Running head: COMMUNITY PREVENTIVE HEALTH IMPROVEMENT

Capstone Community Preventive Health Improvement

Eduardo Alegria
Community and Population Health
University of South Florida

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Capstone Community Preventive Health Improvement
Introduction
Immigration reform is often a controversial topic and is an important subject in current
events due to the ongoing election campaigns. While heavily debated, there is little factual
information made easily available or readily shared with community members across the nation.
For example, are tourists, migrant workers/families, and immigrants awaiting their legal alien
status aware of existing resources for healthcare, financial aid, transportation, hardship needs,
etc.? Are citizens and loved ones able to offer appropriate guidance for friends and relatives
visiting from other countries? To increase our knowledge as citizens, friends, and loved ones, it
is important to learn about existing support services for local, state, and federal resources that are
available for tourists, migrant workers, and immigrants residing in our communities. It is also
imperative to research politicians opinions on these matters in order to make informed decisions
about the future of our ability to offer assistance to these populations. Although every
community is different, many have forms of community preventive health improvement plans.
Many of these plans or policies are in place to assure that people visiting the United States with
tourist visas, migrant workers, and/or immigrants awaiting legal alien status, regardless of which
state or community they are residing in, are afforded protections (Viladrich, A. 2012).
While the census specifies that the people of Sarasota are comprised mostly of
Caucasians living above the poverty level, a third of this population is between 55-74 years of
age (Florida Department of Health, 2016). The City of Sarasota (sarasotagov.org, 2016) also
boasts members in the community of Hispanic, African American, Canadian, Middle Eastern,
and European descent. This information gives us an idea of the general demographics in Sarasota
but does not share gross or detailed information about existing tourists, migrants, and immigrants

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waiting for legal residency. However, these specific populations often have health care issues,
financial, or other critical needs that must also be addressed.
Background and Purpose
The tourist population in Sarasota is most prominently present during the winter months.
Fondly referred to as Snowbirds, this population offers a boost to the local businesses. As the
tourist population tends to average several months to a half a year in Sarasota, routine medical
requirements, urgent healthcare, transportation, and financial needs arise that must be addressed
in a timely manner. These individuals are often from the Canadian providences, European
communities, and northern territories within the United States. Additionally, the immigrant and
migrant populations are known to reside within Floridas borders and Sarasota is no exception.
However, due to the transient nature of the tourist/migrant populations, in addition to the
potential language barriers or financial instability, these populations may experience difficulties
seeking out appropriate resources for healthcare, financial, or other critical needs. Unexpected
hardships may arise resulting in costly healthcare needs, hospitalizations, lack of room and
board, transportation needs, and difficulties finding sources of income to support growing
families. Therefore, it is imperative to emphasize available resources and promote education on
these topics for this population.
For example, as Florida is the gateway to both Central America and the Caribbean,
Maptheimpact.org reports that 19.4% of the states population is comprised of immigrants.
Furthermore, the largest immigrant populations are from Haiti, Cuba, and Colombia. Florida also
reportedly saw a 39% increase in its foreign-born population between 2000-2013.
Florida, also known for its retiree population, has a large number of veterans.
Community discussions with Sarasota members of the Veterans of Foreign Wars (VFW) revealed

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that the veteran population donates significant resources for those immigrants in need. VFW
member Schiffman, E. (personal communication, September 11, 2016) of Sarasota, FL., noted
that many veterans are themselves foreign-born and served in the military while becoming
naturalized citizens. The VFW (Sarasota Chapter) believes strongly in supporting its community
and reports statistics that indicate approximately 30% of Sarasotas small business owners are of
Hispanic descent, many of whom immigrated and then earned their green cards while working to
become citizens (Zong, J., & Batalova, J. 2015).
Moreover, many elderly community members of the Church of the Palms, Sarasota, Bee
Ridge Road, were interviewed during a recent gathering after a musical rehearsal. The church
members noted concerns for the need to better assist those individuals within the community
facing financial or unexpected hardships (personal communication, September 17, 2016). The
church offers assistance via foodbanks, and provides professional volunteer services. Gulfcoast
Legal (2016) facilitates the completion of financial and legal applications and forms for existing
state resources and advises individuals on immigration processes. Sarasota Memorial Hospital
(2016) has a branch of financial advisors specializing in emergency financial assistance for
patients that are in the area temporarily and/or are awaiting legal residency status. Sarasota
community church members also make known existing public transportation options such as the
Sarasota Community Authority Transit bus system which operates on a sliding pay scale
(Sarasota City Hall Scat, Public Transportation. 2016). The church also runs a tutoring service
for school-age children who speak English as a second language. Veterans, medical
establishments, volunteers, and Church families strive to offer assistance to community members
facing significant hardships.
The Healthy People 2020 is a national initiative with major goals to improve a variety of

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issues surrounding community healthcare. Because of the programs goals, such as making high
quality healthcare accessible and equitable to all people (regardless of socioeconomic or
citizenship status), it is necessary to promote better planning and support for immigrants,
tourists, and migrant populations within the Sarasota, FL. community. Based on the existing
Sarasota community involvement and support for families experiencing hardships, it would seem
that current efforts could be easily augmented to incorporate additional Health People 2020
initiatives with a little organization and extra effort on behalf of interested and able community
members.
Evidence-based/Promising Practice Plan
For example, Healthypeople.gov (At Work in the Community: Door-to-Door Program)
detailed how one non-profit organization in Maryland attempted to tackle the Healthy People
2020 topic area Access to Health Services: Health Communication and Health Information
Technology. A few states such as Maryland have started to address this goal of achieving health
equity, eliminating disparities, and improving the health of all groups. Since 2012, measured
benchmarks have tracked improvement towards this goal but also indicate there is still much
work to be done. To begin meeting this one particular goal, the first non-profit organization to
take on this needed benchmark was the Maryland group that hired a Latino community member.
It was this community members job to literally canvas neighborhoods in order to deliver
information about healthcare services as well as to provide cardiovascular screenings to the
Hispanic community. This group determined that the Latino community was largely immigrants.
Their research, combined with that of the national census, determined that Latino immigrants
often do not seek healthcare until the severe or end-stages of disease because they do not know
how to get necessary information or acquire care. Through their research, the non-profit

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organization also learned that immigrants receive healthcare largely only through word-of-mouth
from friends or family members. However, a significant number of immigrants are isolated from
the community without having friends of family; therefore, they are not learning about available
resources. The non-profit organization demonstrated that their positive neighborhood
intervention facilitated an improvement in access to care as follows: of the 128 families initially
surveyed through neighborhood canvassing, 88% initially had no access to any type of
healthcare. The neighborhood outreach program reduced this number to 56% of families lacking
full access to a Primary Care Manager. However, all 128 participating families received Doorto-Door cardiovascular care, cholesterol screenings, medications as needed, information on
reducing blood pressure, and improving overall nutrition/health. These figures demonstrated
significant improvement within the first 12 months of their neighborhood outreach program.
Based on the success of the aforementioned nonprofit organizations goal to tackle the
Healthy People 2020 national initiative, Sarasota, FL. could also introduce a similar effort in the
communities known to house more immigrants, migrant working families, and/or tourist
populations. For example, emergent healthcare issues occasionally occur at inopportune times
(such as travel). With organized efforts, restaurants, community centers, heavily populated
tourist venues, health department, church bulletins, and health clinics could display information
about emergency healthcare options (such as emergency Medicaid, vaccinations for influenza,
prescription medication assistance, public transportation options, etc.). Additionally, church
bulletins could offer brief advertisements about healthcare services for emergencies as well as
hardship assistance such as food banks or even offering professional volunteer services to
facilitate the completion of state/federal applications for financial assistance. With assistance
from volunteers at community churches, health clinics, and even the Sarasota VFW, Door-to-

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Door canvassing could be organized to discuss outreach opportunities and/or conduct in-home
screenings. The success of the Maryland nonprofit Door-to-Door outreach program, developed in
an effort to accomplish one of the Healthy People 2020 initiatives, lends credence to adopting a
similar community effort in Sarasota, FL. The following local stakeholders (contacted while
preparing the windshield survey and the inventory of collaborators) are a potential means for
attaining assistance (financial and other) with this community outreach support endeavor:
Church of the Palms (2016), Florida Department of Health, Sarasota County (Programs and
Services 2016), Gulfcoast Legal (2016), Sarasota City Hall SCAT (Public Transportation,
Sarasota County2016), VFW Sarasota Chapter (Myvfw.org. 2016), and Sarasota Memorial
Hospital Financial Assistance for Patients (Sarasota City 2016).
In order to obtain a baseline of existing knowledge, initial brief surveys (English and
Spanish) should be distributed Door-to-Door and/or made available at the stakeholder venues
such as local churches, Sarasota VFW, department health clinic, Sarasota Memorial Hospital
emergency room, etc. in communities with prevalent immigrant, migrant worker, and tourist
populations. Successful distribution of information could then be tracked in much the same
manner as the program described above (community Door-to-Door canvasing and collection of
data).
Application to The Sarasota Community Population
Using the SMART objectives, the goals for application of this community outreach
program in Sarasota will be to use a timeline of twelve consecutive months. Initial baseline
measures will be obtained in month one, implementation of outreach distribution goals during
the following ten months, and evaluation of accomplished goals at the last month of the
initiative. The specific tasks will be threefold: Obtain initial surveys (results in Spanish, French,

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and English) for existing knowledge of healthcare options during travel, as immigrants awaiting
legal residency status, and for migrant working families. A second initial task for the first month
will be to further determine what knowledge exists about financial resources (local, state, and
federal) for needs such as food, shelter, or other hardships. A third initial task during the first
month of baseline collections will be to gather information on knowledge of basic community
volunteer organizations available to assist families in need. The main body of the program will
comprise 10 months of volunteer efforts to distribute information in venues such as local
churches, food banks, healthcare clinics, hospital emergency rooms, community tourist locations,
schools/social work services (with emphasis on tutoring facilities available with posted materials
on community resources) and Door-to-Door volunteer professionals for healthcare screenings
and assistance with financial applications for available resources. The last task will be to
measure baseline information in comparison to post-outreach efforts detailing questionnaires that
document existing knowledge and available resources being utilized. These tasks can be
achieved by using a combination of private, charitable, as well as local/federal funds related to
the Healthy People 2020 and Immigration Healthcare Reform act of 2010 (Galerneau, C. 2011).
In conclusion, Sarasota, FL., demographics are comprised of diverse populations,
including tourists, migrant working families, and immigrants. The Healthy People 2020
initiative encourages national efforts to ensure quality healthcare and community resources are
available equitably for all people residing within the United States. Due to the intricate needs of
a transient or unstable population, Sarasota, FL. community members would do well to offer
community outreach programs distributing necessary information and healthcare options,
especially to more isolated communities heavily laced with tourists, migrant families, and
immigrants.

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References
Anderson, E. & McFarlane, J. (2008). Community as partner: Theory and practice nursing.
Philadelphia: Lippincott Williams & Wilkins.
Church of the Palms. (2016). Sarasota County. Retrieved from
http://www.churchofthepalms.org/ourmission.html
Florida Department of Health, Sarasota County. (2016). Programs and Services. Retrieved from
http://sarasota.floridahealth.gov/programs-and-services/clinical-and-nutritionservices/eligibility-requirements/index.html
Galarneau, C. (2011). Still Missing: Undocumented Immigrants in Health Care Reform. Journal
of Health Care for the Poor and Underserved.2011 May;22(2):422-8. doi:
10.1353/hpu.2011.0040.
Gulfcoast Legal. (2016). Retrieved from http://www.gulfcoastlegal.org
Maptheimpact.org. (2016). Retrieved from http://www.maptheimpact.org/state/florida/
Zong, J., & Batalova, J. (2015). Frequently requested statistics on immigrants and immigration in
the United States. Migration Policy Institute. Retrieved from
http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-andimmigration-united-states-4
Myvfw.org. (2016). Retrieved from http://myvfw.org/fl/post3233/
Office of Disease Prevention and Health Promotion. (2013). Healthy People 2020 at work in the
community: Door-to-Door Program. Healthy People.org. Retrieved from
https://www.healthypeople.gov/2020/healthy-people-in-action/story/healthy-people2020-work-community-door-door-program

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Sarasota City Hall Scat, Public Transportation. (2016). Sarasota County. Retrieved from
https://www.scgov.net/scat/Pages/default.aspx
Sarasota Memorial Hospital Financial Assistance for Patients. (2016). Sarasota City. Retrieved
from http://www.smh.com/Home/Patients-Visitors/Financial-Assistance
The City of Sarasota. 2016. Retrieved from http://www.sarasotagov.org/#2
Viladrich, A. (2012) Beyond welfare reform: reframing undocumented immigrants' entitlement
to health care in the United States, a critical review. Social Science & Medicine. Soc Sci
Med. 2012 Mar;74(6):822-9. doi: 10.1016/j.socscimed.2011.05.050. Epub 2011 Jun 25