Checkup: Quality of Life

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute issue health rankings that include an index called Quality of Life. That measure incorporates factors including the share of the population reporting poor or fair health, numbers of poor physical or mental health days, low birth weight babies, smoking prevalence, obesity and population per doctor.

The 10 counties in Florida with the highest Quality of Life rankings:			The 10 Florida counties with the lowest Quality of Life ratings tend to be small and rural:
1	St. Johns (healthiest)		58	Union
2	Sarasota		59	DeSoto
3	Collier		60	Dixie
4	Martin		61	Gadsden
5	Seminole		62	Hardee
6	Alachua		63	Okeechobee
7	Palm Beach		64	Madison
8	Nassau		65	Hamilton
9	Monroe		66	Hendry
10	Okaloosa		67	Putnam (least healthy)

HIV Florida

• In 2016, Florida ranked second in new HIV diagnoses, with 4,972. (California was first.)
• The Miami/Fort Lauderdale/West Palm metro area, along with Jacksonville, Lakeland/ Winter Haven and Tampa/St. Petersburg/ Clearwater all ranked in the top 20 nationally in HIV diagnosis rate per 100,000 residents.

Florida Scripts

• There were 266 million retail prescriptions filled in Florida at pharmacies in 2017, 6.5% of the national total. Florida accounted for 7.0% of the nation’s spending on pharmaceuticals.

Checkup: Florida's Doctors

In terms of doctors-to-people, Florida is average, ranking 24th in the nation, according to the Washington-based Association of American Medical Colleges. Home to 53,685 physicians in 2016, the most recent data available, the state had 260 doctors for every 100,000 people.

Florida is:

Checkup: How Floridians Die

Top 10 Killers of Floridians

Heart disease and cancer have been No. 1 and No. 2 for decades. The death rate from heart disease has halved since 1976. The death rates from cancer and stroke also are down, while the rate from unintentional injury has gone up, along with the rate for diabetes. Flu and pneumonia, a top 10 cause of death 40 years ago, have fallen off the top 10 as the rate fell from 26.3 per 100,000 people to 9.6 since 1976.

Top 10 Killers

• Heart Disease
• Cancer
• Unintentional injury
• Chronic lower respiratory disease
• Stroke
• Alzheimer’s
• Diabetes
• Chronic liver disease and cirrhosis
• Kidney disease
• Suicide
• Accidental Death

Only heart disease and cancer kill more Floridians than unintentional injury — falls, car wrecks, poisoning, drowning and other traumatic events. Falls tend to occur in the home and kill more men than women. Among major counties, Pinellas has the highest rate of unintentional death — 66.8 per 100,000 residents. Miami-Dade has the lowest among all Florida counties — 28.2 per 100,000.

Drunk Driving

Twenty-one years ago, the rate of alcoholsuspected vehicle crashes in Florida stood at 161 per 100,000 people. As of 2016, that rate had fallen by more than half — to 77.

The state Highway Patrol, while happy the number is down, says it won’t speculate on why.

For decades now, America has been moving to thwart drunk driving, enacting stricter standards for what constitutes “under the influence,” imposing harsher penalties, encouraging designated drivers and ratcheting up societal opprobrium. Miami-Dade had the lowest rate in the state per 100,000 people in 2016.

Monroe County, home to the Florida Keys and disproportionately impacted by tourism, had the highest. The rate of alcoholsuspected traffic deaths, meanwhile, has fallen more slowly. That rate actually climbed a bit from 1997 through 2005, when it peaked at 6.9 per 100,000.

It fell to 4.6 by 2016. That number still represented 934 deaths. But that sad tally was only seven more than in 1997, when the state had 5 million fewer residents, let alone far fewer tourists.

How Kids Die — A Racial Divide

For all young Floridians, the death rate since 1976 from unintentional injury has fallen by two-thirds. The homicide rate is about the same. The suicide rate has increased.

• From 2014 through 2017, for children, youths and young adults, deaths by unintentional injury, homicide and suicide outnumbered deaths from disease by nearly four to one. Fatal disease is rare among youth.
• For young whites, the top three causes of death are unintentional injury, suicide and cancer. Homicide is fourth.
• For young blacks, the top three are homicide — more than double the number of white-victim homicides — followed by unintentional injury and suicide.

Drug Deaths
Gadsden County had the lowest rate in Florida at 3.7 drug deaths per 100,000 (2012-16). Manatee’s 29.3 rate was the highest.

Major County	Rate Per 100,000 Residents
Palm Beach	22.6
Pinellas	22.2
Duval	22.0
Broward	16.0
Hillsborough	13.9
Orange	13.4
Miami-Dade	5.4

Suicides
The 10th-leading cause of death in Florida (2015-17)

Major County	Rate Per 100,000 Residents
Pinellas	18.1
Duval	15.4
Palm Beach	14.3
Hillsborough	12.9
Broward	11.3
Orange	10.4
Miami-Dade	8.2

Homicides
Miami-Dade led the state in sheer numbers with 1,144 homicides (2012-16). Among the most populous counties, Duval is Florida’s murder capital.

Major County	Rate Per 100,000 Residents
Duval	12.1
Miami-Dade	8.7
Orange	7.5
Palm Beach	6.7
Hillsborough	5.7
Broward	5.2
Pinellas	4.8

 

Checkup: Florida’s Major Counties

Miami-Dade County

A Study in Contradictions

Population: 2.75 million

Miami-Dade is overwhelmingly Hispanic (68%). The population is younger, with a higher percentage of black residents, than the Florida average. More than a fifth of residents aren’t proficient in English. Among major Florida counties, Miami-Dade has the lowest household median income — $5,000 below the state average.

The Good News

Miami-Dade scores the best in health outcomes among major Florida counties. Premature ageadjusted mortality is the lowest among major Florida counties.

• The gap between black and white infant mortality is closing, and the overall infant mortality rate is better than Florida’s. Adult smoking and obesity are also relatively low. The county is much better than the state average in access to exercise opportunities and has the lowest rate of DUI deaths among major urban counties.
• The county health department worked with other groups on the adoption of Active Design Miami Guidelines and Complete Street guidelines to steer new private- and public-sector projects toward designs that encourage physical activity and better health.

The Bad News

• Miami-Dade has a high rate of uninsured residents and the highest health-care costs — some $2,700 higher than the state average.
• It has the highest share of kids among major counties eligible for free or reduced-price lunches.
• The county often has the nation’s highest HIV rate. Opioid abuse is rising.
• The immunization rate, while above 90% since 2013, is in the bottom quarter for Florida.

Broward County

Fitter, But HIV Is a Problem

Population: 1.93 million Compared to the state’s population overall, Broward’s population is younger and less white.

The Good News

• Fewer violent crimes, lower rates of smoking and much better access to gyms, parks and fitness opportunities than the averages for Florida. A Broward resident is more likely than the average Floridian to sleep eight hours a night.
• Poor people in Broward are more likely than other poor Floridians to live within a half-mile of a grocery store.

The Bad News

• Broward vies with Miami-Dade for the highest HIV prevalence in Florida — and therefore in the nation. Overall STD rates are increasing.
• Broward health-care costs are 10% higher than the Florida average.

Palm Beach County

Drug Overdoses Mar the Picture

Population: 1.47 million

Palm Beach County has the highest median household income among major Florida counties — nearly $7,000 above the state number. It’s older than Florida overall, has a somewhat higher share of the population that’s white non-Hispanic and somewhat lower shares that are African-American and Hispanic.

The Good News

• The county has the highest rate of insured kids among major Florida counties. Overall, the number of uninsured is decreasing.
• Residents here have relatively low rates of smoking and obesity, DUI deaths and births to teens. Adult obesity is below state and national averages.
• Palm Beach has a higher than average number of doctors relative to the population. It has the best air quality among major counties and ranks highest among major Florida counties in health factors.

The Bad News

• Highest rate of drug overdose deaths among the major counties.
• Health-care costs are about $500 a year above the state average.
• STD prevalence, though below state and national averages, is increasing.

Hillsborough County

Working to Improve

Population: 1.41 million

Among the major counties, Hillsborough most closely resembles the state averages of about 60% white, non-Hispanic, 17% black and 22% Hispanic. Median household income is higher in Hillsborough than in the state.

The Good News

• The county has a higher percentage of mothers who get prenatal care than in Florida on average.
• Compared to the state and nation, residents live longer. Hillsborough has the lowest rate of violent crime among Florida’s major counties.
• The Department of Health in Hillsborough is offering a diabetes prevention program in Spanish. It also is offering a free national diabetes prevention program.
• Physical activity in the county has increased in recent years. A work group devoted to school transportation identified 10 “high” crash areas to target for improvements to make children safer and encourage parents to let them walk or cycle to school.

The Bad News

• The county ranks poorly in a measure of health outcomes and healthy behaviors — avoiding premature death, how people feel, not smoking and avoiding obesity.
• Health-care costs are above the state average. The county rates slightly below average in the share of population insured, including children. Hillsborough sits in the bottom fourth of Florida counties for kids getting involved in physical activity.
• It’s worse than other major counties at excess drinking, tied with Duval for DUI death rate, has above state average STD rates.
• Critical issue: Alcohol-related fatalities and opioid abuse.

Orange County

Problem Area: HIV

Population: 1.35 million

Among major Florida counties, Orange is younger — it has the lowest percentage of seniors — and larger shares of its population are Hispanic or black. It’s on par with the state in percentage of adults and children insured. Compared to Florida, Orange’s median household income is about $400 above the state as are its healthcare costs.

The Good News

• Nearly nine in 10 county residents have easy access to exercise opportunities.
• The county has one clinical care physician per 1,210 residents compared to the state average of one per 1,380 residents.
• Even with all the tourist traffic, Orange has better air quality than Florida’s average — 13% better than the state in the most recent report. Ironically, the county has higher-than-average numbers of preventable hospitalizations from asthma.

The Bad News

• Orange reports climbing rates for heart disease, stroke, heart failure and diabetes in recent years and hasn’t been able to improve residents’ physical activity. Kindergarten immunization levels are worse than the state average.
• Newly diagnosed HIV cases rose 9% to 458 in 2016. Overall, HIV and STDs numbers are rising.
• ER trips due to opioid overdoses doubled from 2015.

Pinellas County

Too Many Injuries

Population: 970,637

Compared to Florida, Pinellas is older. It has the smallest share of the population under 18 among major Florida counties and the highest share of seniors. It also has, among major counties, the lowest share of AfricanAmericans and Hispanics — by far. Median household income is $900 below the state level, and health-care costs are about $400 higher.

The Good News

• Pinellas has more adults with health insurance than the state average (but is slightly worse than the state level for insuring kids).
• It has had success in reducing low birth weight babies and black and Hispanic infant mortality and the percentage of adults overweight or obese.
• Pinellas ranks best among major Florida counties in clinical care — a measure of insurance coverage, disease monitoring and doctors relative to population.
• Access to exercise opportunities is good.
• All students in Title I elementary schools get dental sealants.
• The county’s Health in All Policies initiative makes all local governments factor health into their decisionmaking. The project is funded by the Foundation for a Healthy St. Petersburg.

The Bad News

• The county is in the bottom quarter among Florida counties in immunizations and also scores poorly in high school drinking, marijuana use and STDs.
• It’s much worse than the state average in avoiding premature deaths. It has a much higher rate of injury deaths than the state.
• Chlamydia rates are rising.
• The rate of death from drug overdose is higher than any other major county but Palm Beach. The county has the highest suicide rate among the state’s biggest counties.

Duval County

Florida’s Sickest Urban County

Population: 937,934

Duval’s population is younger than Florida’s overall and far less Hispanic than the rest of the state but has nearly twice the share of black population as the state average.

The Good News

• Duval has more dentists and more hospital beds per capita than the averages for Florida.
• Among major Florida counties, it has the lowest rate of uninsured, below the state average. It’s tied with several other urban counties for the lowest rate of uninsured kids, and among the larger counties it has the lowest percentage (49%) of kids on free or reduced-price lunch.

The Bad News

• Among the major counties, it has the worst rankings in health outcomes and factors — the highest rate of premature death, child mortality and infant mortality.
• Duval’s rate of drug overdose deaths is 42.5 per 100,000 people in 2016, nearly double the state’s 23.9%. Duval ranks 38th among Florida counties in how healthy people feel and 41st in health behaviors such as drinking and smoking and obesity.
• It has the highest homicide rate in Florida. It’s in the lowest quartile among all Florida counties for school safety and for self-inflicted injuries in teens, for immunizations, for middle and high school-age physical activity, STDs, youth injuries in traffic wrecks and chlamydia in young women.
• It has the worst air quality among major Florida counties.

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