file for the clerk? >> i certainly will do that. >> okay, thank you. >> good afternoon. my name is carolyn brown. pardon my [speaker not understood]. i'm the chief dental [speaker not understood] for the san francisco community clinic consortium. i was also the dental director for the native american health center in the mission district for the past 13 years up until about a week ago. and the dental safety net in san francisco works very hard to try and address all of the dental decay in our city. however, it continues to be one of the highest unmet needs among any type of vulnerable population polled or evaluated in this city. [speaker not understood] exposure to unhealthy diet and

sugar sweetened beverages. so, san francisco community clinics partners see about 38,000 dental patient visits per year and it's all in the low-income and minority patients. all of our centers are located in the neighborhoods that were previously described by my colleagues and really we're the people who can tell you on the ground what we see when we look in the mouth. tooth decay is something that is often called the silent epidemic by the surgeon general and it's really the number one chronic disease in our chill chren in this country. it's 10 times more common than asthma, seven-time more common than allergies and the health disparities are staggering in low-income people in this country. [speaker not understood] multi-spectral disease which is why a vaccine is available for [speaker not understood] because part of what happens with dental decay, the nutritional and home health behavior is a hygiene pieces,

community health [speaker not understood]. it is almost completely preventable. unlike a lot of other diseases that you see and hear about taking good care of your teeth, changing your diet and really, you know, incentivizing patients to be able to take care of their choices and their health is something that can actually positively affect health outcome in the mouth. and it is extremely high and prevalent across the country. around 92% of adults in this country between the ages of 20 to 64 have experienced some form of dental decay. so, sometimes we look at dental decay as something that is bound to happen to us. and not thinking it's preventable. this is a quick pictorial on what happens with dental decay. basically you have a tooth and in the tooth is plaque, the things that [speaker not understood] you brush off when you brush your tooth or floss your teeth every day. the bacteria takes certain type of bacteria, opportunistic bacteria in the mouth that actually start getting active when we eat. and when you drink.

it gets particularly active in the face of high sugar content because it's what feeds it. it's its food source. this produces metabolic waste and eats away at your tooth. the problem with sugar sweetened beverages is that it make that bacteria incredibly active. it's not -- in many, many studies and we've looked at healthy normal and moderate sugar diets at one meal. afterward presented 20% of acid from the bacteria. 20 minutes bad bacteria is starting to try and invade the tooth. in the presence of sugar sweetened beverages that can last up to 60 to 80 minutes. we not only have bacteria that are much more active in the face of high sugar content, they're also active for a much longer time period. >> let me interject a question here. oftentimes in the discussion as it relates to sugary beverage there is a distinction between

diet coke and regular coke. in terms of the active production that sugar is stimulating the bacteria, does it make a difference if it's a diet coke versus a regular coke? >> well, i'm going to say no to that, supervisor cohen. more so because it's actually a two-pronged approach. one is the sugar, synthetic sugar or a naturally occurring sugar, there is a slight difference. if you look at, you know, bench test in a science lab on how active the [speaker not understood] which is the main bacteria involved in tooth decay is minor. but the biggest problem is that there is also huge -- the acid content of just a cup of any type of sugar sweetened beverage because an energy drink like diet coke or regular coke is incredibly acidic. ph of 2 and ph of 4. in general it has a natural ph.

7 is a neutral ph. so, you're taking this acid-loving bacteria, giving them more acid regardless of the sugar, it become not just an additive. it is exponential in the mouth. it is particularly damaging in baby teeth because baby teeth are very, very thin. the aloe dynamically et, protective coating on baby teeth [speaker not understood]. ~ enamel children are drinking sodas. [speaker not understood]. it does speed the loss of calcium from the teeth which makes it more susceptible to decay in the future. sfb, the consumption for children and adults in this country and in san francisco is going up. the consumption of milk and other nutritious drinks or even water is decreasing. i was using the madness picture

to kind of -- >> [speaker not understood]. [laughter] >> we're going to excuse him. >> i want to apologize to the public that unfortunately this meeting lasted a little longer than we expected and i do need to go to another meeting. but one, i need to go brush my teeth. [laughter] >> and two, i'm proud to be a co-sponsor with the leadership of supervisors cohen, wiener and maura round a measure i think all of us care about. and the scientific data is overwhelming and profound and something we need to set the example of in san francisco. so, i just want to say na, and thank you. >> thank you. (applause) >> and i just wanted to use the example from madness how [speaker not understood]. the surgeon general reported smoking health first came out in 1964. >> sfgov-tv, can you please put the overhead on? >> it was not until 1988 when they actually banned smoking on

short-term u.s. flights. it wasn't until 2000 that it was banned on all u.s. flights coming or going to the country. so, it's one of those things where i think when we're looking at change, it's hard for patients and people to take messages that they hear about what's good for them, [speaker not understood]. i think it's one of the things that you all can do as elected official to our city, which is one of the reasons that the san francisco community clinic consortium supports this initiative. >> thank you. all right. thanks for your hard work and your research. now we have dr. domingo. >> thank you very much. thank you for holding this hearing. thank you for inviting me and thank you for your persistence and staying with this topic. so, i am a general internist. i practice at san francisco general hospital. i'm a professor of medicine and

epidemiology at ucsf. i've been in san francisco for a long time. i've done all of my postgraduate training here, raised my family here. this is an issue that i want to give you the context of what motivates me about this issue, and that is really my experience in clinic taking care of patients with type 2 diabetes and thinking about the challenges ahead. so, type 2 diabetes, when i was in school, we were taught what's called adult onset diabetes and that distinguishes from juvenile onset diabetes. and the reality is that type 2 diabetes, adult onset diabetes as well as diseases of children and disease of adolescents and we've really shifted that hep dick i can ~ epidemic to one that happens when you age to becoming more common among teenagers and children. so, this is the statistic that's quite compelling to me. so, one in four adolescents

have pre-diabetes or going to be predisposed to becoming diabetic when they become adults. 10 years ago that number was one in 11. so, i'm not somebody who is usually prone to hyperbole or exaggeration, but this is, this is a crisis. this is, this is a public health crisis and i think these are the patients who will be my patients in the future and this is not a crisis that's happening in the future. this is what's happening right now, these numbers are right now in our children. and if we look specifically at african-americans and latinos, the chances, again, are 50% of african-american youth, 33% of latino youth will develop type 2 diabetes in their lifetime. the numbers are 25% of white youth and this is a problem that's occurring in all of our communities, but it's particularly a problem with

these high rates in african-americans and latinos. so, why do we focus on sugary drinks? there are certainly many things we need to do to prevent this hep ~ epidemic of diabetes. sugary drinks are not the only culprit, but they're the clear reason why we focused on sugary drinks. they are the single most important -- the single largest amount of added sugar in the diet. to the extent high sugar in the diet contributes, soda 40 to 50% of added sugar in the diet comes from sugary drinks. so, it is a reasonable target for public health interventions. we have already heard that liquid consumption appears to be different than just consuming your calories as food. your body doesn't know you're full when you're consumming your calories at liquid. that leads to over consumption of calories when you're consuming calories in liquid form. and finally, the thing that's probably most compelling to me is that sugary beverages

increase the risk of diabetes independent of their effects on weight. if you take normal weight individuals and you take overweight individual and you look who is drinking sugary beverages, the diabetes risk is greatest for drinking sugary beverages regardless of what their weight is after you control for the weight. while the obesity issue is certainly an important one, for me it's the diabetes issue that's really been the compelling one that's motivated me on this topic. so, i've been drawn to this topic because of what i see in clinic as a physician. my research is mostly on the prevention of cardiovascular disease and diabetes and i want to talk with you about the result of two studies that we published on this topic. just as a background as you know, sugary beverage consumption is on the rise. it's on the rise in children and in adults nationally. i want to -- i always like to put this slide up because it really highlights the importance of economics in

facilitating healthier or less healthy food choices. so, if you look at the black line in the middle of this graph, that's the average consumer price index that goes up over time. if you look at the top line it's the price of fruits and vegetables. fruits and vegetableses are more expense ive than everything else. if you look at the bottom red line it's the price of carbonated beverages. so, these prices are low relative to the average consumer price index. and it's this type of trade-off that when i make recommendation to my patients at san francisco general hospital, i ask them to eat healthier, to make better choices. it's this he economic reality that makes this very difficult for many people to make the best choices possible. so, the way we do modeling of health impacts, i'm not an economist. what we do is take economic data. we take health related data. we taken deem yo logical data and we do this type of modeling of health impact for public

health intervention and clinical interventions. i want to he show you the reviews to look at this and look specifically at the effect on disparities ~. we assume that there is some measure that would reduce sugar beverage consumption in this case a tax. we know that would increase the price of sodas, that that would result in a reduction. and then we look at what health impact could we imagine would come from this reduction in sugary beverage consumption. and we think there are three things that would happen. here focused -- we think will happen with these disease conditions. it would result in a decrease in average blood pressure because high sugary beverage consumption is actually linked to elevations in blood pressure. i haven't talked much about that, but that's clear. it would decrease diabetes risk. so, that's on the left-hand side of the screen. and in the middle relate some increase in body weight. but i think what's been compelling to us is even if nothing ever happened to body

weight as a result of this, we would still have the effects of diabetes and blood pressure because the literature tells us that the effects of reducing sugary beverage consumption are independent of the effects on weight. so, the effects on blood pressure and diabetes even if no one lost weight, those things are likely to change with reductions in sugary beverage consumption. and then all of these together, because these are risk factors for heart disease and risk factors for death downstream lead to reductions in cardiovascular disease and death. and, so, what we've projected when we looked at this for california was really strong effects for the result of, in this case, the [speaker not understood] on sugary beverage consumption and depending on how much you projected the consumption to drop, you really would project measurable drops in the rates of new cases of diabetes in california and then new caseses of heart disease

and deaths and result in deaths as well ~. the important thing of the first study that we did, we did the study modeling study nationally. i think this was the most surprising to us. if we added a penny per ounce tax, the a. of cost savings resulted in medical costs that were avoided, diabetes prevented lower rates of obesity, heart disease prevented, the base cost savings exceeded actually the revenue from -- that would be generated from a tax ~. it just speaks to really the burden of all of these illnesses that are the end result of the high sugary beverage consumption. we would imagine that similar ratios of health care cost savings to tax rate level would be projected for california. when we modeled this using the california specific data, relevant to the issues we're talking about today -- >> excuse me for a second. i just want to go back to your slide. i think this is an interesting

one. a cost savings nationally. i was wondering if you were able to model or disaggregate some of the data so we could find out exactly what it would cost the state of california, then specifically san francisco in terms -- this conversation is happening in the backdrop of the health care conversation with obamacare and insurance companies dropping people. >> absolutely. so, we have not done it for california. we could do it for california. i would imagine that this ratio , you're saving more in term of health care costs would be very similar if we did it for california. if we didn't actually model -- i'm trying to remember. we haven't modeled this for california specific, but i think it is as you're saying of relevance to california, especially as we think about these are thing that we pay for in other forms and in san

francisco, you know, we believe in access to health care for these things, but these things cost money. and, so, i think the cost savings that could be projected from anything that promotes prevention of these conditions could be, could be large. >> thank you. >> so, when we look at who specifically who could be -- where the specific -- which groups would benefit, would derive these health benefits, you see on the far right of this graph, this is all californians, the rate of diabetes prevented, and then you see as you move now to the left of the graph greater reductionses in diabetes cases whether african-americans, mexican americans, and an aggregate group of low-income. this is all from california data. we didn't look at asian americans particularly here because we didn't have enough data on asian americans to make those estimates. but these numbers translate to whereas one in 10,000

californians might avert a case of diabetes, 3 in 10,000 african-americans and [speaker not understood]. so, a greater health benefit for the same type of intervention in terms of diabetes cases avoided. why would we imagine that this would be greater in these communities? so, there are two thing that are of relevance here. you have already heard that sugary beverage consumption is higher among african-americans, among latinos and among low-income californian. it is also true that these african-americans and latinos have higher -- have a higher predisposition to diabetes in general. so, both of those combined, we would project would yield larger health benefits in terms of diabetes cases avoided would result in any measures to promote reductionses to beverage consumption. we think our estimates are

conservative. we focused on a penny per ounce excise tack. fully conservative [speaker not understood] from the he economic literature. a really important point i want to emphasize here is we are modeling only adults. so, the impact of actually, as you saw the rates of -- the rates of increase in adolescent sugary beverage consumption are really quite, quite troubling. and if we were to model changes in behavior in adolescents and young adulthood, we think that these numbers could be even larger than this. so, in conclusion here, so, we think that the high rate of diabetes particularly for minority communities requires a clear focus on public health efforts and a prevention and sugary beverages are an important target for diabetes prevention and the benefits of reduction in consumption are likely to be greatest in those communities most at risk. thank you for your time. >> thank you. thank you for your time.

okay. seeing that there are no questions or comments, i'm going to go ahead and dive into public comment on this item. first i'd like to call up at the top of the pile dr. jeff [speaker not understood], physicians for social responsibility, followed by reverend walker of true hope and followed by lotty titus. [inaudible]. >> sure. not a problem. please. hi, my name is [speaker not understood], good morning. i am the president of the richmond democratic club in supervisor eric mar's district who is one of the authors of this -- sorry, this proposal. i am also the chair of the citizen advisory committee for

san francisco public utilities commission. and i am a leader in my community. we've heard a lot about children. i want to talk about larger effect. my father is 71 and two years ago he he was diagnosed with high-risk of type 2 diabetes and heart disease. my father is not overweight. he doesn't drink, he doesn't smoke. he's an auto worker. he was actually pretty fit. but what i can tell you is that my father also had a history of ulcers and high blood pressure. he's also had a coke with every meal including breakfast as long as i can remember and probably farther back. and i know that during his lifetime [speaker not understood] has changed from cane sugar and carmel color to high fructose and [speaker not understood]. to me that is very telling of what long-term consumption of soda does to the human body.

but i can also tell you that my mother [speaker not understood] what very unpleasant [speaker not understood] because of the sugar and because of the caffeine that he was not taking into his body after all those years. my issue here is that we keep hearing that this is an aggressive [speaker not understood]. as a latina, i would be very skeptical of anything that i thought was [speaker not understood] punishing poor people or charging them more money, but i also know that latinos and african-americans have twice the rate of diabetes and obesity than their white peers. and even small children who [speaker not understood] all their life if we don't try to send a clear message to the aba. and i think [inaudible]. >> thank you for your comment. thank you for your time. okay.

we're going to try to get through this quickly. i know it's been a long day. so, we've got -- let's go ahead and move dr. jeff [speaker not understood] and loty titus [speaker not understood]. good afternoon, good to see you. good afternoon, thanks for your persistence and the crowd here, too. i was head of cardiology at kaiser richmond for most of my career and then i was on the richmond city council and i led the richmond soda tax effort. and i just want to really commend you. you can make history here. it's not that often you can do that, and you can make history here in a very special way by improving the health of your most vulnerable population. that's something that the public health community is trying to do all over the world right now. wonderful presentation. and i really commend you for stressing the oral health

because that gets forgotten a lot. but these sugary beverages also now, a long list, not just obesity, oral health, diabetes, heart attacks, dying from heart attackseses, strokes, high blood pressure, some cancers, fatty liver, probably dementia, and the latest on the list, it interferes with sperm motility. so, sugar basically gums up the works wherever it is. but that's not how the soda industry, the beverage industry is responding to all of this, these health concerns. they're increasing their marketing dollars. you're going to see next week a big marketing campaign by coke aimed at young people with young people using the videos of young people themselves provided. as you heard about one in three of the hospital beds are related to diabetes. and if you're latino, that's

over 40%, african-american 39%. and that money is being paid for by public insurance. about three quarters of those hospital costs come out of public insurance and it costs more than $2,000 extra for each diabetic patient in the hospital. most expensive thing you can do is get diabetes. i just really want to salute your leadership on this, supervisor cohen. i mean, this can be groundbreaking and i'm so proud that you and the other supervisors are taking this on. good for you. >> great, thank you very much, dr. ridderman. dr. walker. thank you very much. i want to be in agreement, how to appreciate supervisor cohen and those that are working close with her that represent the city and county of san francisco. i pastor a church here in

bayview hunters point and sitting here today listening to these professional giving the statistic and it's almost frightening in one sense to look at the facts, look at the evidence. and to see and to be a part of responding to this epidemic in the literature i have here, i agree more than ever, based upon what i've heard here this afternoon. and i have some information here, just real quickly i want to refer to, is that since the legislature is doing such a good job, and the tax of 2% per ounce, i believe, on the document i have here and you mean to tell me that since they are creating this problem that we're talking about, contributing to it, is it that they have no concern about how

they're adding to the problem, the difficulties, and hopefully the message will get through to them that what we've heard this evening, to those that are distributing these drinks that are causing this problem will rethink their position. all that i possibly can do, i'm going to do everything i possibly can because i belong to the tabernacle community development [speaker not understood] one of the largest churches in the city, [speaker not understood] perpetually i'll do everything i can to help us be successful. thank you. >> thank you. thank you for your support. next speaker, please. after ms. titus, the next speaker, next will be roberto [speaker not understood] i can't here. i think she had to leave. okay. dr. ga linda, you want to speak in public comment?

i assume i read your statement right. then julisa hernandez, miguel peirez. [speaker not understood]. michael t -- i don't know her last name, i can't read it, then [speaker not understood]. thank you. good afternoon, commissioners. my name is lottie titus. i'm a resident of bayview hunters point and grandmother of five. my daughter is a diabetic and her 9 year old diabetic. she's a full blown diabetic. since finding out sugary sweetened beverages affect the health disparities of our youth and families, we support the tax. i will continue to support this tax because i have a strong desire to live in a healthy community. it's very, very personal for

me. thank you for your support of this tax as well. thank you. >> thank you. next speaker, please. good afternoon, my name is theresa hernandez. i am an organizer for ufpw local 648 and [speaker not understood] has diabetes. my mom is currently 74 years old. she has type 2 diabetes and i have two daughters as well [speaker not understood] very important to me. so, as a union organizer, we endorse this tax. we think it would be positive impact for not only the community, but also for our members and for san francisco as well. so, thank you for doing this. >> thank you for being here. next speaker, please. good afternoon, supervisors. thank you for your leadership and bringing folks together to share information on this

important issue. my name is roberto vargas and i'm here representing ucsf engagement health policy program. and we are not as university taking a stand on the soda tax, but what i am here to say is that since 2010 we've been partnering with the department of public health and community-based organizations to address chronic disease, health disparities here in san francisco. this is one of several priority health issues that we've chosen to address by leveraging the research resources of the university and it's because it's one of the health outcomes that impact san francisco the most when we look at health disparities across the city. and in looking at ways that we can address this problem, we found that it's really important that we do education for folk about what foods are unhealthy with sugary drinks being at the top of that list. we've also fou