among imp overished women, 9.5 percent of medical mothers reports violence. violence does not effect all women, equality, rates of assault, and hospitalization and premature deaths due to violence are 19 times higher among african american women compared to whites. and over all 90 percent of pregnant women in san francisco received the prenatal care in the first trimester. >> 27 of those on medical, compared to those with private insurance did not receive timely care. and 63 percent of mothers on medical had a regular source of prepregcy care and only 55 percent of black mothers receiving, care in the first

trimester. in general, women under utilize healthcare service and one in seven x reported delaying or not getting medical care, and 50 percent of black women reported delaying or not getting needed medical care. >> and that is the end of the formal presentation, and then i am going to have for you. and if you have any questions that i would also like to invite dr., chan to receive any questions that the director of maternal and child health. there is more public comment for the health commission. >> thank you, we did have a request, commissioner, melara would like to make a few comments, and and to take her

comments. thank you. and thank you also for the data, for that was presented. and one of the concerns, that i have is that we are not doing enough prevention in any of these areas and not in all of the areas but in the area of the domestic violence. and i hope that we have a great opportunity as a health department to insure that efrp who every one who comes through the door is prescreened for domestic violence and i think that one of the, there is a data, available, and that shows that, there is a connection and a correlation between the domestic violence and then the physical health. and often, times, people who complain to their doctors about their stomach ache and their headaches, and any aches, and it may be something that is

happening back at home. and they are complainting on what they are experiencing physically, but they are not talking about what is going on, at home. and today, i will need to leave early, because, i am going to catch a flight to attend the california partnership, against domestic violence. and tomorrow, we will have a conference dedicated to healthcare issues and domestic violence. and we will discuss issues of access, health access for survivors and the intersection with reproductive rights, and which by the way, i am not too crazy about the label of reproductive rights, the commissioners know. that i have always said that it should be sexual rights or sexual health because, some of us, or cannot have chosen it is important in and it is important to recognize that all

that we talk about sexual health, and we are talking about men, women, and people who choose to be different and not just choosing and sometimes it is not a choice. and so, service and trauma in the form practices. and so, well i noted that the health department has done tremendous work in a variety of areas.

people are not comfortable about talking about domestic violence and when i talk about the issue with children, what i hear is but, you know, the kids who are in the street and there is violence in the street. if you look at the zip codes that are affected by the street violence, they are the same zip codes that are affected by the domestic violence. and children learn violence at home. and they take it, and they take it out on the street. what i would like to propose is health providers is that they become proactive and, we decide to be in the area of prevention. that every family more than likely is going to visit a

healthcare provider but we take the opportunity to look at possibilities to screen families, for domestic violence, when they first come to a doctor's office. and there are regulations in place that say that the doctors and nurses that are supposed to report the domestic violence. but that is reactive. and that is not proactive. i like for us to think of ways that we could use doctor visits, clinic visits for women, men and children and i mean, men, and because men need to be screened for it too. to insure that we begin to prevent domestic violence now and i ask you that we start now, thank you. >> >> thank you. >> commissioner? >> yes, and thanks. and thank you, commissioner

chow. not to the response to the public comment but i just wanted to mention that last year, white house actually had released a report, on the interfederal agency and the report on the intersection, actually, between hiv, and violence against women and girls and gender based health disparity and within that there were like five sets of recommendations, and definitely (inaudible) informed care was one of the recommendations, including education, and out reach and also, empowerment of the communities and i was wondering, like if we at the department have looked at those recommendations and to really apply that into section into some of the work including, working with all of our

providers, and you know, looking at how to create a trauma response, when it is people come in for one thing and you know, like, if there is one way for us to really engage them in the process and i think that is a great approach and i think that part that suggestions to this and want to use the opportunity to ask that. >> and commissioner, thank you, for bringing that up, we have engaged as of last fiscal year, into the training, as many providers as we can into becoming a trauma informed system of care and we will bring that forward to the commission to give you a more detailed plan, but under the leadership, he started that in the mental health system and we have done that and started to spread that of the network and the public health division and that is something that we are focused on and we can bring you a more detailed plan on the effort and sharing that the providers understand the impact and the trauma in their

provision of care. so thank you for bringing that to the forefront. >> i leave that there are several commissioners on the woman's commissioner that would like to make comments. >> vice president short sner shorter. >> thank you for the report and it was very informative and before i actually do have a couple of specific questions about the report, i just wanted to also make some comment on what commissioner melara had presented and i could not agree with you more and we certainly need to better utilize our system of healthcare, and to do those assessments when the people walk into the hospital, and they walk into the doctor's office. and you had mentioned that there clearly is a correlation between the rates of physical violence that take place in the

street with what is happening, in the homes according to even, if we map it out by zip code. and certainly, that is something that i think that you would find normally in san francisco but we see that, and in the national level, correct? and but i also think that you are acknowledging and not making it exclusive to those zip codes and domestic violence happens in every zip code and it is something that will need to be very mindful of and so it is not something, that is a phenomena that occurs, within those communities, and that are disenfranchised and under economic strain, and etc., and it has, in the bay view, and as much as it, or it has happened as well as in the pacific heights and it happens in the marina and in the mission and so what happens throughout the city, and i think that it was also of the great interest right now and certainly as you are flying off to engage in

this high level discussion, with other national leaders, on what could be done. and as we look right now, in the news of what is happening with the nfl. and what struck me, as of great interest if you are familiar with the sociology and harry edwards and uc berkeley has actually said that believe that stated in the (inaudible) the other day that domestic violence is the number one health concern of this nation. and then, it clearly not just isolated incidents within the nfl which clearly needs to make some reforms but i think that to hear that acknowledgment is always certainly encouraging in terms of changing the public's perception, and hopefully, changing our culture, about the domestic violence. the questions that i have in

particular with the report and again, thank you for the report. as one who actually co-chaired san francisco sensa and in the last census and i am familiar with the demographicses of the city and there is no need to belabor the consistency in terms of the major demographics and but what i do have a question, is that with regard to comparative analysis. >> and any of these and mat jorty of the statistics and the data are of alarm, there is no doubt about that. but one thing that i would like to have, and better understanding of and maybe... comparative and analysis. and the fact that we can look at for instance, on these health indicators of the rate of deaths due to, and i can never say this word, and this (inaudible) heart disease, so

much for all of my many years of education, and i am learning to read. and but how does that compare, for instance, to other cities or in the national level? so, i am trying to understand this, and beyond the bubble of our, i am, and this is very helpful, but, one could say, what does it mean by comparison? we are... doing terribly well, but, what does this mean in the bigger picture? >> one thing that i do not know how to compares to the rest of california or the u.s.. when i think about when i look over all, often, the rates in san francisco are pretty good, where a fairly affluent, and well off, society. however, when you dig into those numbers, and you see that dem graphics and it is way higher than what would be in those comparison counties.

so i did not look up what it would be in california. all of our population should be able to achieve the health that is achieved at the level, which, for example, for the heart disease would be, and asian. and that is our gold standard that we should be shooting for with hispanics and african american women and all of us. >> yeah. and i just want to have an over all comment that in general san francisco, and compared to other counties across california, we faired better and a lot that have is a combination of our excellence in healthcare quality and our access to healthcare and it is all about dem graphics and healthy y l equals wealth. and us and michelle and our

health officer, and our director, mary, are asking us to push further and not be compliant with thinking about comparing ourselves with the rest of the california, and to really dig deeper into the disparity and much of the analysis that michelle has presented is really looking at the raw data and looking at our health out come and related to ethnicity and private insurance verses public insurance, and less, education, of high school students, and high school grads, verses college grads and looking at neighborhoods and so this is just, i know, that they have a lot more data and the population health division has a lot more data, but yes, in general, san francisco does better than the rest of california. in most... >> and what about the other data does exist. >> yeah, it does exist. i mean that it could be pulled together rather the same way that this data is pulled together. >> thank you

>> commissioners. >> i want to thank commissioner melara for setting the tone on domestic violence and i actually wanted to say that dr. harry edwards who is often a commentator on the media and he is a scholar and he was asked to comment on the issue of police accessive force and he really said, on terms of the racial issues that we can't even talk about racial equality until we prevent violence against women and he was asked specifically to comment on whether or not the violence accessive force was a racial issue, and so that is food for thought as you go to your conference. and i am happy with the steps that we have recognized and being on the board of saint francis hospital and there is a

woman's physician dialogue group and so we have had the privilege of having the doctor from ucsf as well as christie from the department of department health as trainers to train the healthcare professionals to be able to identify, the victims of dow domestic violence and we also need to integrate, our care system and those children, who might be going to our public health system and identifying how to prevent them from falling into the hands of violence, and one thing that i noticed in this particular report and i was a 2006, california endowment sell out for thedowneralist fellowship and one area that we talked to was the infant mortality, and in health of the particular society, and in particular, what was, very, shocking to me, was that the black women in

particular, even if they had reached, higher socio economic level they still gave birth to the low birthrate babies and so understanding those healthcare disparities even at different income level and really focus really on particular ethic groups, and i think that it is really important and we tend to over emphasize i think, a monetary level, for people, that i think that we need to drill down a little bit deeper and i want to identify news csf, asian heart and vascular center and so in particular, they die at high rates of stroke. and they may have indicators that measure that they are healthy and so they don't fall into that standard cohort. and i think that we drill down and measure the different community groups.

>> thank you for the report. >> commissioner taylor-mcghee. >> thank you, and i want to thank, former commissioner, and exclusive commissioner for her report. and i want us to just, and i would be remiss if i just didn't say, that the term now, is reproductive justice and a few years ago, a group of african american women came together and talked about the rj frame because it brings into account, the social, political, and economic issues and conditions that impact a woman's right to decide when the time is right to be a parent and that includes domestic violence and because many women are in relationships where they are intimate partner violent and that prevents them for example from taking birth control and all kinds of other issues and so i want to say that i am really happy to see that domestic violence and reproductive justice are integrated in a way that are

going to serve women. >> for sure. >> i had a quick question and not a quick question, could you go to the last slide? so the thing in the bottom, is that relation to pregnancy? >> no it is not. >> that is just a general. >> that is just gift different and the two about them are not related to pregnancy and those are women of child bearing age but not related to pregnancy and they are just stating that women for various reasons don't go to the doctor. >>

>> we ever looking at a vast number of those that are present able and prevention oriented chronic diseases and i am wondering how the health department is use and do you use a gender frame and do you use, a social disparity frame when you are determining what kind of prevention efforts you are going to spending the city dollars on and how does that process work? >> i don't know if i am the best one to answer how we spend the money. >> we are rying to align the

department in the areas of heart disease for sure, because it crosses over, alcohol, and committee for the women as well as there are other areas and you want to align the department so that they were all focus and particularly on the african american health disparity issue. and to be able to focus the health department and we are two billion dollar organization and to provide the incredible amount of healthcare service and we are trying to align our institutions and all of our services to focus on this issue that lifts that health status, and by, insuring that the health department is aligned and focused and give the special attention that the african americans have the best healthcare in the health department and they will move that throughout the city wide as soon as we get our own services in mind and we would love to share that with you and the efforts that we are making in those areas and we do work out of a lens in terms of looking at the population that is in greatest need, of the

full attention of the health department and so we will share those documents to your director association that you are and happy to come and talk to you about the progress in that area. >> okay. >> is your position of chronic diseases separate from maternal? >> yes, and our maternal child and health is in our network area, and particularly because of our nursing services. and we have a whole public health division that is run by our director, and public health, area, and in particular, our health officer and we can also give you our structure of how we are reorganized and so we have done and we are not doing the disease specific any more where we have the hiv area and chronic disease altogether and particularly with the progress and the attention to hiv and also, and the other areas and so we are trying to really focus on the fact that people do have multiple diseases and how we look at that from the

hol list tick way to the comment. >> and do you use the gender lens. >> today that was very clear to me is how do we do that? i wanted to skt staff to look at that through the woman's area. in fact, i think that this commission may be able to go in a new direction on that as well. >> commissioner jung >> i want to see where they are going for the health officer if you have any comments? >> one of the challenges that we have is that average we are healthier than most places in california and than most places in the country, but when you look and when you look at our data what really stands out is

really the health and akties and the disparities and we notice that in general we are healthier than everybody else but addressing the disparities in the city is where the focus should be, and well, i will admit to you that we don't really take and we have heard >> i am thinking about it in terms of obesity prevention and i think that over weight and obesity for women, for girls in particular is different for boys and i don't see that is an area, when we are drilling down into, and not necessarily, a disease, or a health related, and that effects women, primarily, such as breast

cancer, or even, and so we are looking at chronic disease and we know for years, and the health disease and we assume that it applied to women and we are learning a lot of things and i would like to encourage you to continue to use that lens on the diseases that maybe don't seem like they are maternal. or women diseases. >> i agree with you, thank you so much. >> commissioner? >> i just had a couple of questions in follow up, to what commissioner ackerman questions were. one, it would seem to me in looking at the rate of death due to these issues around heart disease, and the department and the health

department out reach, and initiatives that were described by the director garcia. and is there a economic piece to this? in terms of i am just going to talk about or it is just straight talk for me, okay? and it was stressful for be a black woman in san francisco. and it is especially stressful if you are under economic duress, we are less than 6 percent of the population, this is a round up in terms of the population, and in 1991, i believe that we were around 13 percent of san francisco, population, and we are now less than half of that. and we have been exiting san francisco for a variety of reasons, most of which are because of the economics. and so, i would speculate that the health issues have not

really diminished greatly, and certainly, there are some triumphs through the departments initiatives over the years. but nonetheless, the numbers continues to be very stagnant. and so, is there any particular one, is there any particular initiative between the health department and those working on the economic development issues, in the city. in order to help improve and elevate the status in the quality of life, for the segments of our population and most specifically black families or black women? you are stressed in having strokes and heart disease and other particular health challenges much due to stress. much due to lack of access to healthy diet. and much less i would imagine

also, access as less. and by limited resources. and also, some others barrier and so the way that i read this, is that perhaps, the economic factors for once, and certainly there are other factors but the economic factors are also a cause or a factor in this and how does the health department, work in conjunction with those persons or those agencies that seek to provide economic security, for san francisco? so that is it. >> a couple of areas, one is that we are closely working with our housing authority, and those new developers, for the sf sites. and there is a whole workforce development component to that. and particularly for young people and that are living in these areas and also, the

families. and so they are very involved in the development of the health component to that. but i see that as a major focus is really looking at the families in some of the sunny dale areas and the hill area and so we have been very focused on the dedicated staff who are working with the redevelopment programs, the workforce development and the programs. and particularly in those areas. >> and i have just one last question. >> and thank you for that. >> because, we are talking before in terms of the zip codes, where the people are existing and you have described some of those public housing areas. do we have any indication in terms of these numbers the ages of the women that are largely representative of this 113.8 percent, and