the same time homeless statistics haven't front yard and i think what'sizing is the conversation we've had together supportive jorge's is a priority and the people who are doing it, it's not been easy. they haven't had the tools or serve funding are access to health care. so today's conversation is really important we're having the conversation of how to marry the hours with the health care. we've only gotten to thirty percent not because there isn't enough housing there's a direct co- recollection between the units that have been created around the country we haven't gotten the thirty periods of time because we don't have the

health care. we can't cope people into the housing because of the health care or we've left them on the streets because we can't deal with that. that's a priority that's where we want the resources the cost of effectiveness argument works. >> okay. well this is our opportunity to have a conversation with the panelists. you've got 15 minutes if you could tells the who you are >> sure i'm with bill i'm with the please state your name and address and i want to thank you all for our comments. i've an advocate for affordable housing. i'm sproitd people aren't talking about fooshlth.

there's aren't the section 8s available for people at the lowest income level. i haven't heard you talk about affordability in section 8 so - >> well, i mean that's a key poise. the section 8 program the dollars cope going up every year but because housing costs rise the number of people served e served is reduced. that's one the facts is affordability you can't afford your rent it's stressful. we need to focus on this strategy >> i normally say it isn't a healthy home if it's not an affordable home. if you are spending more than 50

percent of your income when you heard under secretary jones talk about it's not a sustainable thing. we know that those trade office motivator. i think that more and more trying to make the argument the investment in affordable housing is good for the community and part of our brapd and a conversation that that he need to >> good morning marsha thank you for this pro vocal cord confidence. in terms of the solution we recognize the systems don't work well together and some small changes i've wonder for a long especially with the expansion of medicaid the simple changed of

having a universal rule that medicaid can be used for housing costs as it is in the states that have the waiver and for limited pilot programs would make an enormous different in the way of creating housing and make it assessable to the low income people. we know from the brief amount of time we had the rapid housing program that it worked. no one mentioned any of the studies but from a prospective measure it's worked to prevent homelessness. and i third federal policy issue is that the health system and the food system and the childcare system and the housing system all use different definitions and the local service use different

definitions some are based on poverty and pregnancies or percentages of the area memoranda income and especially in high cost community and tight housing marketed the cross over between those two is dramatic and doesn't reach as bill said the housing doesn't reach those at the poster levels where the need it greatest. seems like we've known the health and social science research but how home matters but we've known of the system impediments to reach more people it two far reached to expect those under those conditions to

have and to have sequestration to teaspoon where we have you voufrndz from an incredibly bad system and effecting about a one hundred thousand homeless people who are receiving serves we've got to do a better job to reach the population and not let the budget cut elders have the floor all the time and in forging opinion. >> thank you tights interesting you brought of snap also known as food stamps. some of our planned showed that loss of a housing subsidy made you unsure but lots of snap made

you less likely to feel secure so the interrelatedness of childcare is important. i think more and more thinking of the single shop stopping ways in which we can integrate and the other piece that's interesting is medicaid has the essential benefits rule that some can go towards unlonsz provider people that we are delivering health services it's like community healthy workers. sometimes kids those are their homes teaching them how to make their homelands healthier. it could be something of a covered serves but the fact that medicaid can pay for rent i

don't see that ever happening. it's one of the things i think this is where i get worried about there are people who cost a lot of people money their superfluous utility earrings their million dollars patient that's important we should design systems for them but i care about my patient who's a year old and i worried about setting up a health care solution for them that's not a public solution not just in the health care fold more about the linkage >> i appreciate but you've got a line behind you i'm sorry. we probably have another 10 minutes or so, so if there are just questions that would be

helpful and i'm the director of the housing program here in san francisco since 1963. been called that originally but a very quick antidote. the health department has a health commission it heard recently a report from the health director and the consults who were hired to voices them open health reform at the meeting a thing was declared that san francisco was compared to the rest of the country over institutionalized and they called on the three things the hospital, the lou began honda and housing. i knew about la gunman i heard,

in fact, their advocating not investing in the housing program. director a couple of weeks later said no, it was not backing up on the commitment to supportive housing it struck me that what they followed that comment about housing what a huge investment in the information extension in order to integrate the information systems that are necessary to make manage medi-cal function properly. there 63 different data systems that drive the department of public height that fit together to make health care work and

talking about the honorable investment of money in order to integrate the data. this was money if their lack shifting from what you've been doing into what's going to be necessary in order to put the system together. so i'm curious just to hear our responses about how the health reform is going to be driven by those kinds of heavy front end investment that are noted not only here but cross the country to the point to make the data systems to work the conversation about housing or habitation or early intervention all those things aren't going to see the light of day when it comes to medicaid, 34th allocation

decisions >> obviously from the extent of my analysis we've about that treating a lot of people with cold that anti biotics they - we've created a balloon system that no department can sustain. the san francisco city as a hsht controlled system in the country. so if you compare homelessness you have to say something's wrong. you can't ignore that so if they didn't dlu disclose that they're not doing their jobs.

we can't spending send people to the streets we're stuck because we have not dpifrtd our income we're using general fund to pay for our housing when others diversity city's are oourgdz hud i don't condition the report to the health system was doing the job without delores those systems. we have to use our layers targeted services i think they did their job >> debt do you want to say anything about that. >> no. >> before josh goes i'm not familiar with the report. let me say two things. first of all, i think community annoyed to invest in data

systems they'd the only woo we're going to get the tart for the most individuals that need the supportive housing. i didn't know what expect the housing issues were coming in play when the city talked about the housing with inspections. that's the conversation around the country >> if we could i think we'll take more questions. >> at the i'm josh simon. i'm the the eastwood corporation i'm also a school board member of a small school. my question is about the prevention side and the big opportunity that seems to be roll call out over the research and promised neighborhood.

we know in the school world everything every time a custody moves their test scores drop. we know how affordable housing how important it is with our school health clinic we know what's happening and one secondy question the new funding formula for schools every school has to put together an organizing plan to work with parents and how do you see opportunity with the health community and the schools community to use that as a vehicle to talk >> it's interesting in massachusetts they did a pilot where they assigned specific voufrndz we have the rental

voucher program they assign the vouchers to schools to their high-risk children could receive the vouchers to cope the kids in school to improve their test scores. many parents because of the lack of affordable housing shuffle from dissected. a study was done where basically kids in k0ir7bd there was only 11 percent chance they would be there in 12 grade it was because they were moving between school districts. we invest in families and don't coordinate it investment but we need to coordinate investment not only in terms of housing but in terms of food investment and safety and in terms of being able to reduce community violence.

all of those things are interrepelled in health. today we are going talking about health and health care as a flafrm and how housing and health care could work together but the school is an incredibly important partner. i agree and i think the research is coming out more and more viflt in place matters and thinking about place is one of the investment but also thinking about schools >> and in tacoma washington looking at what the housing authority one family moving into a district had to sign a pledge not to move and they would then be given housing assistance. but it will improve outcomes for the community >> this is a sort of continuum

we use 0 only think about the building and then to hope 6. so those who who don't know one nonprofits mission and out the the bay view demonstrate there's a program there >> hi, i'm with the area health initiative we work with lifting bay health programs. we've 25ubd housing in today's event i'm wondering if you can speak a little bit to the issues of higher housing costs and displacement and upstream policies like we're seeing a lot

of the increases in suburbia poor because people being forced out of the city and less resources for those groups as well as the - yeah, that. the upstream strategies around policies like anti displacement >> i want to make one comment everyone deciphers housing but housing is not a health care thing for folks. in the health department we have to help reduce the costs but that doesn't mean there isn't another part of the government that shouldn't be tending to a lack of sdpift because of the high rental costs and so on it's

not was the inhibiting should be leading the charge around. one of the things we've done in the san francisco health department we're going to have the health treatment but it only works for a narrow population. and that's where the health care interference in terms of reducing the health care costs needs to be applied >> i will say i'm more and more complars the health term. entity is this idea of being able to not only have an even playing fold but brings in the idea of equal opportunity stae really understanding racism. and so that mori think understanding particularly neighborhood level interventions

the children's zone is a great example in new york they took an area to make it better for kids. at the at the end up having to fight identification because they made the neighborhood to annoys. there are more and more ways we're able to think about those interference. i think home matters. i'll talk about the 4 whys matter that is it's more than having a roof over our head and who is under you tell roof and who lives in that community. there's neighborhoods we need to think about having stable neighborhoods it's one of the social detriments.

>> i think about the housing covets the mayor spoke about the initiatives underway we can't answer those questions because it's a question that needs to be address. so for those of you in lion there are 3 of you i have less than 5 minutes left so i'm going to have to ask you to make our questions short if you would please. i personally held the microphone for giuliani. i'm david i represent t n d c and the people you're talking about is someone like me i was homeless from 25 years i came back from vietnam. and i was in the va system it was pretty good there. it's not a question i'm here to make at that statement thanking the people in this room helping

someone like me get to where i am today. somewhere where i can move other people forward someone like modifying. i represent barship and advocate i do a lot of this in the tenderloin. and without the supportive or support of you and i see colleagues here and people who moved me long in 95 my housing. i didn't want to be here but i'm here. and i appreciate the fact that other people are here to support people like me. i know i just wanted to thank you guys for the energy and i'm the reason you guys are here and the result is been heightened

greatly to so i can move other like me to see the vision >> thank you. thank you. (clapping.) >> hi, while i would like to drawing draw your at the scene not only people living in china town by the tenderloin. it's one step higher homeless i was a counselor for housing rights committee in inform. i've been advocate for people in my building this don't speak english to advocate for they're right and education. i worked the first cloy and took them to - i asked the landlord to fix the condition of my place

but the land and reenforce the code. 5 indoctrination came over and closed the case i had to take it down to the fire department and the case is still open. people have children and their old so there are seniors and health conditions and we have club downtown and i take it up to the commission and the executive director they don't care, you know, you have club downstairs and we say it's defense attorneys the base that's shaking the building. and i'm just actually, i'm frustrated because no one really care about they say this is not my jurisdiction.

i want to know can someone tell me who i can collaborate with to solving this issue otherwise my you neighbor st. is going to chow my area off. i say same thing nor me bylaw because people hang off the revolver and one hour i have to get ready for work. i have to communicate i have a whole day meeting from 7 to 9:00 p.m. >> i don't know if you panel can help you but i'll tell you iowa what if you give me our card i'm get you connected. >> you know the mayor started with his career providing legal services that are soviet from some of the cases you're talking

about. >> i talked to the mayor's office office but it all failed. >> we'll see what we can do for you. >> we have medical-legal partnership is is where legal prods you can work with those together it will prove healthy housing. this is our last speaker for the day we we have to be quick >> mr. right i'll be quick as i can. thank you for helping the homeless people i've been homeless for several years i'm hours in this same building i want to thank you. my input is preoccupying to

rehabilitation centers for people who have auditions for substance abuse and a medication pills and so forth and who are disabled and traveling in who cares. i spoke numerous times at the city hall for budget cuts for the past several years there's also a cut postponing to programs to rehabilitate people with those addictions. my point is i'd like to see the type of effort you're putting into housing people to be applied to rehabilitation centers because their notice room there's a long waiting list and as a result people who are struggling with their addictions that want to acquit have to maintain that addiction and

that's a large percent of the homeless population. i would like you to address that in the same manner as addressing the issue of putting people in affordable housing. my second issue this the proposition c and b pertaining to housing that's being built in the embarcadero area. i'm hearing conflicting information mayor ed lee and the former mayor have been making commercials and opening up a park and i see the previous mayor whose got experience mayor agnus is conflicting information there's not going to be affordable housing in that and/or (laughter)

>> so when i vote i can rotate in the right direction because i've getting conflicting information. there's people saying there's no affordable housing and dollars a club going to be built in this area and only certainly income levels can go there >> do you live in this community i don't. >> 81 thank you for your participation. my feeling is substance because is most of the problem with the health problems. i unfortunately don't know anything about the local proposition >> maybe the legacy of women