gleason and Gianni Versace), particularly tropical south Florida. Many working and middle- to upper-class individuals plan their retirement to the state to live out their lives surrounded by palm trees and water, in a relaxed pace with a relatively low cost of living. However, Florida is not paradise for the growing number of residents who suffer from poverty, health problems, and a lack of access to health care and social services. The purposes of this paper are to present data on health care problems and disparities throughout the state of Florida and in select south Florida counties as well as to analyze these disparities using Flaskerud and Winslow's framework for ethical practice, research, and political action with respect to vulnerable populations.

Demographic Profile and Health Needs of Florida

Florida residents have similar rates of morbidity and mortality as the general population in the U.S. However, there are differences between the state of Florida and national statistics in terms of population characteristics and demographic trends, health disparities in select populations, major risk factors, and health care coverage. As a large and diverse state (i.e., 4th largest state population) (Florida Highway Patrol [FHP], 2003), Florida is comprised of approximately 15 million residents including elderly persons, immigrants, and national and international visitors (Florida Department of Health [FDH], 2002a). The state has experienced a population growth of between 20 and 80% each decade since 1920, with a 56% growth spurt since 1980. Further population growth of 29% by the year 2020 is anticipated, and 66% of this growth is expected to include people over the age of 65 (Health Resources and Service Administration [HRSA], 2003). Immigrations rather than resident births account for over 75% of Florida's population expansion (FDH, 2002a). The large number of elderly persons, low income persons moving from other states, and immigrants from less developed countries create several factors that impact the health of the state and services that are provided. Contributing factors encompass the growing threat of infectious diseases including HIV/AIDS; the continual threat of natural disasters; a disproportionately large number of substance abusers; other lifestyle-associated health conditions and problems; and the many Floridians without access to health care services.

According to the FDH (2002b), a major five year goal is to treat infectious diseases of public health significance. Two infectious diseases are among the state s top 10 causes of death: HIV/AIDS and influenza /pneumonia.

HIV/AIDS in Florida

HIV/AIDS is the leading cause of death both for black males and black females aged 25 to 44 years in the state of Florida. In terms of causes of premature death, AIDS is second only to unintentional injuries (note: Florida has higher rates of death from unintentional injuries than the national norm [37.3 vs 35.9/ 100,00]). Florida has the third highest number of cumulative AIDS cases in the nation, and state rates currently account for 11% of all persons living with HIV/AIDS in the U.S. (Florida Department of Public Health [FDPH] Bureau of HIV/AIDS, 2002). Of the six HIV/AIDS epicenters in the state, Miami currently reports 25,357 cases, a number that surpasses the combined cases of Georgia, Maryland, Massachusetts, and Virginia (Centers for Disease Control [CDC], 2002a). Fort Lauderdale's rate of 13,594 cases is greater than the combined cases of Louisiana, Connecticut, Ohio, Michigan, North Carolina, South Carolina, Missouri, and Tennessee (CDC, 2002a). When examining the HIV prevalence rates by race/ethnicity and gender in Florida, 1 in 202 White males, 1 in 111 Hispanic males, and 1 in 38 Black males are infected (FDPH Bureau of HIV/AIDS, 2002). Prevalence rates in females show the following patterns: 1 in 1,073 White, 1 in 433 Hispanic, and 1 in 57 Black women are infected (FDPH Bureau of HIV/AIDS, 2002).