2013

Community Health Needs Assessment Kaiser Foundation Hospital – SAN FRANCISCO License #220000188

To provide feedback about this Community Health Needs Assessment, email [email protected]

I. EXECUTIVE SUMMARY    Kaiser Foundation Hospital San Francisco submits this Community Health Needs  Assessment (CHNA) in response to the federal requirements described in section  501(r)(3) of the Internal Revenue Code and related excise tax and reporting obligations,  applicable to hospital organizations that are (or seek to be) recognized as described in  section 501(c)(3) of the Code.     Kaiser Foundation Hospital San Francisco has long valued a systematic approach for  identifying community health needs in order to guide thoughtful and effective  community benefit investment for years to come. Kaiser Foundation Hospital San  Francisco has conducted community health needs assessments on a three‐year cycle  under the requirements of California Senate Bill 697, enacted in 1994. This 2013 CHNA  continues Kaiser Foundation Hospitals’ long‐standing commitment to the communities  we serve by understanding their needs and assets in order to define where and how  Kaiser Foundation Hospital San Francisco community investments can have the greatest  impact.     In coordination with academic partners, the San Francisco Department of Public Health,  other nonprofit hospitals as well as the broader San Francisco community, Building a  Healthier San Francisco built on years of successful collaboration to work on this  community health needs assessment (CHNA).  Serving California’s only consolidated city  and county and a diverse population of 805,235 residents, the partners made every  effort to create a community‐oriented process aligned with community values.    With a long history of successful collaboration, the partners agreed to work together  once again to tackle the requirement under the Affordable Care Act (ACA): to identify  and prioritize community health needs. This effort is not unfamiliar to San Francisco’s  nonprofit hospitals, as they have undergone a similar process every three years since  California Senate Bill 697 was passed in 1994. For many years this collaborative (Building  a Healthier San Francisco) has conducted collective community needs assessments.  Helpful to this year’s process was the number of similar efforts being undertaken to  assess community health needs to design improvement strategies such as accreditation  for the San Francisco Public Health Department and the Health Care Services Master  Plan. To leverage resources required for these endeavors Building a Healthier San  Francisco made use of a community‐driven process that engaged more than 160  community residents and local public health system partners who identified the  following key health priorities for action:     Safe and Healthy Living Environments   Healthy Eating and Physical Activity   Access to Quality Health Care and Services   

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 2

II. INTRODUCTION/BACKGROUND    a. Purpose of the Community Health Needs Assessment (CHNA) Report     This report was written in order to comply with federal tax law requirements set forth in  Internal Revenue Code section 501(r) requiring hospital facilities owned and operated  by an organization described in Code section 501(c)(3) to conduct a community health  needs assessment at least once every three years.  The required written plan of  Implementation Strategy is set forth in a separate written document.  At the time that  the hospital collaborative conducted this CHNA, Notice 2011‐52 from the Internal  Revenue Service provided the most recent guidance on how to conduct a CHNA. This  written plan is intended to satisfy each of the applicable requirements set forth in IRS  Notice 2011‐52 regarding conducting the CHNA for the hospital facility.    b.   Approach to Community Health Needs Assessment  From July 2011 until February 2013 the partners engaged in a process to collaboratively  assess the community’s health needs. The partners decided to 1) agree on data  elements and indicators to be collected, 2) identify the parties responsible to collect  those data, 3) identify the methods to solicit and incorporate community input, 4) share  findings, 5) identify prioritization criteria to be used, 6) conduct the prioritization  process, and 6) obtain community stakeholders’ input on strategies to address the  health needs.     i. About the new federal requirements  Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate  that hospital organizations under 501(c)(3) status must adhere to new regulations, one  of which is conducting a CHNA every three years. With regard to the CHNA, the ACA  specifically requires nonprofit hospitals to: collect and take into account input from  public health experts as well as community leaders and representatives of high need  populations—this includes minority groups, low‐income individuals, medically  underserved populations, and those with chronic conditions; identify and prioritize  community health needs; document a separate CHNA for each individual hospital; and  make the CHNA report widely available to the public. In addition, each nonprofit  hospital must adopt an Implementation Strategy to address the identified community  health needs and submit a copy of the Implementation Strategy along with the  organization’s annual Form 990.    ii. SB 697 and California’s history with past assessments  For many years, the partner hospitals have conducted needs assessments to guide  allocation of Community Benefit resources. In 1994, California legislators passed Senate  Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a  CHNA every three years. As part of SB 697 hospitals are also required to annually submit 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 3

a summary of their Community Benefit contributions, particularly those activities  undertaken to address the community needs that arose during the CHNA.     iii. CHNA framework and process    The CHNA takes a comprehensive look at the health status of San Francisco and helps  identify priority community health needs. It will serve many purposes including but not  limited to planning community benefits strategies for nonprofit hospitals, planning  health services in San Francisco, informing decision makers about San Franciscans’  health status, identifying key health priorities for the City/County and gaining a better  understanding of health disparities and inequities. Between mid‐2011 and late 2012,  similar assessments were taking place in San Francisco. Representatives of these  projects agreed to collaborate to leverage their assessment work and to incorporate  grassroots community participation.  These intersecting initiatives, all of which share  common aims, are described below:      Health Care Services Master Plan (HCSMP): The HCSMP was created by local  ordinance and requires SFDPH and the San Francisco Planning Department to create  a plan that identifies the current and projected needs for health care services in San  Francisco and makes recommendations on how to achieve and maintain an  equitable and appropriate distribution of health care services in the city.      Nonprofit Hospital Community Needs Assessment: Building a Healthier San  Francisco is a citywide collaborative of nonprofit hospitals, SFDPH, local foundations,  health plans and a variety of health organizations and philanthropic foundations that  conducts a community health needs assessment for San Francisco every three years  as required by state and now federal law.      Public Health Department Accreditation: Public health department accreditation  seeks to advance quality and performance within public health departments  nationwide. Accreditation is conferred by the national Public Health Accreditation  Board and documents the capacity of a public health department to perform the  core functions of public health and the 10 Essential Public Health Services.  Accreditation signifies that the health department has an appropriate mission and  purpose and the ability to meet the needs of the community it serves. SFDPH is  pursuing public health department accreditation for which a community health  assessment is a prerequisite. The Public Health Department is also undergoing an  integration of its Population Health and Prevention divisions as part of this process.    



San Francisco Health Improvement Partnerships (SFHIP): A program of UCSF to  improve the health of the community by integrating the interests, assets, and  expertise of UCSF, community and civic stakeholders to address the most compelling  public health issues in San Francisco.  

 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 4

The process and timeframes for key components of this collaborative project include  the following:    From July 2011 to April 2012, the Health Care Services Master Plan Task Force met in a  series of nine meetings, including neighborhood‐based community forums. Augmenting  that work from February to April 2012 the data‐consulting firm, Harder + Company  conducted focus groups to learn more about their perspective on community health  needs.     As part of the Public Health Department’s Population Health and Prevention Integration,  focus groups were conducted from March to May 2012. The visioning process with  grassroots community participants included attendees from 21 San Francisco  neighborhoods.    Culminating in July 2012 Harder + Company completed the Community Health  Status  Assessment that includes 150 indicators.     In late May and early June 2012 the Leadership Council reviewed different criteria  options, and chose the Hanlon method to prioritize the community health needs. The  Leadership Council along with members of the Building a Healthier San Francisco  coalition identified priority needs using these criteria in early August 2012.     In late August 2012, about 60 community participants attended a meeting to  understand the three priority areas, and were asked to generate strategies for each  priority.     In September and October 2012, small community groups were convened to further  hone the strategies, described later in this report. Although the Affordable Care Act  requirements stipulate that this report only identify the community health needs, it is  important to note that this grassroots, transparent course of action respected the  interests of the neighborhood participants who were interested in moving towards  implementation as soon as feasible. In the last quarter of 2012, the partners developed  goals and objectives for each priority as well as related measures and strategies to  address the needs.    III. COMMUNITY SERVED  The hospital service area includes all populations residing in the City and County of San  Francisco. Historically underserved and vulnerable populations residing in San Francisco  continue to demonstrate poor health outcomes. The primary focus of Kaiser Foundation  Hospital San Francisco’s community benefit programs is on the needs of vulnerable  populations. We define vulnerable populations as those with evidence‐based disparities  in health outcomes, significant barriers to care and the economically disadvantaged. In  the map and description below, the indicators and associated factors identify the 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 5

Bayview, Chinatown, Downtown/Civic Center, Visitacion Valley and Excelsior  neighborhoods with those characteristics. Reviewing the demographic profile, these  neighborhoods experience poverty, low educational achievement and are linguistically  isolated. These factors, described in this report as “social determinants of health” are  defined by the World Health Organization as “the conditions in which people are born,  grow, live, work and age, including the health system.”  

  Table 1: Demographic Profile   Total population:  Median age:  Average household income:  Percentage living in poverty:  Children living in poverty  Living under 200% poverty  Percentage unemployed:  Percentage uninsured: 

805,235 38.2 $ 73,127 11.86% 15% 27.59% 9.5% 11.53%

           

White: Latino: African American:  Asian and Pacific Islander:  Native American:  Other:  Linguistically Isolated  No high school diploma: 

48.5% 15.1% 6.1% 33.7% 0.5% 3.72% 23.78% 14.29%

  Sources: http://www.countyhealthrankings.org; http://www.CHNA.org/kp;  http://www.sfdph.org/dph/files/reports/PolicyProcOfc/CHSA_10162012.pdf    To demonstrate the disparities rooted in social determinants of health, the exhibit  below reveals high school non‐graduation, unemployment, poverty and inadequate 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 6

social support by race/ethnicity in San Francisco. These measures have critical and  studied links to health status:     Educational attainment has an important impact on health as years of formal  education correlates strongly with improved work and economic opportunities,  reduced psychosocial stress, and healthier lifestyles.    Unemployment may lead to physical health responses ranging from self‐ reported physical illness to mortality, especially suicide. It has also been shown  to lead to an increase in unhealthy behaviors related to alcohol and tobacco  consumption, diet, exercise and other health‐related behaviors which in turn can  lead to increased risk for disease or mortality. Because employee‐sponsored  health insurance is the most common source of health insurance coverage,  unemployment can also limit access to health care.    Poverty can result in negative health consequences, such as increased risk of  mortality, increased prevalence of medical conditions and disease incidence,  depression, intimate partner violence and poor health behaviors.    Poor family support, minimal contact with others, and limited involvement in  community life are associated with increased morbidity and early mortality.  Furthermore social support networks have been identified as powerful  predictors of health behaviors, suggesting that individuals without a strong social  network are less likely to participate in healthy lifestyle choices.    The disproportionately high rates for Black/African American residents for every one of  these socioeconomic factors underscores the significant health equity issues that exist  for Black/African American San Franciscans.     Table 2: Social and Economic Factors in San Francisco by Race/Ethnicity   

 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

 

PAGE 7

The exhibit below displays these same socioeconomic factors by San Francisco  neighborhood. Only those neighborhoods consistently worse than the citywide average  appear on the chart. Please note that it is primarily the same four to five neighborhoods  that have the highest disparities among these social and economic determinants of  health:  Bayview, Chinatown, Downtown/Civic Center, Visitacion Valley and Excelsior.  The Financial District also shows significant disparities, but these data are less reliable  due to the relatively small population living in this area.    Table 3: Social and Economic Factors in San Francisco by Neighborhood 

IV. Who Was Involved In The Assessment     a. Identity of hospitals and other partner organizations who collaborated on the  assessment    During 2012 a number of other community‐based needs assessments were underway at  the same time as the CHNA. In order to reduce duplication of effort, leverage resources  and to respect community members’ time commitment to the process, the CHNA was  combined with the Health Care Services Master Plan process, the Department of Public  Health’s process to achieve accreditation that requires the completion a Community  Health Assessment (CHA) and a Community Health Improvement Plan (CHIP) and the  work of the San Francisco Health Improvement Partnerships. This fortuitous  combination of efforts brought together a number of additional partners beyond the  members of Building a Healthier San Francisco who are tasked with producing the  hospital community needs assessment every three years.     Following is a list of Building a Healthier San Francisco members who are responsible for  guiding this and every triennial nonprofit hospital community health needs assessment:  

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 8

 

  Building a Healthier San Francisco Membership  1. Anthem Blue Cross  2. California Pacific Medical Center  3. Chinese Hospital  4. Hospital Council of Northern and Central California  5. Kaiser Foundation Hospital  6. McKesson Foundation  7. Mount Zion Health Fund  8. NICOS Chinese Health Coalition  9. Saint Francis Memorial Hospital  10. San Francisco Community Clinic Consortium  11. San Francisco Department of Human Services  12. San Francisco Department of Public Health  13. San Francisco Foundation  14. San Francisco Medical Society  15. San Francisco Unified School District  16. St. Mary's Medical Center  17. UCSF Medical Center  18. United Way of the Bay Area      Below is description of collaborating organizations and individuals that enriched the  input through a variety of perspectives and contributions to the combined efforts:      Nearly 30 community stakeholders – including representatives from San Francisco’s  nonprofit hospitals, academic institutions, health plans, the African American Health  Disparities Project, San Francisco Human Services Agency and SFDPH.    Close to 70 community residents and members of the local public health system –  including representatives from K‐12 education, higher education, philanthropy,  nonprofit agencies, minority health equity coalitions, government (including the San  Francisco Mayor’s Office and Health Commission), hospitals and more.   Hospital and academic partners, who continued to partner with SFDPH on San  Francisco’s CHA/CHIP Leadership Council, which has guided the development and  will guide the implementation of San Francisco’s CHIP.    The CHA/CHIP Leadership Council was responsible for steering the multiple processes  that intersected during this community health needs assessment process. A  representative from each of the initiatives met on a regular basis to ensure that each  project’s requirements were being met. The Leadership Council members are listed in  the table below:    

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 9

  CHA/CHIP Leadership Council     Program/Project 

Organization/ Department 

Lead 

Health Care Services Master  Plan and DPH Public Health  Accreditation  

San Francisco  Department of Public  Health 

Barbara Garcia, SFDPH, Director of Health 

Community Transformation  Grant 

San Francisco Health and  Prevention, Department  of Public Health 

Patricia Erwin  SFDPH, Program Manager, Newcomers Health  Program 

Population Health  Assessment 

SF PHP Population  Health & Prevention  Department of Public  Health 

Tomas Aragon, MD, MPH   Director, SFDPH Population Health &  Prevention (PHP) 

BHSF (Building a  Healthier San Francisco) 

Abbie Yant, Vice President Mission, Advocacy  and Community Health    Saint Francis Memorial Hospital    Lara Sallee, Community Benefit Manager   Kaiser Foundation Hospital ‐ San Francisco  Medical Center  

San Francisco Health  Improvement Partnerships 

University of California  San Francisco 

Kevin Grumbach, MD Department of Family  and Community Medicine, UCSF    Wylie Liu, Director of University Community  Partnerships, UCSF 

Health Development  Measurement Tool 

San Francisco  Department of Public  Health 

Rajiv Bhatia, MD Director of Occupational and  Environmental Health 

Community Health Needs  Assessment 

    b. Identity and qualifications of consultants used to conduct the assessment    A number of consulting firms and consultants were involved throughout this process  including 1) Heart Beets for community engagement; 2) Circle Point for ongoing  communication with stakeholders; 3) Harder and Company for data collection and  analysis; and 4) Nancy Shemick for meeting facilitation and report writing.     HeartBeets Director Laura Critchfield brings more than 20 years’ experience in the  health and education fields, with a focus on ensuring the voices of those most affected  by policies and programs play a lead role in designing and implementing them.  David  Fernandez has extensive experience around diversity and systems integration.  HeartBeets facilitators are trained in the Institute for Cultural Affairs’ techniques that  ensure focus groups build trust among diverse participants, highlight common interests  in an efficient way and lay the groundwork for tangible community‐centered action.      SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 10

As Project Manager at Circle Point, Ms. Daniels provides administrative support,  communications outreach and facilitation of the partnership efforts.  She coordinates  CBP, BHSF and Champions meetings as well as helps execute the tasks including  management of the Building a Healthier San Francisco website and Facebook page,  coordination of public outreach events and correspondence, management of public  health indicator data and maintenance of the stakeholder contact database.  She was  instrumental in recruiting and organizing community input. She holds a Masters of  Science Degree in Community Development.     Harder + Company is a consulting firm specializing in research, strategic planning,  evaluation, and facilitation services with offices in Davis, San Francisco, San Diego and  Los Angeles.  Its mission is to provide health, social service and advocacy organizations  with the information and tools they need to do their work effectively.  Since 1986, they  have worked with public and private human service agencies throughout California and  the country to plan services and evaluate programs that improve the health and well  being of diverse populations.  In particular, they have developed short and long‐range  strategic plans for philanthropy, government agencies, nonprofit organizations, and  community groups, as well as for numerous advocacy organizations.      Ms. Shemick holds a Masters Degree in Public Administration and has been working  with community and public health organizations for over 35 years. She completed the  required California SB 697 Community Needs Assessments for Kaiser Foundation  Hospital in San Francisco in 2010.  Ms. Shemick has also worked as a consultant to the  San Francisco Department of Public Health as well as several community health centers  in San Francisco. She uses her skills in strategic planning, Board development, project  management and group facilitation.    V. Process and Methods Used To Conduct the CHNA    Both qualitative data as well as quantitative data were collected as part of this process.  To honor community members’ substantive contributions of time and energy devoted  to generating qualitative data for MAPP (Mobilizing for Action through Planning and  Partnerships, whose components are described in the exhibit), San Francisco’s  CHA/CHIP Leadership Council – consisting of representatives from the numerous  assessment initiatives – took initial responsibility for synthesizing the data. A graphic  description of data sources and their purposes for each assessment is noted in the  exhibit below.     

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 11

Exhibit 1: San Francisco CHNA Data Sources   

 

 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 12

    a. Secondary Data    Community Health Status Assessment  An analysis of over 150 data indicators (see Appendix II for a listing of the indicators)  was conducted by Harder + Company who was engaged specifically for the Community  Health Needs Assessment process. To ensure that all the Kaiser Foundation Hospital  required indicators in this assessment were included, a comparison of these 150 data  indicators was made with those available on the CARES database. In a few cases, the  CARES indicators yielded different or small variations from the Harder + Company  results, but they were not significant. The Leadership Council  (please see page 10 for a  table of Leadership Council members) agreed to the final list of 150 indicators. The  indicators and each data source is located in Appendix II.   Harder + Company conducted a comprehensive review of secondary data sources to  obtain the most current and reliable data for the CHSA. Secondary data sources and  resources include but are not limited to the US Census 2000 and 2010, the American  Community Survey 2009 and 2010, the California Department of Public Health (CDPH),  the California Department of Finance (DOF), the California Office of Statewide Health  Planning and Development (OSHPD), the California Department of Education (CDE),  SFDPH, SFDPH Healthy Development Measurement Tool (HDMT), Health Matters in San  Francisco, the California Health Interview Survey (CHIS), the Behavior Risk Factor Survey  and Surveillance (BRFSS), Health Resources and Services Administration (HRSA), Healthy  People 2020 (HP 2020), the 2012 County Health Rankings and Community Health Status  Indicators.     In all cases, Harder + Company used the most current data available to complete the  current CHSA (i.e., data that were considered preliminary were not used). These data  were exported in database formats, cleaned and basic statistical techniques were  applied to analyze trends. Where applicable, benchmark or target data were included.  All data were carefully reviewed and analyzed to ensure that they accurately address  and respond to each of the indicators and category areas. Sample sizes for datasets  were examined to ensure that they were large enough for analyses, particularly for sub‐ populations. If sample sizes were not large enough, results were either aggregated over  several years, were not presented, or the indicator was presented as “statistically  unstable.”   

The data compiled from OSHPD to examine health care utilization throughout San  Francisco describes individuals who access some kind of health service based on patient  discharge data or patient registration data.   

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 13

Therefore, these data does not capture those who did not access health services or who  access health services at a health agency whose data is not collected or reported to  OSHPD. In addition, neither OSHPD nor any other source provides comprehensive data  regarding the distribution of private sector health professionals and the patients they  serve. This information gap reflects the fragmented nature of the health care system  and illustrates the difficulty of health service planning for optimal community health.     Also, although US census 2010 data were released between the end of 2011 and early  2012, all of the data required for this report were not yet available, such as the  descriptive breakdown of poverty status in San Francisco. In those instances, data from  the American Community Survey (ACS) 2009 and 2010, an ongoing sample survey  calculated by the US Census Bureau, were used and cited as such. Additionally, certain  demographic data is no longer available through the US Census but rather comes  through the ACS.    A limitation of the cross‐sectional data currently available is that it does not allow for  examination of the cumulative or interactive effects of various factors that may impact  health status. (e.g., being poor, female, Latino, and living in a certain neighborhood may  have cumulative effects on the risk of disease and illness that are not reflected in  individual indicators). In addition, while neighborhood boundaries do not necessarily  reflect residents’ lived experiences or their personal definitions of neighborhood,  geographic data are presented in the format in which they are available (i.e., planning  neighborhood, zip code, County supervisorial district).     b. Community Input     As part of the collaborative community health needs assessment, numerous focus  groups were convened, ranging from the goal to create a vision for a Healthy San  Francisco to learning about health issues and needs that informed the health care  services master plan. In addition to sessions to create a vision for a healthy San  Francisco, six consumer focus groups were conducted for the health care services  master plan. In these sessions, the participants were asked about the community’s  health needs. The focus group sessions were organized in groupings that included  persons with low‐incomes, those who are medically underserved, minority populations,  and individuals with chronic conditions. The focus groups were titled 1) Older adults and  the disabled, 2) Lesbian/gay/ bisexual/transgender, 3) Monolingual Spanish, 4) Excelsior  District families, 5) the Richmond/Sunset neighborhood areas, 6) Youth.    Recruitment for the focus groups was community based, and local health and social  service providers also assisted with the recruitment. Recruitment techniques included  posting flyers at community locations where potential participants may visit and placing  calls to service providers with instructions for face‐to‐face recruitment. All potential 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 14

participants were screened for eligibility based on the eligibility criteria for each focus  group.    Each group consisted of up to 12 participants. Elderly – Disabled group participants were  either elderly (60 years or older) and/or living with a disability. They are also medically  underserved and suffer from chronic conditions. Their ages ranged from 40 to 78. Of the  eleven total participants, ten were male and one was female. Most participants  reported residing in the San Francisco neighborhoods of South of Market or Tenderloin,  and live on low incomes.    The Lesbian, Gay, Bisexual, and Transgender focus group members—although intended  to be diverse—all identified as being transgender. All five focus group participants  identified themselves as female (male‐to female transgender). Three were African‐ Americans, one was Asian, and one was White. All reported living in the  Market/Tenderloin/Civic Center area. They are medically underserved.     Participants in the Richmond or Sunset districts focus group all lived in the Richmond or  Sunset districts and identified as being Asian or Asian American. Five were female and  one was male, and they ranged in age from 28 to 69 years. All are members of minority  groups.    Participants in the Excelsior district neighborhood focus group live in that neighborhood,  with ages ranging from 37 to 61. Four of the nine participants self‐identified as female  and members of Asian/Pacific Islander minority groups. The others did not self‐identify.     In the monolingual Spanish focus group, there were twelve participants, nine of whom  were female and three were male, ranging in age from 49 to 81 years. They are also  medically underserved and live on low incomes.   

The teen focus group included eleven teenage participants of the Mo’ MAGIC program,  a San Francisco neighborhood‐based nonprofit organization whose mission is to  transform the community and youth through collaboration. The teens represented a  variety of San Francisco neighborhoods: seven participants were female and four were  male.      In addition to the input from the community residents described above, experts in  health care, public health, issues that affect community health and health inequities  gathered on August 28, 2012 to review the health needs and to share their perspectives.  A list of these public health and related experts, their organizations and titles as well as  the groups that they represent is located in a table as Appendix III.     VI. Identification and Prioritization of Community Health Needs    a. Identifying Community Health Needs 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 15

  In May 2012, a review of the outcomes of each assessment was conducted to determine  the common community health needs. Not surprisingly, each assessment’s outcomes  generated common community health needs, as described by poor health outcomes  and their associated drivers. The process first grouped results of the Mobilizing for  Action through Planning and Partnerships (MAPP, whose sources are described in  Exhibit 1 on page 12) and Community Vital Signs (also described in Exhibit 1, page 12)  health indicators into common health needs, using a grid to group like data points.     The community health needs were then placed in a grid format to facilitate presenting  them in easy‐to‐understand high‐level data concepts by data source and overarching  theme. Then members of the CHA/CHIP Leadership Council reviewed the grouped poor  health outcomes and their associated drivers, to ensure all data were considered and  grouped correctly. Staff made revisions based on input from the Leadership Council.    b. Prioritized Description of all community health needs identified through the CHNA     The staff then presented the process and findings to experts and others from of the  broader San Francisco health system, including members of the Building a Healthier San  Francisco coalition and the CHA/CHIP Leadership Council. Following an in‐depth  discussion of the data, they then reviewed the data synthesis grid with common health  needs. They were given the opportunity to comment and suggest revisions. Participants  felt that the community health needs were accurate—based on the numerous data  sources used for the assessments, the process to find commonalities, as well as their  professional experience.  The seven community health needs are:    1. Safe and healthy living environments  2. Behavioral health  3. Access to quality health care and services  4. Physical activity and healthy eating  5. Spread of infectious disease  6. Early childhood development  7. Seniors/persons with disabilities’ access to care and services    SAFE AND HEALTHY LIVING ENVIRONMENTS    NEED

a. Safety and crime prevention

INDICATOR (Source)

Annual SFGH violent injury incident rate per 100,000 population (SFGH Trauma Registry)

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

SF BASELINE EQUITY

Black/African American: 453.8 Latino: 121.1 Best-performing: Asian: 18.9

CITYWIDE

75.1 (606/year = actual number)

PAGE 16

NEED

INDICATOR (Source)

Perceived safety at night among adult residents (SF City Survey)

Five-year average annual rate of severe and fatal pedestrian injuries per 100,000 population (SCI) b. Exposure to environmental hazards

Proportion of population living in area with 10 ug/m3 or higher 2.5 concentration (SFDPH and Bay Area Air Quality Management District via SCI)

Percent of population living within an area with average daytime and nighttime noise levels greater than 60 decibels (SFDPH via SCI)

SF BASELINE EQUITY

94107: 33.9% 94112: 32.8% 94102: 31.4% 94134: 22.9% 94124: 13.1 % Best-performing: 94114: 75%

CITYWIDE

51.1%

Age 65+: 16.75 Best-performing: Age < 18: 8.4 Mission Bay: 15.80% Financial District: 7.10% SOMA: 6.10% Bayview: 4.40% Excelsior: 4.00% Best-performing: Several neighborhoods are at 0%

Downtown/Civic Center: 99% Western Addition: 98% Financial District: 97% Haight Ashbury: 96% SOMA: 95%

11.60

1.20%

70%

Best-performing: Seacliff: 1% Annual number of housing violations per 1,000 residents (SFDPH and Department of Building Inspection via SCI)

Downtown/Civic Center: 24.5 Nob Hill: 13.2 SOMA: 11.5 Mission: 10.3 Russian Hill: 9.8

5.4

Best-performing: Pacific Heights: 1.2 Percent of adults who smoke (CHIS)

c. Safe, green, “active” public spaces

Black/African American: 28.5%* Adults 18-24: 26.7%* Best-performing: Asian: 6%* Seniors: 2.3%*

11.5%

Complete subpopulation disparity data unavailable.

72.4%*

Percent of teens feeling that their local park/playground is safe during the day (CHIS)

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 17

NEED

INDICATOR (Source)

Percent of land that is open space (SF Planning Department via SCI)

SF BASELINE EQUITY

Treasure Island + Yerba Buena Island: 0.0% Crocker Amazon: 0.6% SOMA + Nob Hill: 1.3% Mission + Presidio Heights: 2.0% Outer Richmond: 2.9% Best-performing: Seacliff: 70.4%

CITYWIDE

22.8%

BEHAVIORAL HEALTH     NEED

Mental health, smoking, alcohol abuse

INDICATOR (Source)

SF BASELINE CITYWIDE

Age-adjusted death rate due to suicide

Current: 10.7/100,000 Target: 5.0/100,000 Current: 12.5% Target: 12% Current: 51.6/100,000 Target: 48.7/100,000 Current: 14.8/100,000 Target: 5.5/100,000

Adults who smoke Lung & Bronchus Cancer Incidence Rate Liver & bile duct cancer incidence rate

  ACCESS TO HEALTH CARE SERVICES   NEED

INDICATOR (Source)

Preventable emergency room visits: Health insurance or enrolled in a comprehensive access program

Hospitalization rate due to congestive heart failure Hospitalization rate due to uncontrolled diabetes Hospitalization rate due to immunization-preventable pneumonia or flu

  SPREAD OF INFECTIOUS DISEASE    NEED

Access to care for Hep B patients Access to caremedical home

SF BASELINE CITYWIDE

Current: 237.8/10,000 Target: 234.6/10,000 Current: 30.9/10,000 Target: 18.3/10,000 Current: 0.40/10,000 Target: 0.40/10,000 Current: 7.1/10,000 Target: 2.6/10,000

 

INDICATOR (Source)

SF BASELINE CITYWIDE

Number of clinicians on the SF Hep B Free Clinician’s Honor Roll (DPH) Liver and bile duct cancer incidence rate Infants fully immunized at 24 months

Current: 702 clinicians Target: 1,350 clinicians

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

Current: 14.8/100,000 Target: 5.5/100,000 Current: 79% Target: 90 %

PAGE 18

HIV/AIDS death rate among Black/African American men nearly three times that of the city overall.

HIV incidence estimate

Current: 621 new infections Target: 467 new infections Current: 530.4/100,000 Target: 314.6/100,000 Current: 258.6/100,000 Target: 47.5/100,000 Current: 44.0/100,000 Target: 2.1/100,000

Chlamydia incidence rate Access to prevention and treatment

Gonorrhea incidence rate Primary and secondary syphilis rate

  EARLY CHILDHOOD DEVELOPMENT    NEED

INDICATOR (Source)

SF BASELINE CITYWIDE

Access to prenatal care Access to care and education

Mothers who received early prenatal care Hospitalization rate due to pediatric asthma

Current: 87.3% Target: 90% Current: 11.9/10,000 Target: 3.3/10,000

HEALTHY EATING + PHYSICAL ACTIVITY    NEED

a. Physical activity

b. Healthy eating

INDICATOR (Source)

Percentage of physically fit children within the San Francisco Unified School District who score 6 of 6 on the California Fitness-gram test (CDE and SFUSD)

Minutes per day residents spend walking and/or biking for nonleisure, utilitarian trips (SFCTA via SCI) Food Market Access Score (SCI)

SF BASELINE EQUITY

5th Grade (African American): 11.5% 7th Grade (African American): 12.9% 9th Grade (Native Hawaiian/Pacific Islander): 5.1% Best-performing: 5th Grade (White): 27.3% 7th Grade (Asian): 41.5% 9th Grade (Asian): 44.2% Outer Mission, Bayshore, Hill Districts, and Sunset: < 20 min. Best-performing: SOMA: 43.3 min. Treasure Island: 0 Visitacion Valley: 25 Lakeshore: 29 Bayview: 33 Ocean View: 45

CITYWIDE

5th grade: 20.3% 7th grade: 30.4% 9th grade: 34.8%

27.6 min.

56

Best-performing: Downtown/Civic Center: 93

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 19

NEED

SF BASELINE EQUITY

INDICATOR (Source)

Percent of children and teens (ages 2-17) who consume five or more servings of fruits and vegetables daily (CHIS)

c. Number of residents who maintain a healthy weight

Percent of children and adolescents who consumed two or more glasses of soda or sugary drink yesterday (CHIS) Percent of youth (San Francisco students in Grades 5, 7, and 9) who score within the “High Risk” category (obese) for body composition on the Fitnessgram physical fitness test (CDE via Kaiser Permanente) Percent of adults that report a BMI ≥ 30 (CHIS)

Black/African American: Not Available1 White: 17.6%* Asian: 17.2%* Best-performing: Latino: 26.7%* Asian: 24.2%* Latino: 33.9%* Best-performing: White: 4.4%* American Indian/Alaska Native: 42.6% Latino: 37.7% Black/African American: 32.8%

CITYWIDE

18.3%*

17.2%

24.2

Best-performing: Asian: 15.3% Latino: 56.9% Black/African American: 33.4%*

17.2%

Best-performing: Asian: 7.1%*

  ACCESS TO HIGH QUALITY HEALTH CARE AND SERVICES    NEED

a. Integration + coordination of services across the continuum of care b. Connection of individuals to the health services they need

c. Services are culturally + linguistically appropriate

SF BASELINE EQUITY

INDICATOR (Source)

Percent of currently insured (CHIS) + percent enrolled in Healthy San Francisco (HSF) Percent of persons who delayed or did not obtain medical care (CHIS) Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees (CHR) Percent of adults who speak a language other than English at home who have difficulty understanding their doctor (CHIS)

Subpopulation data unavailable White: 23.5% Black/African American: 19.7%* Best-performing: Asian: 2.5%*

CITYWIDE

94%

15.1%

Subpopulation data unavailable

49

Spanish: 29.9%* English & Spanish: 9.9%* Chinese: 5%*

2.7%

Best-performing: English: 0.6%

1

 Please note that Black/African Americans and other racial/ethnic groups may be underrepresented among children  and teens who consume 5+ servings of fruits and vegetables daily; CHIS does not provide estimates for samples  smaller than 500 people.

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 20

NEED

INDICATOR (Source)

d. Access to a health care home

Percent of persons who have a usual place to go when sick or need health advice (CHIS)

SF BASELINE EQUITY

Asian: 85.4% Latino: 86.8%* White: 88.1%* Best-performing: Black/African American: 97.8%*

CITYWIDE

86.8%

c. Process and criteria used for prioritization of the health needs    To help frame its thinking about the definition of health and health needs this process  built on the work by the Bay Area Regional Health Inequities Initiative (BARHII).  Members of this forward‐thinking group created a Conceptual Framework for  Understanding and Measuring Health Inequities that helped the partners frame their  work beyond the concept of medical care.     A clear implication of this framework is that vulnerable populations and communities  often experience health disparities; that is, they have poorer health outcomes than  other segments of the population. Health disparities that are avoidable, associated with  social disadvantages that create barriers to opportunity and are considered ethically  unfair are called health inequities. This framework encouraged the decision to define  “health need” as “A poor health outcome and its associated health driver(s).”   The framework also supported what type of data were collected as well as the  populations involved in the community input, along with the public health experts who  contributed to identifying the health needs and the prioritization process.     To prepare for the prioritization session, the Leadership Council agreed that this  important process is best accomplished through agreeing on a set of the criteria that  consider not only the importance of the health issue (quantitative and qualitative  aspects) but also the effectiveness and feasibility of potential interventions. The  Leadership Council reviewed approaches used by other organizations and health  departments, and took into account criteria that emphasize equity and community  sentiment—two values brought forth by the community. The Leadership Council came  to consensus and agreed to use a modified “Hanlon Method.” On August 3, 2012  members of the Leadership Council and Building a Healthier San Francisco met and used  these priority‐selection criteria:    1. Magnitude/Size of the Public Health Issue  2. Other Factors Related to Importance of the Public Health Issue  3. Effectiveness of Interventions  4. Feasibility and Sustainability of Intervention Implementation  5. Equity (some groups are more affected by the issue/a health inequity  exists for the issue)   

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 21

Please note that San Francisco elected to highlight equity as a priority‐selection criterion  to uphold the collaborative’s fundamental value of reducing disparities in health access  and outcomes for San Francisco’s diverse communities. (Please see Appendix I for a  more detailed explanation of San Francisco’s priority‐selection criteria.)   

Once agreement was reached about the seven community health needs, the  participants individually ranked the seven needs against health priority‐selection criteria  with “1” indicating highest rank and “7” indicating lowest rank.     Facilitators totaled individual scores for each data theme and criterion to identify San  Francisco’s top three health priorities for action. These priorities, as well as some assets  available to address them (see Appendix IV for a full list of assets), include:    Priority 1: Ensure Safe and Healthy Living Environment  Some community assets and resources available to respond to this need:   Strong interagency and community collaboration (e.g., SFHIP, CBP, Community  Transformation Grant Team, Healthy Homes Project)   Sustainable Communities Index, which facilitates health impact assessment in land  use planning   Strong existing programs that address these issues such as SF Tobacco Free Project  and Bayview Safe Haven after school program (Effective Practice)   Strong network of existing and well‐maintained parks    Priority 2: Increase Healthy Eating and Physical Activity  Some community assets and resources available to respond to this need:   Strong interagency and community collaboration to improve nutrition (e.g., SFHIP,  Southeast Food Access Network, SF Food Security Task Force)   Strong interagency and community collaboration to improve opportunities for  physical activity (e.g., Sunday Streets, Walk First, Bayview HEAL Zone, Safe Routes to  School, SFHIP)   Current Assessment Efforts: Communities of Excellence in Nutrition, Physical  Activity, and Obesity Prevention (CX3)    Priority 3: Increase Access to Quality Health Care and Services  Some community assets and resources available to respond to this need:   Health Reform as driver toward primary care home as well as integration and  Coordination   Healthy San Francisco + SFPATH (provides affordable medical care to people living in  San Francisco)   SF system of care (SFDPH, nonprofit hospitals, community clinics, private providers)    Session participants reviewed the identified priorities and agreed that all selected  priority issues were reasonable and appropriate for San Francisco. On August 23, 2012 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 22

the priority areas were presented at a meeting of over 60 community members,  nonprofit organization leaders and public health experts interested in improving the  health status of all San Franciscans. The participants were asked to contribute their  ideas on the best strategies to address each of the three areas.    The partners will unveil their work to community, business and other partners in the  second quarter of 2013. A goal is to identify collaborative strategies to increase the  likelihood of having a greater impact on the health needs.     In conjunction with this report, each hospital will develop an implementation strategy  for each health need identified. These strategies will build on assets and resources, as  well as evidence‐based strategies, wherever possible. The Implementation Strategy will  be filed with the Internal Revenue Service using Form 990 Schedule H.    Appendices:    Appendix I: Criteria for Prioritizing Community Health Needs  Appendix II: Data Indicators and Sources   Appendix III: Public Health Experts Involved in Community Health Needs Identification  Appendix IV: Community Assets for CHNA Priorities 

SAN FRANCISCO COMMUNITY HEALTH NEEDS ASSESSMENT REPORT

PAGE 23

Appendix I: San Francisco Criteria for Prioritizing Key Health Issues + Related Considerations  Criteria A: Magnitude/Size of the Public Health Issue 

Percent of population at risk 



Mortality rate, premature death rate, prevalence, incidence, or other measure of issue’s impact  on population 



Degree of disparity between various groups (e.g., county versus other county, state, or federal  comparisons; intra‐county comparisons between groups)

Criteria B: Other Factors Related to Importance of the Public Health Issue 

Importance to the community; degree of public concern on the issue 



Level of support from community members and other stakeholders 



Alignment with national, state, and/or local health objectives 



Work on the issue is “mandated” by statute or other authority 



The local public health system has a clearly established role to address the issue 



Legal or ethical concerns related to the issue 



Linkage to an environmental concern, including safety

Criteria C: Effectiveness of Interventions 

Interventions have been successfully applied to the issue 



Level of evidence supporting the interventions 



Other rationale for use of interventions 



Preventability of the issue or condition 



Extent to which interventions will address root causes

Criteria D: Feasibility and Sustainability of Intervention Implementation  

Within the power of the local public health system to control 



Cost‐effectiveness of the interventions 



Interventions are culturally appropriate and acceptable to community members 



Size of the gap between community resources currently addressing the issue and need 



Needed resources are available 



Timeliness of implementation and expected benefits 



Ease of implementation 



Ease and likelihood of sustainability/maintenance of effort 



Legal or ethical concerns that may arise as a result of the intervention 

Criteria E: Equity  

Some groups are more affected by the issue/a health inequity exists for the issue (e.g., by  race/ethnicity, gender, age, other social determinant of health)

Definitions  

Health Disparity: Difference in the distribution of disease and illness across populations.



Health Equity: Health equity is achieved when every person has the opportunity to “attain his or  her full health potential” and no one is “disadvantaged from achieving this potential because of  social position or other socially determined circumstances.”



Health Inequity: Systemic, unfair, avoidable, and unjust differences in health status and  mortality rates



Intervention: Action intended to improve a specific public health issue 



Social Determinant of Health: Economic and social conditions that influence the health of  individuals, communities, and jurisdictions as a whole

Appendix II: CHNA Data Indicators and Sources

#

Needs Assessment Indicator

Origin

Variable(s)

Data Source(s)

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

Notes / Questions

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

National Prevention Strategy

Demographic Characteristics, Category 1 1

net change in population/population density

NACCHO

2 3 4 5

age sex race ethnicity

NACCHO NACCHO NACCHO NACCHO

6 7 8 9 10

Socioeconomic Characteristics, Category 2 employment % below poverty level - sex % below poverty level - age % below poverty level - race/ethnicity % below poverty level - children

NACCHO SF DPH SF DPH SF DPH NACCHO

11 % below poverty level - families

Census/ACS, CHSI Report

N

Census/ACS, HDMT Census/ACS, HDMT Census/ACS, HDMT Census/ACS, HDMT

N N N N

percent unemployed, percent unemployed by race count and percent below poverty by sex count and percent below poverty by age count and percent below poverty by race/ethnicity count and percent below poverty by children count and percent below poverty by families, fmailies with realted children under 18, maried couples, maried couples with children under 18, female householder, no husband, female householder, no husband with children under 18 household income, total number of households median household income, median household income by neighborhood graduation rate for cohort who entered 9th grade 3 yrs prior by race/ethnicity, by socioeconomically disadvantaged, by ELL, by special educatio, by migrant education immigration status, immigration status by age groups number of homeless people by SF District language(s) spoken at home by population 5 and over, language spoken by Kindergarten ELL educational attainment for population over 25, by selected neighborhoods household composition - married couples, female no husband, male no wife, same breakdowns with children where medical facilities (hospitals and clinics) are located by neighborhood

BLS ACS 2010 ACS 2010 ACS 2010 Census/ACS, CA DoF

N

N

neighborhood level

x

Census/ACS, CA DoF

N

neighborhood level

x

Census/ACS, CA DoF

N

neighborhood level

x

Census/ACS, CA DoF

N

neighborhood level

x

California Department of Education

N

Census/ACS SF-HSA Homeless Count

N N

district level level

x x

Census/ACS

N

neighborhood level

x

SFMTA, SFDPH EHS

N

x

HCSMP Ordinance

percent of commute trips made by biking/walkding

SFMTA, SFDPH EHS

N

x

HCSMP Ordinance

charity care applications by supervisorial district, by zip Health Reform, OSHPD; Charity Care code of residents and hospital visited report

NACCHO

12 % below poverty level - total

NACCHO

13 median household income

NACCHO

14

ratio of students graduating who entered 9th grade 3 years prior

NACCHO

15 migrant persons 16 homeless persons

NACCHO NACCHO

17 non-English speaking persons

NACCHO

18 persons 25+ with less than a high school education

NACCHO

19 single parent families

NACCHO

20 transit and infrastructure availibility

HCSMP Ordinance

21

traffic characteristics - incl. mode split among cars, public transit, bicycles, and pedestrians

22 community obligations of providers

"pre-" population/population density numbers, population density by neighborhood age sex race, breakdown by neighborhood ethnicity, breakdown by neighborhood

x neighborhood level neighborhood level neighborhood level neighborhood level

x x x x

x

x

Census/ACS, CHSI Report

N

x

Census/ACS

N

x

N

neighborhood/dsitrict level

X

x

Health Resource Availibility, Category 3 23 persons without health insurance

NACCHO

24 health coverage in San Francisco

SF DPH

25 Healthy San Francisco use

H+C, SF DPH

26 preventable emergency room use

H+C, SF DPH

27 intensity of use

HCSMP Ordinance

28 payment for services

HCSMP Ordinance

29 rate: Medicaid eligibles to participating physicians 30 rate: licensed dentists to total population

NACCHO NACCHO

31 rate: licensed general practice PCPs to total population

NACCHO

32 rate: licensed family practice PCPs to total population

NACCHO

33 rate: licensed internal medicine PCPs to total population

NACCHO

34 rate: licensed ob/gyn PCPs to total population

NACCHO

uninsured by race health coverage status, breakdown of health coverage types, health coverage types for children, health coverage types for 65 and older HSF participation by age, race/ethnicity/income, neighborhood; HSF participating hospitals and medical homes rate of preventable emergency use per 10,000in SF and by neighborhood where medical facilities (hospitals and clinics) are located by neighborhood, rate of hospital utilization, rate of PCHC use

OSHPD Patient Discharge Data, CHIS, Health Matters in SF

N

Health Matters in SF, ACS 2009, Healthy San Francisco Annual Report

N

Healthy San Francisco Annual Report

N

X

N OSHPD, Planning Dept - Dunn & Bradstreet

Emergency Dept Data, Health policy sources of payment for health services by neighborhood, research (KFF, RWJF, CHCA), OSHPD primary care health center utilization by payment source Patient Discharge medicaid eligibles, participating physicians number of licensed dentists, and total population CHSI Report number of licensed general practice PCPs, and total CHSI Report population number of licensed family practice PCPs, and total CHSI Report population number of licensed internal medicine PCPs, and total CHSI Report population number of licensed ob/gyn PCPs, and total population CHSI Report

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

x

N

N

x

trend assessment; neighborhood level

? N

x x x

N

CHSI collapses all PCPs into one number

x

?

CHSI collapses all PCPs into one number

x

?

CHSI collapses all PCPs into one number

x

?

CHSI collapses all PCPs into one number

x

Page 1 of 6 9/24/2013 11:52 AM

Appendix II: CHNA Data Indicators and Sources

#

Needs Assessment Indicator

Origin

Variable(s)

Data Source(s)

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

35 rate: licensed pediatrics PCPs to total population

NACCHO

number of licensed pediatraic PCPs, and total population CHSI Report

?

36 rate: licensed PCPs (total) total population

NACCHO NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance NACCHO, HCSMP Ordinance

number of licensed PCPs (total), and total population number of licensed acute hospital beds, and total population number of occupied acute hospital beds, and number of licensed acute hospital beds number of licensed specialty hospital beds, and total population number of occupied specialty hospital beds, and number of licensed specialty hospital beds number of licensed hospital beds (total), and total population number of occupied hospital beds (total), and number of licensed hospital beds (total)

CHSI Report

N

OSHPD

37 rate: licensed acute hospital beds to total population 38 rate: occupied acute hospital beds to total available 39 rate: licensed specialty hospital beds to total population 40 rate: occupied specialty hospital beds to total available 41 rate: licensed hospital beds (total) to total population 42 rate: occupied hospital beds (total) to total available acute hospital services, including those that require 43 specialized facility accomodations

HCSMP Ordinance

44 rate: visiting nurse / IHSS to total population

NACCHO

45

proportion of population w/o regular source of primary care (incl. dental)

46 Medicare adjusted average per capita cost

NACCHO NACCHO

rate: local health department full-time equivalents to total NACCHO population dollars in local health department operating budget per 48 NACCHO total population 47

49 neighborhood primary care health centers

Harder+Co

50 health centers/clinics that target specific populations

Harder+Co

51 governmental policy

HCSMP Ordinance

52 use of health care services by patients from outside SF

HCSMP Ordinance

x

N

SFDPH wants current and projected capacity

x

x

OSHPD

N

current and projected capacity

x

x

OSHPD

N

SFDPH wants current and projected capacity

x

x

OSHPD

N

current and projected capacity

x

x

OSHPD

N

current and projected capacity

x

x

OSHPD

N

current and projected capacity

x

x

OSHPD

?

current and projected capacity

per capita health care spending for Medicare beneficiaries

N

x

N

x

SFDPH

N

SFDPH

N

OSHPD, SFDPH, SFCCC

N

SFDPH, OSHPD Healthy Kids, Healthy SF, & Healthy Workers, (Colleen); Health policy research (KFF, RWJF, CHCA) OSHPD

x x

number of SFDPH FTEs, and total population

X

x do they mean per person? What is the "total population"?

x

N Y - DPH (Colleen)

related to distribution, access, quality, and cost of health care services; trends assessment at national, state, regional levels

x

N

x

referral of patients from SF to medical institutions 53 outside SF 54 sources and uses of capital for investment in services

HCSMP Ordinance

N/A

HCSMP Ordinance

?

trends assessment

x

55 emergency services including trauma services

HCSMP Ordinance

OSHPD, SFDEM

?

current and projected capacity

x

56 57 58 59 60

ambulatory care services including primary care hospital-based and free-standing urgent care services rehabilitation services long-tem care services home health services behavioral health services, including psychiatric 61 emergency services

HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance HCSMP Ordinance

OSHPD OSHPD OSHPD OSHPD OSHPD SFDPH Community Behavioral Health Services

? ? ? ? ?

current and projected capacity current and projected capacity current and projected capacity current and projected capacity current and projected capacity

x x x x x

?

current and projected capacity

x

62 medically underserved areas for particular services

HCSMP Ordinance

N

will also come out of HCSMP Task Force community meetings

x

HCSMP Ordinance

63 waiting times

Listing of all health services/facilities in SF along with map

Listing of all health services/facilities in SF along with map geography, transportation/communication options, unique barriers to accessing care (cultural competence, lanugage, HRSA MUA, HRSA race, immigration status, gender identity, substance abuse, public assistance SF DPH

National Prevention Strategy

x

?

total SFDPH operating budget, and total population

Percent of patients discharged from SF hospitals that were residents outside of SF

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

could not find on CHSI

number of visiting nurse / IHSS providers, and total SFHSA (DAAS)? population number of people without regular source of primary care, HRSA Health Professional Shortage Areas and total population and Medically Underserved Areas

map with listing of all PCHC, number of pts. Seen, number of services provided in fiscal year, sources of payment for services narrative, listings on map of PCHC

Notes / Questions

Y - DPH

cannot get data, only available through interviews

x

brought up at 7/1 meeting

Quality of Life, Category 4 64 Perception of health and wellness

H+C, SF DPH

65 social support

H+C, SF DPH

66 perception of safety

H+C, SF DPH

67 satisfaction with quality of physical environment

H+C, SF DPH

proportion of persons satisfied with quality of life in 68 community

NACCHO

Percent of adults who reported poor or fair health; average number of self-reported physically unhealthy days and mentally unhealthy days Receiving social support: availability of others for understanding problems; someone to health with daily chores; others for relaxation purposes percent of SF residents who feel safe walking alone during day and night percent of SF residents who are satisfied with phisical environment in which they live SEE INDCATORS ABOVE

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

BRFSS, County Health Rankings

N

CHIS

N

SF City Survey

N

SF City Survey

N N

X

SEE ABOVE INDICATORS

x

Page 2 of 6 9/24/2013 11:52 AM

Appendix II: CHNA Data Indicators and Sources

#

69

Needs Assessment Indicator

proportion of adults satisfied with health care system in the community

Origin

NACCHO

70 proportion of parents in Parent Teachers Association

NACCHO

70 school quality

H+C, SF DPH

number of openings in child care facilities for low-income NACCHO families 72 number of neighborhood crime watch areas NACCHO civic organization/association members per 1,000 73 NACCHO population 71

Variable(s)

proportion of adults satisfied with health care system in the community number of parents in Parent Teachers Association, and number of SFUSD parents percent of parents who gave a grade of good or excellent when rating child's school number of openings in child care facilities for low-income families number of neighborhood crime watch areas number of civic organization/association members, and total population

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

Data Source(s)

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

Notes / Questions

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

Focus Groups

N

Will use focus groups to get at this

x

SFUSD; CDE Dataquest

X

Data does not exist in SF

x

City Survey State Licensing; State Child Care Resource and Referral HDMT

National Prevention Strategy

N N

number occupied and available

x

X

Will not use this indicator

x

total population? adults only?

x

in progress

Page 3 of 6 9/24/2013 11:52 AM

Appendix II: CHNA Data Indicators and Sources

#

Needs Assessment Indicator

74 percent of regisgered voters who vote 75 neighborhood empowerment

Origin

NACCHO

Variable(s)

number of voters, and number of registered voters

Data Source(s)

HDMT Neighborhood Empowerment Network

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

Notes / Questions

N Y - Megan

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

National Prevention Strategy

x

Behavioral Risk Factors, Category 5 76 substance use and abuse - tobacco use

NACCHO

77 substance use and abuse - illegal drug use

NACCHO

78 substance use and abuse - binge drinking

NACCHO

79 lifestyle - nutrition

NACCHO

80 lifestyle - obesity (adults and kids)

NACCHO

81 lifestyle - exercise and sedentary lifestyle

NACCHO

Pecent of adults who reported smoking, percent of high school students who reported smoking percent illicit drug use, marijuana use, cocaine use, nonmedical use of pain relievers, trend data percent binge drinking among madults and high school students

CDC-BRFSS and YRBS

N

NACCHO groups into youth (< 18), adult, and older adult (>64)

x

X

National Surveys on Drug Use and Health, 2006-2008

N

same as above

x

X

CDC-BRFSS and YRBS

N

same as above

x

X

X

N

same as above

x

N

same as above

x

X

X

N

same as above

x

X

X

x

CDC-BRFSS, CA data in CHSI Report, percent of high school students who consumed soda; fruit CHIS, Pediatric Nutrition Surveillance and vegetable consumption; fast food consumption System obesity rate among adults and chidlren overall and by CDC-BRFSS, CA data in CHSI Report; race/ethnicity CHIS percent of adults who reported doing no leisure time exercise or physical activity; percent high school students CDC-BRFSS, CA data in CHSI Report; who report no physical activity; percent of students who CHIS; California Department of Education did not pass the physical fitness challenge percent who use a seat belt, percetn of high schol students CDC-BRFSS and YRBS who reported not using seat belt

82 protective factors - seatbelt use

NACCHO

N

same as above

83 protective factors - child safety seat use

NACCHO

number of conviction for improper child car seat restraint CA DMV

N

same as above

x

84 protective factors - bicycle helmet use

NACCHO

percent of Sf residents who wear a bike helmet percent of high school students who resported not using a condom percent of Medicare pts who received a screening % or men 40+ who had a PSA women 18+ who have had apap in last 3 yrs % of woment 40+ AND 50+ who have had amammogram in last 2 yrs

City of San Francisco Bicycle Count

N

same as above

x

CDC-BRFSS and YRBS

N

same as above

x

85 protective factors - condom use

NACCHO

86 screening - diabetes 87 screening - prostate cancer 88 screening - pap smear

H+C, SF DPH H+C, SF DPH NACCHO

89 screening - mammography

NACCHO

CDC-BRFSS, CA data in CHSI Report

N

percent of age-specific female population

x

CDC-BRFSS, CA data in CHSI Report

N

percent of age-specific female population

x

Behavioral Risk Factors by Special Population, Category 5 continued 90 substance use and abuse - tobacco use (adult)

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

X

91 substance use and abuse - illegal drug use

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

X

substance use and abuse - binge drinking (adults; alcohol 92 NACCHO use also captured for teens)

see above where applicable

CDC-BRFSS

N

see above where applicable

x

X

93 lifestyle - nutrition

see above where applicable

CDC-BRFSS, CA data in CHSI Report, CHIS

N

see above where applicable

x

NACCHO

94 lifestyle - obesity

NACCHO

see above where applicable

CDC-BRFSS, CA data in CHSI Report

N

see above where applicable

x

95 lifestyle - exercise

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

96 lifestyle - sedentary lifestyle

NACCHO

see above where applicable

CDC-BRFSS, CA data in CHSI Report

N

see above where applicable

x

97 protective factors - seatbelt use

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

98 protective factors - child safety seat use

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

99 protective factors - bicycle helmet use

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

100 protective factors - condom use

NACCHO

see above where applicable

CDC-BRFSS

N

see above where applicable

x

101 screening - pap smear

NACCHO

see above where applicable

CDC-BRFSS, CA data in CHSI Report

N

percent of age-specific female population

x

102 screening - mammography

NACCHO

see above where applicable

CDC-BRFSS, CA data in CHSI Report

N

percent of age-specific female population

x

?

burden of illness, trends assessment

x

in progress- address when Master Plan is redone in 3 years trends assessment

x

Health System Trends (from Ordinance) 103 disease and population health status

HCSMP Ordinance

SFDPH, Health Matters in SF, Healthy People 2020, 2011 County Health Rankings, phpartners.org, CHIS

104 disaster planning, surge capacity needs

HCSMP Ordinance

SFDEM, NERT

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

N/A

Page 4 of 6 9/24/2013 11:52 AM

X

Appendix II: CHNA Data Indicators and Sources

#

Needs Assessment Indicator

Origin

Variable(s)

Data Source(s)

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

105 clinical technology

HCSMP Ordinance

phpartners.org

?

106 communications technology

HCSMP Ordinance

phpartners.org

?

Notes / Questions

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

advances that help deliver care (e.g., VMI, electronic medical records), health information technology and standards trends assessment trends assessment

National Prevention Strategy

x x

Environmental Health Indicators, Category 6 107 air quality

NACCHO

number and type of US EPA air quality standards not met CHSI Report

N

x

108 109 110 111

NACCHO NACCHO NACCHO NACCHO

SF Policy of monitoring of waters and flouridation SF Policy on indoor air percent of OSHA violations rate of food-borne disease per total population number of children under 5 who have blood levels exceeding 10mcg/dL, and total number of children under 5 who are tested

SF PUC SF Policy OSHA CHSI Report

N N ? N

x x x x

Joe Walseth

N

water quality + waterborne disease indoor clean air workplace hazards food safety

percentage of what?

112 lead exposure

NACCHO

113 waterborne disease

NACCHO

rate of waterborne disease per total population

2009 Annual Report of Communicable Diseases in SF

N

x

114 fluoridated water

NACCHO

number of people (households?) with fluoridated water supplies, and total population

SF PUC

N

x

115 rabies in animals

NACCHO

total number of cases of rabies in animals

2009 Annual Report of Communicable Diseases in SF

N

x

HDMT

N

HDMT

N

HDMT

N

116 violent crime (homicide and physical assault)

H+C, SF DPH

117 community noise

H+C, SF DPH

118 overcrowding

H+C, SF DPH

119 120 121 122 123 124 125 126

Social and Mental Health, Category 7 During the past 30 days, average number of days adults report poor mental health Number and rate of confirmed child abuse and neglect among children Homicide rate Suicide rate Domestic violence Psychiatric admissions Alcohol related motor vehicle mortality Drug-related mortality Maternal and Child Health, Category 8

NACCHO

average number of self-reported mentally unhealthy days BRFSS

N

NACCHO

Number of child abuse and neglect cases

RAND, HDMT

N

NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO

Homicides per 1000 by neighborhood Number of suicides countywide and by neighborhood rate per total population Number of admissions

HDMT OSHPD OSHPD

N N Y N

number of drug-related mortality

OSHPD

N

SFDPH

N

127 birth rate (by subgroup)

Harder+Co

128 prenatal care in 1st trimester

NACCHO

129 births to adolescents as a proportion of live births 130 Adolescent pregnancy rate

NACCHO NACCHO

131 Very low birthrate

NACCHO

132 Child mortality 133 neonatal mortality 134 post-neonatal mortality Death, Illness and Injury, Category 9 135 General health status 136 Average number of sick days within past month 137 causes of death / death rate 138 All Cancers 139 Breast cancer 140 Lung cancer 141 cervical cancer 142 colorectal cancer 143 Unintentional Injuries 144 Years of Productive Life Lost

NACCHO NACCHO NACCHO

145 Causes of Premature death

homicites per 1000 by neighborhood; physical assoults per 1000 by neighborhoods; rape or sexual assault per 1000 by neighborhood Average decibel of daytime and nighttime outdoor noise by neighborhood proportion of households living in overcrowded conditions by neighborhood

NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO NACCHO H+C, SF DPH

birth rates by ageof mother, by race of mother, by neighborhood number of mothers who did not receive 1st trimester prenatal care, by neighborhood births to mother under 20 years, by nieghborhood

X

X

X

X

X

X

x

x

N N N

percent of babies born under 1,500 grams, 1500 to 2499 grams, 2500 grams or more

N N N N

percent of respondents reporting health status; percent of self-reported physically unhealthy days rates for all causes number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of cancer cases, incidence rate number of unintentional injuries by type number of YPLL under age 75 per population causes of premature death by sex and zip code/neighborhood; average age at death

BRFSS BRFSS CA State death rates CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CA Cancer Surveillance registry CDIC HDMT

N N N N N N N N N N

SF DPH

N

Communicable Disease, Category 10

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

Page 5 of 6 9/24/2013 11:52 AM

Appendix II: CHNA Data Indicators and Sources

#

Needs Assessment Indicator

Proportion of children at kindergarten entry who have receive dall age-appropriate vaccines Proportion of adults aged 65 and older who have been 147 immunized for pneumonia Proportion of adults aged 65 and older who have been 148 immunized for influenza 146

Origin

NACCHO NACCHO NACCHO

149 Syphillis cases

NACCHO

150 Gonorrhea cases

NACCHO

151 Chlamydia cases

NACCHO

152 Tubueculosis

NACCHO

153 AIDS

NACCHO

154 Bacterial meningitis

NACCHO

155 Hepatitis A cases

NACCHO

156 Hepatits B cases

NACCHO

157 Hepatitis C cases

NACCHO

Variable(s)

Proportion of children at kindergarten entry who have receive dall age-appropriate vaccines Proportion of adults aged 65 and older who have been immunized for pneumonia Proportion of adults aged 65 and older who have been immunized for influenza

Data Source(s)

California Department of Health Services

Sentinel Events, Category 11 State SF County protocol and referece mobidity data 158 above

Notes / Questions

NACCHO HCSMP Healthy Accreditaion/ Ordinance People 2020 IOM

National Prevention Strategy

N

SF DPH

In Progress

SF DPH

In Progress

SF DPH 2009 Communicable Disease Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease Tuburculosis case rates by age groups, by race/ethnicity Annual Report; Tuburculosis Control Section AIDS case by gender, race/ethnicity, exposure categories, 2010 HIV/AIDS Epidemiology Annual neighborhoods Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report SF DPH 2009 Communicable Disease rates by age, sex, race/ethnicity Annual Report

rates by age, sex, race/ethnicity

Need Help to Obtain Data? (Y, N, ?, IN PROGRESS)

N N N N N N N N N

In Progress x

S:\Public Affairs\CB\Needs Assessment\CHNA\CHNA Reports\FINAL\Revised Cover Page Versions\Final for Posting\San Francisco\ Appendix II - CHNA Data Indicators and Sources.xls Variables - All

Page 6 of 6 9/24/2013 11:52 AM

Appendix III: Public Health Experts Involved in Community Health Needs Identification       Name    Adrian Nunez  Aine Casey  Amor Santiago  Anne Quaintance  Anni Chung  Beverly Upton  Bill Hirsh  Brenda Storey  Brian Basinger  Carlina Hansen  Christina Shea  David Pating, MD 

Estela Garcia 

Gina Fromer  Gloria Thornton  Jessica Flintoft  John Gressman  Karen Gruneisen 

  Organization  

  Category of Expertise 

Healthy Kids, SF Health Plan     Health care for uninsured children  Independent Living Resource Center  Services for persons with disabilities APA Family Support Services  Services for Asian populations  Deputy Director, Meals on Wheels of SF;  Services for seniors, persons with  Long‐term Care Coordinating Council  disabilities  Exec. Dir., Self Help for the Elderly  Services for seniors  Exec. Dir., SF Domestic Violence   Services for victims of domestic  Consortium  violence  Exec. Dir., AIDS Legal referral Panel  Services for persons with HIV/AIDS  Exec. Dir., Mission Neighborhood Health  Health care for Latinos, uninsured   Center  Exec. Dir., AIDS Housing Alliance  Services for persons with HIV/AIDS  Executive Director, Women’s Community  Health care for women, uninsured  Clinic   Richmond Area Multi‐Services; Asian‐ Health care for Asian Pacific  Pacific Islander Health Parity Coalition  Islanders  Dir., Chemical Dependency  Recovery  Behavioral health care  Program, Kaiser Permanente San  Francisco  Health care for Latinos, uninsured   Exec. Dir., Instituto Familiar de la Raza;  Chicano/Latino/Indigena Health Equity  Coalition  Director, Bayview YMCA  Services for African American and  Asian populations  Community resource Center, Anthem  Health care for the uninsured  Blue Cross   Reentry Policy Director , Office of the  Services for ex‐offender populations Public Defender  Exec. Dir., San Francisco Community Clinic  Health care for the uninsured,  Consortium  minorities    Associate Director, Episcopal Community  Services for homeless populations  Services 

Kevin Grumbach, MD  Dir., Clinical Translational Science  Institute, University of California San  Francisco   Kevin Truitt  Asst. Superintendent, Director of  Wellness Programs, SF Unified School  District  Le Tim Ly  Chinese Progressive Association  Lucy Johns  Health Care Policy consultant 

PUBLIC HEALTH EXPERTS INVOLVED IN COMMUNITY HEALTH NEEDS IDENTIFICATION, PAGE 2

Population health and prevention  

School‐based health care services 

Services for the Chinese population  Health care policy and planning 

  Name    Margy Baran 

  Organization  

  Category of Expertise  Community support for seniors and  persons with disabilities  Health care for children, uninsured  Physician services  Services for uninsured minorities  Services for transgender populations Health care for African Americans 

Roma Guy 

Exec. Dir., IHSS Consortium;  Long‐term  Care Coordinating Council  Children’s Council of SF  Exec. Dir., SF Medical Society  Exec. Dir., Portola Family Connections  Exec. Dir., Transgender Law Center  Exec. Dir., African American Health  Disparities Project  Exec, Dir., Black Coalition on AIDS;   African American Community Health  Equity Council  Former President, SF Health Commission 

Sherilyn Adams 

Exec. Dir., Larkin St. Youth Services 

Steve Fields 

Exec. Dir., Progress Foundation 

Tavi Baker  Tomas Aragon, MD 

Boys and Girls Club  City Health Officer;  Dir., Population  Health & Prevention, SF Dept. of Public  Health  Dir. Of Community Partnerships, UCSF 

Maria Luz Torre  Mary Lou Licwinko  Maryann Flemming  Masen Davis  Michael Huff  Perry Lang 

Wylie Liu 

PUBLIC HEALTH EXPERTS INVOLVED IN COMMUNITY HEALTH NEEDS IDENTIFICATION, PAGE 2

Health care for African Americans,  persons with HIV/AIDS  Population health and prevention,  public health  Services for youth, homeless,  uninsured  Mental health services, uninsured,  homeless  Services for youth   Population health & prevention,  public health  Public health, population health &  prevention, health care for the  uninsured 

Appendix IV: Assets for Community Health Need Priorities  Increase Access to Quality Health Care and Services  Organization   Project Name (if applicable)   SFGH  Health Reform as driver toward primary care  home as well as integration and Coordination  SFDPH  Healthy San Francisco + SFPATH  San Francisco Community Clinic Consortium    Operation Access      Women’s Community Clinic      Project Homeless Connect       SFGH Foundation      SFDPH, nonprofit hospitals, community  SF system of care  clinics, private providers  On Lok 30th Street  Falls Prevention Maintenance Exercise  Program  Asian & Pacific Islander Wellness Center  The Wellness Clinic serving A&PI & LGBT  population  Healthcare Foundation of Northern and  African American Health Disparity Project  Central California  Health Initiatives for Youth  Middle Schools Go Healthy  Dimensions Clinic  Brief Intervention, Education, and Engagement  for Transgender Youth  Women's Community Clinic    UCSF AIDS Health Project  Reducing Mental Health Treatment Waitlist for  People with HIV/AIDS      Increase Healthy Eating and Physical Activity  Organization   Project Name (if applicable)     Strong interagency and community  collaboration to improve nutrition (e.g.,  SFHIP, Southeast Food Access Network, SF  Food Security Task Force)    Strong interagency and community  collaboration to improve opportunities for  physical activity (e.g., Sunday Streets, Walk  First, Bayview HEAL Zone, Safe Routes to  School, SFHIP)  Current Assessment Efforts: Communities of    Excellence in Nutrition, Physical Activity, and  Obesity Prevention (CX3)  Urban Sprouts  Garden Based Education Nutrition  Enhancement Project  San Francisco Green Schoolyard Alliance  2013 Grounds for Healthy Kids Project  Family Service Agency of San Francisco  Healthy Families, Healthy Lives Wellness  Program 

Family Service Agency of San Francisco  Community Grows  Boys & Girls Clubs of San Francisco  Shape Up San Francisco  Sunday Streets  Gateway to Fitness Program 

Healthy Families, Healthy Lives Wellness  Program  Seed‐to‐Mouth Cooking Classes  Power Play Expansion       

  Ensure Safe and Healthy Living Environment  Organization   Project Name (if applicable)     Strong interagency and community  collaboration (e.g., SFHIP, CBP, Community  Transformation Grant Team, Healthy Homes  Project)    Strong existing programs that address these  issues such as SF Tobacco Free Project and  Bayview Safe Haven after school program  (Effective Practice)  Strong network of existing and well‐   maintained parks  Sustainable Communities Index, which    facilitates health impact assessment in land  use planning  Straight Forward Club        LEAP (Look to End Abuse Permanently)    3rd Street Youth Center & Clinic  Fellas  Sunset Youth Services  Comprehensive Juvenile Delinquency and  Violence Prevention Program  Kidpower  Vaccine Against Community Violence  Insituto Familiar de la Raza,  Peace Dialogues  Community Matters  Whole School Climate Initiative to Reduce  Community Violence