Minutes of the Health Commission Meeting
Tuesday, April 2, 2002
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order by Vice President
Roma P. Guy at 3:05 p.m.
- Vice President Roma P. Guy, M.S.W.
- Commissioner Arthur M. Jackson
- Commissioner Harrison S. Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
- President Edward A. Chow, M.D.
- Commissioner Lee Ann Monfredini
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF MARCH 19, 2002
Action Taken: The Commission approved the minutes of the March 19, 2002
Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Jackson chaired, and Commissioner Umekubo attended, the
Budget Committee meeting.
3.1) CHN-SFGH - Request for approval to enter into the IMPACT Program
Hospital Services Agreement with the Regents of the University of
California, UCLA Medical Center, in the amount of approximately $50,000
per year, to provide prostate cancer treatment to uninsured men
diagnosed with prostate cancer but who do not qualify for MediCal or
Medicare, beginning on April 1, 2002 and will automatically renew for
successive one-year periods.
3.2) CHP-Primary Care - Request for approval of a retroactive sole
source contract renewal with North East Medical Services, in the amount
of $218,354, to provide Breast and Cervical Cancer Control Program
services to women, for the period of October 1, 2001 through September
3.3) PHP-AIDS Office - Request for approval of a retroactive sole
source contract renewal with Continuum HIV Day Services, in the amount
of $714,427, for the Homebase Program which provides transitional HIV
support services to incarcerated individuals, and the HOPE Study which
assesses the effectiveness of the Homebase Program, for the period of
July 1, 2001 through June 30, 2002.
Action Taken: The Commission approved the Budget Committee consent
4) DIRECTOR’S REPORT
Anne Kronenberg, Deputy Director of Health, presented the Director’s
Tobacco Free Project
Youth advocates working through the Tobacco Free Project recently
demonstrated the ease at which young persons can access tobacco via the
Internet. The young people conducted a tobacco purchase survey of 19
Internet tobacco-retailer sites. All 19 sites sold and shipped tobacco to
the youths without any ID or age verification. At a cyberspace cafe press
conference on March 27, youth advocates announced their findings, provided
an on-line demonstration and called for stronger laws that restrict
tobacco on-line access. The event generated extensive local and regional
STD Awareness Month
April is National STD Awareness Month. As part of STD Awareness Month,
the STD Program will be collaborating with the Castroguys to implement
their Spring Cleaning Program. Castroguys is a new and unique
collaboration whose purpose is to promote the health and wellness of gay
men in San Francisco. The Program is designed to encourage sexually active
gay and bisexual men to get a STD test during the month of April. The
Program also includes "community rewards", which are perks and
premiums from businesses in the community for men who test in April.
Harm Reduction Month
DPH has declared April "Harm Reduction Month" and planned a
series of events to increase knowledge and generate discussion on the
subject. Harm reduction is a philosophy, which promotes methods of
reducing the physical, social, emotional, and economic harms associated
with drug and alcohol use and other harmful behaviors. Harm reduction
methods and treatment goals are free of judgement or blame and directly
involve the client in setting their own goals.
The Department has long been an advocate for harm reduction and is
currently implementing the resolution passed by the Commission last Fall,
which will require certain DPH publicly funded programs to address how
they will provide harm reduction treatment options. For more information
on harm reduction and DPH related activities, please visit: www.dph.sf.ca.us/harmreduction
- Commissioner Umekubo asked what the ramifications are for Internet
sites that sell tobacco to minors. Ginger Smyly said that the Federal
Trade Commission regulates the sale of cigarettes over the Internet,
and the next step will be to take legal action.
- Commissioner Jackson asked if the same problem exists for purchasing
alcohol over the Internet. Ms. Smyly said that this has been a
problem, but it came to light sooner than the issue of access to
tobacco via the Internet, and more steps have been taken to prevent
this from happening.
- Commissioner Guy said that the Harm Reduction update was presented
to the Population Health and Prevention program and the program is
really alive. The Department has taken a policy and created a good
program. It is an important part of our public policy work.
5) PRESENTATION OF EMPLOYEE RECOGNITION AWARDS FOR APRIL
Commissioner Parker, on behalf of the Health Commission, presented the
Employee Recognition Awards for April.
Jail Health Services
Cynthia Marshall, R.N.
Silver Avenue Family Health Center
Naomi Wortis, Annelise Goldberg, M.D., and Maureen O’Neil
6) PUBLIC HEALTH WEEK - APPROVAL OF A RESOLUTION
Ginger Smyly, Acting Director of Community Health Promotion and
Prevention, presented a proposed resolution honoring Public Health Week,
April 1 - 7, 2002. The theme for National Public Health Week is “Healthy
People, Healthy Communities.” This theme is strongly present in the
Department’s Strategic Plan. Ms. Smyly distributed a calendar of Public
Health Week activities and noted that April is also Harm Reduction Month
and Sexually Transmitted Disease Prevention Month.
- Commissioner Parker said that Public Health Departments throughout
the nation are the core entities serving impoverished people and
controlling infectious disease. Without public health departments and
workers, the nation would be unhealthy.
- Commissioner Guy said that the next meeting will be held in the
Mission District and this is another way to celebrate public health
week/month. Commissioner Guy said that another theme is the focus on
health disparities. This Health Commission is attempting to do this in
various ways. This Commission and Department have focused on community
health and all of these efforts are something to celebrate.
- Commissioner Sanchez said that there are key national figures of
color in health leadership positions that are very aware of inequities
in health care and they may prove to be important assets. This gives
us an opportunity to focus on the national inequities in health care.
Action Taken: The Commission approved Resolution 4-02, titled “Honoring
Public Health Week, April 1-7, 2002, ” with one technical amendment to
change the number of States celebrating National Public Health Week from
21 to 46.
7) OVERVIEW OF HEALTH STATUS
Randy Reiter, Ph.D., presented the 2002 Overview of Health. The purpose
of the report is threefold. First, it is to use evidence-based public
health data to develop a “big picture” of the overall health of San
Francisco’s population. Second, it allows the Department to assess how
it is doing with the two major national objectives for Health People 2010,
which are to increase the length and quality of life and to eliminate
disparities within the population. Third, it is to produce timely data for
DPH planners and programs, the City and for the public.
The Overview is organized into three sections. “Who We Are”
provides demographic view of the age and ethnic distribution of our
population. “How We Live” presents information on conditions that are
known to be major determinants of health in populations. “Our Health”
covers major physical and mental health outcomes. Dr. Reiter summarized
the demographic findings.
San Francisco versus California
- Ethnicity: San Francisco has fewer Whites and Hispanics, more Asians
- Age: San Francisco has fewer children, more adults and elderly
- Household language: 56% English, 24% Asian, 12% Spanish, 15%
- Foreign-born: 2/5 coming to US over past three decades
San Francisco Households
- Less than half of the households are families
- Less than half of married couple families have children living with
- One third of the population live in non-family households
- 127,000 single person households
Dr. Reiter also presented work and income statistics as well as
information on poverty levels.
Dr. Reiter said that African Americans have by far the highest death
rates for both males and females. In addition, they have the lowest life
expectancy rate. Life expectancy has continued to increase, but the
disparities still exist. San Francisco’s overall death rate is 10% lower
Another indicator that the Department uses to measure the overall
burden of disease and injury in a population is Disability Adjusted Life
Years (DALYs), which are a combination of years lost to premature
mortality and the number of years lived with a disabling condition. The
measure emphasizes premature mortality. The data from 1998 shows that
ischemic heart disease is the number one cause of premature deaths for
males and females of every ethnicity. The top five causes of DALYS are
drug poisoning, alcohol dependence, ischemic heart disease, HIV/AIDS and
- There are still gaps in local data, including mental health, dental
conditions, certain common diseases and risk factors, and they want to
fill some data gaps with data from the California Health Inventory
Survey, which should come in the next few months, and census data.
- Quantify size of burden and benefits of interventions on
determinants to provide more evidence to inform policy.
- Commissioner Parker said that the overall health status of the Asian
population is better than that of other populations. Has the
Department been able to learn from this and apply to other groups? Dr.
Reiter said that there are a number of possible explanations that need
to be pursued to clearly identify the factors for the better health
status. For example, immigrants from other countries are almost always
healthier, but the longer they live in the United States, the less
healthy they become. More systematic reviews are necessary.
Commissioner Parker wants to be able to clearly identify the causes of
inadequate health outcomes so that we can approach it systematically.
Dr. Reiter said they would be developing attribution analysis that
looks more deeply at the influence of various factors on the burden of
health. Commissioner Parker said that behavior, for example drug use,
has a tremendous impact on people’s health, so the Department should
be concentrating on behavior changes. Dr. Reiter said that behavioral
factors like tobacco and physical inactivity, which are considered the
two leading causes of death in the United States, clearly have a
health impact. However, there are social determinants that make it
harder for people to engage in healthy behavior, and these large scale
social determinants need to be more clearly understood. Commissioner
Parker said that the much of the health disparities are a reflection
of America’s social, economic and political system and the
Department of Public Health cannot solve the problem alone.
- Commissioner Jackson said that it seems that there have been many
more instances of inter-family violence. Mental health services need
to be more directly targeted toward these kinds of situations. Jorge
Partida, Director of Community Substance Abuse Services, said that
many studies have shown people’s overemphasis on work and not
socialization. The demands on workers are increasing, and work becomes
the families’ priority. This also leads to little supervision of
children. In addition, there are not a lot of opportunities for youth
that give them a sense of belonging.
- Commissioner Sanchez said that people do not live near where they
work to the extent that they did in the past, and therefore do not
have as much time to invest in family and community. Programs such as
the Boys and Girls Clubs play a critical role for a lot of these
families and children. This is not just a San Francisco problem, and
needs to be addressed regionally. San Francisco is losing families.
The data in the report gives us the opportunity to think about the
various factors and will allow us to develop an all-inclusive model.
- Commissioner Umekubo asked Dr. Reiter to address why San Francisco
has a lower death rate than the rest of California. It seems to
indicate that, as a city, we must be doing something differently than
other cities in California. Dr. Reiter said that some of it is due to
us having a larger proportion of Asians who have lower death rates.
Also, a lot of people try to practice healthy behavior and we have
good access to health care compared to many places. Dr. Reiter said
that we will be in a better position to answer this question next year
when once we have better information about health related practices.
- Commissioner Guy said that there is a tendency for the data to be
problem identified, rather than wellness identified. The World Health
Organization and other researchers are trying to do a paradigm shift
to focus more on wellness. With regard to the impact of income on
health, Dr. Bhatia did a study that showed that there is a well being
associated with higher income. There are social conditions that create
ill health and there are social conditions that promote well being.
Also, San Francisco has a large number of runaway youth, which
contributes to isolation and contributes to our overall health status.
Commissioner Guy mentioned that this report was discussed at the
Population Health and Prevention Joint Conference Committee and at
that time there was a lot of discussion about gender. Men have higher
morbidity and mortality than women, and we really need to examine why.
- Elizabeth Frantes said it appears that the Commission has written
off Healthy People 2000. San Francisco has never been a family
friendly city. Single adults are completely ignored because of all the
attention given to children.
8) PUBLIC COMMENT/OTHER BUSINESS
The meeting was adjourned at 4:45 p.m.
Michele M. Olson, Executive Secretary to the Health Commission