discussion? commissioner soo? >> okay that was just, and okay. and thank you. >> and so from the commissioner, side, and all of those fa favor of the resolution, please say aye. and all of those opposed. the resolution is passed. and we will go on to the plan and the status for women. >> great. >> we also have the resolution before us, and so could i have a motion to approve? >> motion to approve. >> is there a second? >> second. >> any public comments? >> no, i have not received any public comment. >> all of those in favor. >> aye. >> okay. >> thank you. >> next item is a resolution recognizing the 2014, cedaw woman's human rights awardees and these are just for the women commissioners. >> you can proceed. >> great.

can we make a motion as approving it? >> so, i guess that i would just, i would just like to say that next monday we will, the friends of the commission on the status of women, will host a luncheon event where we will honor a group of women, who are giants. and in many different fields, and i would just like for the good of the order to read out their names, alicia kudrow who is the president of mill college and we are recognizing at&t and particularly ken mcneilly for their great work. and we are recognizing becca

prowda and a former commissioner, and her work with levi, and we are recognizing another person that i considered giant among giants katherine dodd for her extraordinary work inside and outside of government. we are recognizing elizabeth avar tarchi an amazing city attorney. and for her work. and we are recognizing dr. nancy mulcan who is the director of the ucsf national center on excellence on woman's health. and we are recognizing regina scully, and among other things has produced the invisible war and she is a incredible supporter of women and we are

recognizing rita simel who i am sure that many of you know for her extraordinary interfaith work in this community in bringing many people together. and we are recognizing dr. sue, yun who you may know not is the union representative for the international alliance and the chair of the ngo and the committee on the status of women and for the united nations and a partner to us and our work on cedaw and other things and we are recognizing the great chief justice of the state of california tony cadel. and i am going to mess up her name. and who we are is the second woman in the first philippine woman and an incredible leader in domestic violence and so i would ask for a motion to

approve all of our resolutions from one of the commissioners. >> i so move. >> okay. >> is there a second. >> i second. >> okay. >> is there any public comment? >> seeing none, i will call a vote. all of those in favor? >> aye. >> great. >> thank you. >> item 2 d is the top health issues affecting women in san francisco, and director barbara garcia will introduce the item. >> i will welcome the commissioners from the status of women and the director, and i am sorry from the commission, and from the department, and dphs and multiple roles in the city and and our city wide responsibility and we are response for protecting and promoting the health of all san franciscan and we also provide a full spectrum of healthcare services through our dph clinic and hospital and our community based organization and in our role to assess and improve the

health of all san franciscans we track the health issues city wide and we have two presenters for us today, and shadery and michelle kirian from the population health division that will present the top health issues effecting women in san francisco. >> good afternoon, commissioner and directors. thank you, for the opportunity to present at this special meeting. and i am going to give the demographic overview. so there are approximately 356,000 adult women living in san francisco and representing 46 percent of the population. and the majority are white are of asian decent and in fact, there are women who are asian

in san francisco is much higher than the proportion of the women who are asian state wide which is 23 percent and african american women we have 6 percent and women identifying as hispanic or latino are 17 percent in san francisco compared to 37 percent state wide. the women in san francisco are holder than the women across the state and so the median age here is 38.7 and compared to 37 for women state wide and if you look at this distribution sorry, i don't have a pointer. and if you look at the age distribution, the bars on the bottom shows that among the 18 to 24-year-old group, san francisco which is an orange has fewer women compared to the state and then at the 85 and older all the way at the top we have more than the state's average.

>> women in san francisco, are highly educated with over 50 percent being holding a bachelor's degree or a graduate degree and this is much heighter than the state wide, over the 30 percent of women hold the bachelor's or the graduate's degrees, the women in san francisco, are highly likely to have health insurance and this graph shows the present of 18 to 64-year-olds who are uninsured and so on the left you have california men and women and on the right you have san francisco men and women and you will see that shortest bar represents san francisco women, and with only 13 percent unininsured and so they are taking advantage of their employer responsered public or private insurance options. >> the birthrate in san francisco among women, is generally, lower than that of the state, and so if we look at the group of bars that is the second from the bottom, the over all rate of the women 50,

it is 39 per 1,000 women, and state wide, and if you break this down by age and this is the top three bars, you will notice that women in san francisco are giving birth later in life. and so, and among the 35 to 50-year-olds, we have a higher birthrate than the women state wide. >> san franciscans in general will earn more than their peers state wide, however, gender based income disparities do persist, and here you have median and men and women working in san francisco and you will notice that the women are earning ten to 20 percent less for the same work compared to men the graph shows the gender, i am sorry, the median annual income by gender for the various sectors of the work. and so you will notice that 52 percent of women work in the management business, science or arts and but they are earning

$15,000 less than their counter male counter parts and this is true across all sectors. so this may lead to partially why there are more women living in poverty in san francisco than there are men and over all 16 percent of women live in poverty and when we break that down by age, that proportion goes up to 23 percent for women who are 75 or older, and then, for women, who are in families, this is, especially, important issue, because, the bar, all the way to the left is all families, living in poverty and that is at 9 percent and the families living in poverty is 13 percent and if you see the three bars to the right those are all families that are headed by female householders without another partner, and so the proportion living in poverty, and increases dramatically. and so it is that background and i will turn it over for michelle for the health

overview. >> and good afternoon, commissioners, and thank you for allowing me to present. and we are going to present a selection of health specifics on the key health issues for women. and however, before i begin, i do want to acknowledge that much of the work that went into getting these statistics was done by maternal child and adolescent health. >> and the top ten causes of death among women in san francisco are due to chronic diseases and of these, four are cardio vascular diseases and in the top cause of death, is the cardiac disease, which is 12 percent of deaths. and cancer, and lung, and trachia and breast cancer and colon and alzheimer's and other dementia and diabetes are all causes of cancer among women in san francisco. but not every women is equally

to die of one of these diseases. and that is for all of the top colleges, and they are significantly higher among the black women. and the death rate of the heart disease is almost three times higher, among black women than asian women who have the lowest rate of death and heart disease. and however, over all, the rates of death due to the top causes of these, have been decreasing over time. in san francisco. obeesty effects more than a third of women in san francisco. and women, who are live in poverty, here defined as those under 300 percent of the federal poverty level, are significantly more likely to be over weight or obese than those who are (inaudible). and also, latinos, are more likely to be over weight and obese than whites or asians. and the statistics for the

black women are statistically unstable, but they do suggest. the high rates of obesity in over weight. and the low education attainment, income insecurety and workplace conditions are interrelated and important to the health and well-being of women. women are low income families do work on virtually every health measure for which we have data and education and occupation, and income differences underline much of the disparitis in health and health related conditions and behaviors in san francisco. 1 in 4 mothers, i am sorry, 1 in 4 women who gave birth have high school education or less. 15 percent of the population live below 100 percent of the federal poverty level, 40 percent of mothers do not have more than a high school education, and the majority of black mother haves a high school education or less at the time of giving birth.

>> and many mothers experience the financial difficulties during or after pregnancy, 1 in 6, mothers experience job loss to themselves or to their partners, during the pregnancy and ten percent experience reduced hours of pay. and lower income mother and please excuse the labels are switched for the income. and the lower income mothers, are more likely to experience and the races and ethnicities and those who work in the low income professions are more likely to experience the job loss and unfortunately the quality data on the job loss is not available. and over all, ten percent of all women, and 30 percent of the low income women report food insecurety during the

pregnancy. (inaudible) breast feeding and paid leave as well as minimum wage and flexible schedules have been cited during the recent assessment conducted by the maternal and child (inaudible). and significant issues for women in san francisco. and almost, one in four, report needing help for the mental health problems and or alcohol and drug use. and 17 percent reported seeking medical care for emotional health and or alcohol drug issues eleven percent reported needed medication, for mental health. >> and almost seven percent reported serious psychological distress. and about 1.5 percent of women

reported or hospitalized with a mental health diagnosis and another one percent with a mood disorder or a self-inflicted injury, and again, black women are significantly more likely to be hospitalized for any of these. >> the rates of mental health have been increasing recently. >> and they indicate, both safety, and violence and including domestic violence as an important issue for women in san francisco. over all, 3.4 percent of women, experience physical or psychological violence during pregnancy. much higher rates are seen 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 th