it because they can win larger amazes they can win and 2, 3, 4 weeks they are motivated to take that before the confident the regret if we have e-mail addresses on everyone if you had not taken it and your lucky number was drawn you'd get an e-mail saying you would have one $500 and that regret motivates people because they have the same odds of next week winning we don't have e-mails but we're hopeful that the unions can help us to communicate how many people in the department or union have been drawn so the people are excited and realize it's happening not some off in

the dance lottery balls people in the same department talk that's the piece of it we've designed. that's all i'm going to highlight i'm happy to highlight anything from the plan or presentation >> thank you for your excellent presentation it was a wonderful presentation on health economics so i want to commend you to include one package on policy change but i'm going to tell you blunlt e bluntly i don't see it in statistics a so you're going to get a bigger bank from our buck go trying to motivate individuals to do individual

behavior when we haven't changed the environmentalist i'll curious about your you thoughts. >> i can tell you what's in my head and make sure i'm understanding what you're looking for the idea we found out what policies exist and what environmental factors exist today and how the departments are doing and what areas do we want to target next year and training the champions on how to get there 0 so if we see a common thread it will be teaching the champions how to table go those things or policy level working with the departmental heads or the d hr if nights appropriate to do it

across the city that's our intention to do the departmental changes. >> from my prospective through the logistics you've talk about the departmental survey and talk about the departmental survey so in terms of the logistics if someone like me goes to the graphics and it didn't talk about the height vending and a or the percentage that's more specific to environmental and policy changes i would also suggest that the virtual policy changes could be expanded when there's a lot of things available i don't see opportunity here and then my final questions on policy changes is why are you doing this department by department so f healthy vending machines why

not pursuing this the policy of the city no shbd in the vending machines and we will work with d hr sometimes, the way the city works the vending machines are not under the same carriers yes, we have to work with them individually to work with the carriers and fourth who owns the vending machines and in the specific departments is a champ d s a has taken this on its a slow transmission definitely a project worth taking on but we have to balance the way the city works and the different departmental structures along

with the citywide policies as well as the departments have their ability to dedicate opportunities so some of it which departments can do it quickly and finding out where they are we don't have baseline on who has vending machines. >> i compete understand the implementation will be in the end different i encourage you to think about the difference it makes where there are no shubd in the vending machines buses as a departmental head it's easier to implement those when i don't have to august with my employees and the next department has to argue with their employees so put another way the champions will have an easier time if they

have the backing how to make it happen does that makes sense. so the other thing reflected back to you who is extremely supportive supportive any department it is trying to mandate the question of wellness i urge you to think about giving department heads as well as the wellness challenges concrete evidence of benefit they'll get because it is additional work that eventually decided placed other work so being as concrete as you can to make it clear to those folks the specific benefits that will come back to their department a might help you in our effort so i'm going to oh, there's one other thing

on the log ikdz in our incentive strategies you talk about considering changes to co-pays to regard action to well-being i won't support a plan because we have to think about the equality issues changing a payment to the health services we know that people that be lowest on the economic scale can't afford to pay for the changes and yet are the ones most burdened by the health and equates i'm literally rifting this in my county san mateo county i can't support it. which one was that >> on page 20 on the logistics on the payment strategy.

>> i'm excited you made it to page 28. which part >> under 2015 considering the plan to reward the - >> i'm sorry i understand but here's the problem is that we're that stanley going back to individual and saying change our behavior with you we can't change where they live so it's part of the commitment i've made to my own integrity i can't let those go unexchanged to the not about you but more in general, i think we're going down collectively american society that will not reap the outcomes

if we focus on individuals we don't have a diabetes epidemic because everyone is getting diabetes but the diabetes we're consuming numerous amazes of shrug but until we make policy changes and get the signs out and make changes just talking about it sdm isn't going to drive down our health care costs. >> any other comments. >> just in a board context one of the things we've requested that was stripped from the business is the business even if research system this is precisely the type of ear that type of work needs to go on and if indeed the city is willing to

through a joint committee and spending untold hours of collaboration and communication in the department of human resources and here and everything else to be short-sighted we need to have a boarder understanding of what works and you're not going to get as heroic effort i know you are and you that need to understand what he will is out there and how it might bear and improve upon what we're doing it's another you know penny wise pound foolish decision we need to be informed by real science my documents and fourth how to thank you what we're doing and reporting i recognize you've got good skills but enhanced by research support as well

computer it support to help you track and trim the stuff. we're talking at cross purposes this is disturbing we want to launch an initiative we believe will have a prone impact on health care costs. which is a common concern to everyone yet we don't want to invest in the tools to make it work that's part of the message it needs to go back to the budgetary discussion. thank you >> thank you any other comments do we have a motion this is an action item. >> i'll move we return this to staff for further elaboration and change of the co-pays in ri7. >> second on.

>> i would have a question was there are 3 entities working with this thing so i'm trying to understand the process. we're going to approve that the h.r. is going to approve that and someone else i forget who else >> they've all approved that. >> the last it here. >> so the plan was the approval and the kickoff with leaders and the champion training and rolling things out for the employees by september. >> by september then let me raise a question in the spirit of commissioner rephrasingiers motion if it passes how quickly skew come back with staff work that will help to clarify the concerns she's raised. >> tomorrow. >> tomorrow as soon as you like.

again, i think it's in the intentions in the delivery the change so i don't think it will be difficult to especially related to the environmental and policy changes the plan design conversation needs to go back to the sponsors so >> would there be a problem to pitting this over to august? >> we can't do the lisp kickoff without approval unless you gusts approval to do the leadership convention director dobbs please. i'm wondering if we could work on language with commissioner phrasingier and if the board and other commissioners will empower stephanie and commissioner frazierier to retool that section and give approval

pending the retool and i'm certainly to work with stephanie on that i don't think it's that complicated but i did hear and understand the timing problem what i did hear let me reflect back the removal of the co-pays excuse me. the removal of item of 2016 relating to the financial incentives requires going back to the sponsors. >> yes. >> i'm really sorry for me that's a deal breaker i'm completely honest you don't i can't see in good conscious to support a document that talks about that as an incentive. >> okay. >> i have a suggestion that you just vote to approve the plan

except for the plans you don't support as related to the co-pay plan and design that can be fixed or not meantime without interrupting the dates that the city is concerned about. >> so the motion so approve the plan with the addition specific conceptual suggestions regarding environment and policy changes and with the removal of the co-pay that requirement. >> right everyone understand it was going to be looked at and dealt with in the future. >> i'll be happy to change the motion. >> and considering the co-pays will not be expected when we going to the next year and then go back we i mean only the portion we will take it out and

return it back to the sponsors and continue through to the plan. >> is that a second. >> yeah. (laughter). >> i would like to have the motion stated as it would be amended so i understand it. >> i move approval the city and county of san francisco wellness plan with amended language in the vial and policy changes that is currently on page 22 to elaborate that and in particular to call anti citywide actions to support the policy changes and with the removal on page 28 entitled log ifshgz on the column entitled 2016 and the row and incentives strategy to eliminate that box. >> and then probably we could

before i say probably we could review the plan again next year prior to the benefits so we could change the plan on a yearly basis. >> yes. increase an intentional to have an annual plan this is overall. >> the overall. >> the overview wellness to the city those have the things to target this year would actually happen every year and beyond 2016. >> again. >> it's been moved and seconded and -- okay. and thank you very much stephanie. >> is that agreeable and you'll be going back to the sponsors and let them know. >> yes. >> the motion and second. >> thank you stephanie par all

right. it's on moved and seconded is there any public comment? >> claire from the retired city employees. at our last time meeting we had a wellness coordinate to speak and retirees and every group is very, very supportive of wellness programs, however, when you talk about on incentive and reducing the co-pays those are negotiated benefits and here where we're required to apply certain standards across the board so while they maybe somebody for people to consider with regard to our system and the comments from commissioner frazier and those may not be the

people that can achieve them in doing the due diligence of this board it is equal across the board those employee organizations negotiate different co-pay structures we need to be consistent. who is doing some of the surveys if you ask the management of departments to fill out your survey as the culture and environment in the departments you'll get a different answer then if you ask the employees i'm glad mta is participating there are a number of divisions were lunches are dlourgd and have there's much more pressure on individuals to be spending every minute including their own time working for mta and not getting the breaks they need away from the workforce it's important to talk to the

employees and to though get a response and some days to survey across the board there's a prospective their voices are not going to be heard and only the management will be responding that's a challenge and lastly i'd like to ask for the specific to the fire department and the problems that have gone on with specifically illness i looked at did police officers and the muni drivers there are different kinds of health conditions related to the specific work and i hope those departments are being involved with regard to wellness being the focus and the effort to diminish those critical types of deeds that seem to be more common i know we've got will female firefighters but male firefighters there are certain problems and within drivers there's a significant number of

molecular skeleton issues and other health problems so focusing on certain departments is a way to go. thank you very much >> is there any additional public comment. >> please come forward. >> hi silver i'm an interim for stephanie fisher and i want to address commissioner frazier. as senators our comment open shubd leading to type two diabetes i'm counter in my first degree of health, i would challenge our statement that

swgd lead to diabetes i can say that the cola over the sweetened accordingly i had before my 10 mile run i don't have diabetes. diabetes type of two mostly being obey as a result of body fatso 64 percent type two diabetes women 54 percent is excess body fat transcribed to type of two diabetes and 77 men with body fat contributes so i would ask you to consider your statement and the totality of it saying one directly lead to

another i believe that's an exaggeration collars in and out a caution to the possibility of people taking our statement and thinking that one directly leads to another without looking at the holistic view of it. thank you >> thank you. i appreciate our comments there's a new science out fantastically how fast does liquid sure get into the blood extreme and sugar in liquid form is absorbed in thirty minutes that leads to a spike in sugar and the pancreas reacting with insulin so the condition is long-term one soda is not going

to cause zebras dooebz but there's the fantastically new research about the effect of liquid sugar and the resulting spike in blood sugar that leads the liver to create fat in liver you're aware it is in particular liver fat there's a clear coercion of diabetes i don't want to say a couple sodas creates diabetes but the liquid sugar science is showing is problematic >> i'd love to talk about nutritious. >> herbert he wooifrn i hope this also addresses the employee assistance program there is definitely organizational problems in city government.

i've personally experiences 3 and a half years under a supervisor mac the death penalty look merciful i'm sure that other city employees have had this experience we center to address this because staff is placed under tremendous work loads when this happens then the worse part of people coyotes you can have friction among employees and managers getting brutal you have people that have sleepless invites and people develop sickens this is a problem in organizations. there's research done by dr. name i didn't have he has a

workplace institute and he has shown people quite their jones and some people get fired and loss their houses there's a ton of things this is one of the worse things to the credit of the e ap they've started workshops but i want to see the results of those updates get formulated go rules and regulations that can be instituted by resources there should be progresses it enhance moral and product goes up and less singes those are very good things. i don't want to have people i developed a case of help it's

guarantee i get time away from my supervisor i have to front this problem this is workplace height it's a national problem there's research being done a work site wwwback off.com it's a manager from the foundation that's the author with the associates of some of the articles people should read those and implementing them and we have a motion that's been moved and seconded in favor >> i. opposing it's unanimously. and positive. action item 14. item 14 action item presentation of h ss resolution for director

dodd >> catherine dodd you have a resolution i drafted after dr. and commissioner slang and wanting breslin and i had two communications in conjunction or not with our board meeting hold a forum on states use even if concerned with the american clj of card lifts that came out with a standard of care and required that people who don't have indicators for the need for stalg even use go on them. so 75 they estimate it will one

in every 3 people between the ages of 15 and 75 will be on staten so the idea was to have a panel to invite our major vendors to talk about their standards of care this is not to say there's not an important role for state and local governments but exercise should be tried first and try counseling or mental health issues and if that doesn't work consider going on some kind of pharmacyal but to have the first line of defense being the non pharmaceutical i was advised when we met with kaiser rather than the form include card lifts

we ask appropriate experts their experts on cholesterol if we ask the experts to come and present their prospective on the issue we've looked for rooms to have an evening meeting to open this up to the public there were none available i i know none available in september we'll have to do it around our agenda time we could have time in august. so the resolution is before i. >> all right. any discussion >> yes. i'd like to talk about the foreman maybe g