Minutes of the Health Commission Meeting Tuesday, April 2, 2002 at 3:00 p.m. 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. Present: 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. Absent:  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 30, 2002. 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 calendar. 4) DIRECTOR’S REPORT Anne Kronenberg, Deputy Director of Health, presented the Director’s report. 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 press coverage. 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 Commissioners’ Comments 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. Awardees Division Nominated by Shayne Johnston Jail Health Services Frank Patt 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. Commissioners’ Comments 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% linguistically isolated 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 them 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 than California’s. 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 unipolar depression. Next Steps 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. Commissioners’ Comments 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. Public Comment 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 None. 9) ADJOURNMENT The meeting was adjourned at 4:45 p.m. Michele M. Olson, Executive Secretary to the Health Commission