at safety throughout the department. of course san francisco general is our first priority right now. >> yeah, thank you. so if there are no further areas that commissioners would like to be sure, thank you commissioner melara. >> just a suggestion that we've had so much wealth of information here today that i would suggest that this be taken at the join conference committee in that periodic report from the joint conference committee come to the full commission. >> yes, we will see that. this remains on the commission calendar and we'll try to do our work during conference to bring you the best answers

behavioral health, women's health and sexual health. i want to point out that -- and in that roll i have been looking at this data now for almost 15 years and i can tell you we have a lot of work to do and what i want to emphasize now is the leadership that

director garcia is -- she's put together an african american health initiative and we're actually going to focus in the area specifically in our healthcare system. we expend a huge amount of money and we need to within our system and some parts of or system are more than 50 percent of our population and we feel -- we can't turn the curve with a patient, the clients, the people whose lives we're touching, how can with go with communities so that's going to be a real important focus and i want to say that's what we're going to do. i want to end up with one little quote that my wife tells her first gradesers. she tells her first graders believe in yourself, work hard and dream big. and that's what we're going to do. we're dreaming big. we think if we're very aligned and focused and we can make a difference with african american patients and what we learned we can and, per tease we can bring into the community.

i'm going to turn it over to susan phillips. >> good afternoon commissioners, i'm marry as the director of maternal child and health sheer here in san francisco our mission is to promote the health and well being of women of childbearing age, infants, children adolescents and families in san francisco. we take a population based approach in our work and this way we support the effort to achieve health equity in populations that are at greater risks for poorer health. we develop programs and interventions that focus on young children and young families because experiences early in life have an impact

later in life. including the effect on health status. making positive change to the three head lieb indicators this you'll see on pages 47 through 53 will have important effects into the future and save resources that would have been required for more complicated interventions. we work in collaboration with partner organizations both within the city, family and in the community because the problems faced by san francisco families are complex. changing outcomes requires a thinking and efforts of many. work to change our third headline indicator on dedz line prohiv diagnosis in san

francisco and key strategies are going to be implementing newer strategies that can detect infections earlier as well as print or prep for communities and individuals that at increased risk for hiv. second, increasing the percent of newly diagnosed persons sfdph linked program which has specialists in linkage in support as well as other case management services in the city and really trying to strategize around colocating services those people who are at risk for hef and those affected to provide the finally increasing

the percentage of people living with hiv who have viral loads that are below the level of protection. that's a very key prevention stat ji that reduces the transmission risk for others to have a suppressed viral load. in doing this we feel that some key strategies will include supporting behavioral health often are interruptions to continued kaer and effective treatment and supporting clinicians both within our health network and throughout the city in the ability to provide care and treatment in order to get peop hiv to have very suppressed viral loads and treatment. thank you very much. >> in closing today is election day and today we bring you a resolution to adopt our strategic plan it's fitting that we know that since this is something you need to review you will vote on at the next

meeting we wanted to bring it to you today. it sends a message for us and the community and the public health accreditation board that you are standing behind the yafrs in which we are focusing on in our stat jis. this is just the beginning. i let you know next steps is for us to come together to look at our programs to see what works, what doesn't work and what we need to improve in order to make this strategic plan live in the community. we'll take your questions. >> i received no public comment requests. >> okay. we're prepared for questions. commissioner mal. >> yeah. yeah, i was wondering because i remember when we started with this plan we talked about -- i thought violence was included in this somewhere and i don't see it anywhere so when i look at safe and healthy living environments i don't see street

violence or domestic violence or children with trauma anywhere so i'm wondering where we -- >> focus area on child health around the maltreatment of children that talks about both violence, trauma, abuse, emotional, physical, the entire spectrum. >> i want to make sure it's included in there. yes, commissioner. >> i want to congratulate you and your staff on this. i enjoyed reading this. it gave me a sense not only of what you're doing, but a little bit the public health history of how these problems got started and how we're attacking them so congratulations to all of you on this. i would like to point out that last meeting we got of the commission we were handed the california rankings of health

factors and health outcomes, and san francisco county ranked fifth in health factors and those are areas where your efforts and your part of this department's efforts really have a quite a large impact and what was striking to me is that we were ranked so highly and we're a pretty complicated county in terms of these issues so i'll give you a sense of the counties that ranked ahead of us and they're much more ho moj nous on 14 different dimensions than us -- marin, san ma day owe and santa clara. that's a credit to this department's efforts and the team's efforts. i get you're not satisfied, but we're doing okay. . >> we're number five in risk factors, but 22 in outcomes. >> that is true. >> we still have a lot to do

with disparity. >> you have to give a little kudos where -- >> you can accept a little of it. >> yes, commissioner -- >> so congratulations. i think this is an exciting next step as part of the whole accreditation process. and what -- as i was reading this, what called to me is how to get this to the rest of the san francisco. you know, how these are tangible, tangible actions that are going to have an impact and the more we can get the rest of the san francisco community to understand tangible things are being done i think would be important. so we're part of this so this is part of our contribution so doing collective impact we know we're not the only ones as we bring to the table as we work in partnership to really bring together but this is kind of

our things that we bring to the dinner table. >> right. i just want to make sure everybody knows how much you're bringing. >> thank you. >> i'd like to add my congratulations to staff and to doctor aragon for the work you've put forth. i think this is monumental. it actual lyly brings tangible goals. and you've stated very clearly where we're trying to go and we're not satisfied with where we are and some of the most important major things so my comments are -- and number two, that i think for particularly our african american friends

and neighborhoods, we've now, again, been more clear about what we see as our need to move forward. there's been, as you have described, so many different approaches and initiatives, i think this is one that actually can be much more successful because we're taken some tangible areas that could have real outcomes and we're going to be trying to work on those and measure them. we're not trying to do the entire ballpark. i still remember when we went out there and we said we can't deal with health until we deal with security. well, we can't just wait and i think this is very commendable that we now have some measurements that will start hopefully impacting upon the disparities. so talking about disparities then, recognizing that this is a a summary document, it's

really important to be able to parse apart the fact that there are different levels here, the complexity commissioner singer has pointed out for or population that in contrast to marin in which most of the populations in the certain quadrant or actually almost majority, the high majority, we have an enormous diversity you've pointed out. so refinement to this would be really in some of the areas to point out where within -- aside from the african american initiative, that some of these are more disparate in certain populations than others and so that where we might look real good when we just aggregate the data, then we focus on a particular population so that others wouldn't say well, in today's very limited resource, why are we chasing after item number two because item number

two is already resolved. well, it isn't resolved for a particular population and i think you may find that you would be better if then that were described so that you are going to focus our activities upon those areas that you've already spoken to. within that, i just would also mention the one on obesity and i think you've touched on it somewhat, but the vmi issue within the east asian community at least and certainly actually the opposite and the pacific islander community really needs to be considered and those numbers could vary considerably as our performance as a county and if you just aggregate it you probably will have more people within the group that needs to be addressed because we were using the current bmi

measurements, you pointed out obesity is at 30 and the world health organization and things like our national programs and the diabetes coalition of the asian pacific islanders that i happen to have intimate knowledge of have pointed out in fact the epidemic is worse because we're using the wrong numbers for our asian population. >> yes, we're actually doing in death penalty work within community hoelt equity and promotion in that area and our focus right now has been around sugarly beverages. you may not be aware of this, they do have a different bmi calibration, but it turns out that asians, and especially chinese develop die diabetes so china has a huge epidemic of diabetes so they're at higher

risk and i think that's an important thing to point out because somebody might not be obese, but are at a higher risk. >> that's not reflected in a document at this point. >> we are going to come back with an action plan, but we have detailed work in that specific area. >> yes. my only other critique which is sort of my usual editorial thing is that if you're going to have a document that says what works in partners and strategies, maybe you want to keep the same format for all your points because it seems to vary depending on which section we're looking at. >> we'll fix that. >> i would like to add on behalf of our dean here, colleges and universities do include usf and other organizations that have health programs so that [inaudible] is correct, but i ensure we want to take advantage of -- i know the outreach you assess is

tough. because that could be an added resource. >> i ae gree. agree. lastly. >> the other added resource, within the hiv population, but some of those also could be partly related to have partnership with our private sector providers and medical groups and mans. plans. >> and that's actually part of the intention of our reorganization is our disease prevention and control branch. we were designed specifically to address that approach. >> very good. >> so commissioners, because this had not been heard at our community level, but was important so that we brought it directly to the commission, we had noted on the record that the commission will hold the

resolution for two weeks for further comment that may come from the public or commissioners and that we will agent diez this for the commission at our next meeting. >> before we -- because we're not having a meeting at the beginning of -- >> no. the beginning of june. so we are having a meeting in two weeks so we will take that up in suggestions in terms of the resolution will be accepted and will be passed on to the staff. >> we're planning to apply in july so we're really incredibly grateful for your understanding. thank you. >> congratulations for a job well done. thank you very much . >> the next item on the agenda is listed as item 8 and it's

the third quarter financial report. >> thank you. >> i will walk through the financial report first. i wanted to give quick information on the mayor's budget which was released yesterday. he was there for the speech and it was a very positive speech, especially given where we've been for the last several years. there's a lot of good news in the budget overall message is that, you know, the city as we know, riding on a wave of

positive financial news and that has really helped turn the financial situation around. we're not totally to a point though where the budget is out of deficit territory, but there is room to do a lot more positive work as opposed to being focused on cuts. so i think the central message from the mayor was around the affordability issues in the city, which are related to the economic growth. one of the big pieces is the funds allocated for housing, so that's obviously important and has a significant connection to the services and the population that we're serving here. there is the $44 million from the approved housing trust fund and an additional $15 million on top of that in the budget

for affordable housing in the city so that will be a major initiative for low and moderate income san francisco citizens. but a couple of other big pieces -- there are -- as it relates directly to health department, the mayor has restored the $8.8 million of proposed reductions to community services so that was approved in last year's budget. $8.8 million reduction. the mayor restored the full 8.8 million in the first year and another 8.8 million in the second year. there does remain a 8.8 million reduction, but taken in total that $17 million worth of what we thought were going to have to be reductions have come back into our budget so we're incredibly pleased and grateful for that.

in addition the mayor has restored, back filled federal cuts to hiv funding so that is another hull that we have to grapple with which has been solved in the budget. we're still kind of digging into what was released to understand the details, but there are some significant other social safety net investments. there are dollars as we mad discussed here for mental health including the care initiative that the health department has been working on with the mayor's office. there are funding for other homeless services including some dollars for the hot team and we will get you some more detail on that as we have a chance to sit with the mayor's office and understand exactly what the appropriations are and what they'll mean for us.

overall, very, very positive budget for the health department and for the city as a whole so we were quite pleased. obviously we still have our work cut out for us because going into next year we're going to see a lot of movement on the aca settle into place and we do have a lot of financial risk for the department. i don't think that we're out of the woods, but for this point in time, we're definitely in a much more positive financial environment than we have been recently. so going back in time to the present, the current year, looking at our third quarter financial report, this is a little bit later than we usually get this to you because of the timing, but to let you know where we project that we're going to end this fiscal year. we have -- as we've seen in the

first and second quarter financial reports, we continue to be relatively stable compared to where we have been in the past, but a lot of that is due to the correction of the structural problem with the salaries that the mayor's office did in last year's budget so that has really turned things around for us in terms of our ability to live with in our budget. we have some positive news on federal revenues, some of that is one time revenue that's come unexpectedly in this fiscal year and that's plumping up our bottom-line. the bottom-line for this report is we're projected to end the year with a $34.2 million surplus so i'm very pleased with that. it is -- if you consider the size of our budget, still a relatively thin margin, but it's

a good financial performance for us and that's money that's gone into the mayor's office calculation of what they could do in next year's budget so when we look at a lot of that god news that we heard from the mayor yesterday, this balance is contributing towards their ability to fund that in the budget. od news that we heard from the mayor yesterday, this balance is contributing towards their ability to fund that in the budget. major concepts are primarily where they have been in the past. we have a funny thing in our financial statements at san francisco general where we have excess budget a authority for intergovernmental transfer programs that was unused so we have a short fall in both revenue and expenditure that are equal and that makes these

numbers look a little bit funny. that's 32 million so we are formerly showing a $28 million revenue short fall, but once you factor out that $32 million of extra authority, we're actually in a positive revenue situation by about $12 million at san francisco general. that is coming from a couple of things. we've had two payments for the sb 208 program, which is the supplemental reimbursement for seniors and persons with disabilities and managed care so that's $35.8 million positive and we also have income from the low income health program participants shifting on to managed care. we're now getting rates at the medical expansion rate for that population.

we've also factored in here the loss of realignment dollars that we've talked about here before due to the state's recoupment of realignment. one thing that i've pointed out in the past and i'll do again briefly is you see a lot of large moving numbers here and this is because we have these big federal programs, primarily through the medical 1115 waivers where we get big payments and assumptions come in and out of our budget that makes it hard to predict on a very thin margin and i will expect to see that continue over the coming years, but we've got a big reduction in our anticipated dish payments due to a revision of those projections and then some other offsets of positive rev nuss.

patient rates at the hospital is 15.1 million so they've got about 9 of that is due to a single prior year of waiver settlement, so right about at budget target and a little bit above for our patient rates. at laguna honda we also have some additional positive news. the biggest piece of this is -- let's see. here we go. the biggest piece of that is in a prior financial report there was a change to the way the state pays us for our distinct nursing facility supplemental dollars. they've changed their policy to give us an interim payment, which means we get our money sooner and more accurately . they've gone two years retroactively in the current