Florida: Coming Together for Public Health

In promoting the health of people with disabilities, delivering effective health communication messages, and assessing health risks and the health status of people with disabilities, Florida faces some unique challenges. First, more than 3.2 million Floridians – 22.2 percent – have a disability1 —considerably more than the national average of 19.3 percent. And the number of residents with disabilities is growing. In 2001, 17.4 percent of adults in Florida reported activity limitations on the Behavioral Risk Factor Surveillance System (BRFSS). By 2003, the prevalence of activity limitations had increased to 20.2 percent.

Second, disability issues in Florida are not addressed by any one organization. For example, the agency that manages elder affairs is outside Florida’s Department of Health. Thanks to a grant from the CDC and under the direction of principal investigator Elena Andresen, Florida will soon have its own Office on Disability and Health (ODH).

Andresen said, “We have some extremely competent state government offices and independent agencies, but we might be a little less centralized than other states. So we must build partnerships across public health and other agencies, each with their own budgets and their own criteria. This presents some challenges.” Andresen is a professor and chair of Epidemiology and Biostatistics at University of Florida’s College of Public Health and Health Professions in Gainesville.

Within various state agencies in Florida, disability programs often reside in different departments based upon diagnosis or age. For example, the Bureau of Chronic Disease Prevention and Health Promotion is subdivided into programs such as Arthritis Prevention and Education, Diabetes Prevention and Control, and Comprehensive Cancer Control. Similarly, the Agency for Persons with Disabilities provides services only to persons with developmental disabilities. Florida’s Department of Elder Affairs administers human service programs to the state’s elderly population (those 55 and older).

Within these different agencies, however, substantial expertise in disability and health issues exists, as does a variety of programs and services. These are the elements essential for a strategic plan, as well as a comprehensive disability and health program in Florida. The newODH will monitor disability, health programs and services to ensure access for people with disabilities and to coordinate disability and health activities across organizations. In addition, the ODH will analyze BRFSS data to inform policy decisions and monitor the reported health of people with disabilities.

Based on the 2000 census, Andresen and her colleagues developed the Florida Chartbook on Disability and Health (available online athttp://ebs.phhp.ufl.edu/FloridaChartbookDisabilityandHealth.pdf ). The chartbook addresses types of disability by age group, education by disability status and employment by disability status, all broken down by county. They will use the BRFSS in 2010 to gather more disability data and are updating the chartbook with interim census data for larger counties.

Andresen and her team have worked extensively with disability and health-related survey data. In 2004, they developed a Caregiving Module for the BRFSS. The Bureau of Chronic Disease Prevention and Health Promotion in Florida’s Department of Health also has extensive experience in BRFSS data analysis and summary. The Bureau has produced multiple reports using BRFSS data, including in-depth analyses and reports based on the diabetes and tobacco modules.

The team plans to include at least three additional questions on the BRFSS each year. For 2008, the BRFSS in Florida will field the 10 questions about caregiving to begin to understand the scope of issues for families and others who are informal caregivers. Future questions may address transportation, access to health care, pain, stress and fatigue. The questions will be chosen in concert with advisory board members and partners to address emerging disability and health issues in Florida.
A major aim of the ODH will be to generate
epidemiologically sound and consistent data on disability and health, using both new and existing sources of data, so that disability and health related public health policies and programs within the state are data-driven, evidence-based best practices.

To address emergency preparedness for people with disabilities, epidemiology students from the University of Florida investigated preparations for and the aftermath of hurricanes during 2004. Andresen says they tracked mental-health-related quality of life before and after the hurricanes. All of these data will help Andresen and her colleagues put together a strategic plan during their first grant year.

Florida has a large number of aging and older adults with disabilities, and it is the fourth largest state in the country. Andresen says, “There are many people in Florida who are very well-entrenched and thoughtful about disabilities. It provides rich ground on which to think about building strategic alliances combining all this valuable expertise. Our strongest partner is the Bureau of Chronic Disease Prevention and Health Promotion within Florida’s Department of Health.” The first meeting with all the partners will take place in February, and Andresen is also looking forward to the upcoming State Grantee meeting.

Although the public health challenges ahead loom large,
Andresen is excited to be helping to shape a new future for public health in Florida. Epidemiology focuses on numbers and the big picture, but Andresen’s long-term goal is to improve quality of life and access to care for everyone in Florida with a disability.

1 As reported to the U.S. Census (Andresen et al., 2000).