we transition for ucsf, all that will create more acivity so it is for the good of the patients so we can't do that unless we have access for staff and patients. >> thank you >> so, with that we could propose the amendment-we could propose the resolution leaving the staff to add the new whereas >> so move. >> that's where that whereas that will help site the added service squz needs we'll have. is there is a second to that? >> second. any further discussion >> following up on commissioner [inaudible] consideration of the planning commission, we meet with them annually, can that be added as issue of ours to the annual docket? i know it is a ways away, like 10 months away, but

the parking thing is 10 years in the working >> the meeting that we have joibtly with the planning commission is specifically requested by their legislation regards to the health care planning ordinance and i have to ask coleen, do aiosee this may filt or do we want to make this is a different item? >> the health and planning commission meet together for twoe reasons one is health care services master plan and the other is the cpmc development agreement >> those are the 2 items we mandated >> i may suggest that based on commissioners [inaudible] i'll look back at the rational that can be developed from-the rebuilt of san francisco general hospital if it were subject to helt care services mamaster plan isn't only consistent with the master plan

have praenl recommended for insentsives and that may be leeway with parking. i look at that and report back to the commission. >> would that satisfactory? there should be more collaboration between the 2 departments and we may want to put that within the planning session to see how that might be able to be done thats rises from this discussion >> i also say that with the house commission and planning commission will meet toort on the master plan probably not until 2016.

>> my last question is whether the [inaudible] will include transit dor [inaudible] out to mission bay if there is issues we have in terms of the new ucsf development or any of that [inaudible] we need to put in the resolution- >> good information questions that the director can answer. >> i don't have that. >> or maybe mrs. joan-there has been question regarding all the transportation issues >> for mission bay they impt lmented bus routes that go from 16 street bart to mission bay but it hasn't included anything that comes to san francisco general. this was very specific to the mission bay project. >> that is a thinking when

you drive to general you are off the grid and it would be nice to look at the transit cor dors that make general more part of the city as well as-also in addition to parking finding alternatives to driving cars >> i understood that we have been in discussion about public use of public transportation and there had brin changes during construction. have we had further discussion on [inaudible] >> there hasn't been anything specific to bringing [inaudible] to sfgh specifically. there are changes that impact the hospital and i can't say for sure because i'm not sure of the details, but think it is a negative impact. [inaudible]

mission bay. >> it would sound that [inaudible] take thup option squz help track the progress that would go on. that is also a part of the-relocation too as we open the new hospital, we should be concerned with the cor dors >> absolutely. they expect to see a very [inaudible] transportation to management program so they have to be able to make the bus routes or whatever public transit routes most accessible to staff and patients in particular coming to the hospital. >> so, why don't we bring that topic to joint conference to be able to review that if it makes sense at that point? for right now so we make sure that topic is on our agenda.

>> thank you. >> thank you, any further discussion? are we repaired for the vote >> i note there is no public comments >> all those in favor of the resolution with the amendment we have spoken about say aye. opposed? the resolution passed >> san francisco childrens [inaudible] commissioners i will pass out a corrected page to the presentation. i will pass it down now. >> thank you. >> good afternoon, thank you for having us. my name is markerate fisher and i'm a oral health consultant [inaudible] today we are going to have members of the san francisco

health [inaudible] partnership, childrens oral health, strategic planning collaborative present the presentation. we also have a resolution that we hope you will consider approving after hearing our presentation. i would like to introduce doctor susan fishero. >> thank you. good afternoon. as mentioned-can you pull the slides up? my name is susan fisher oens and apedetration at san francisco general. i'm a researcher at rks csf [inaudible] we are presenting to you a plan under which we have worked for a year. this is a incredible

impressive collaborative of people coming together to make san francisco children carries free. i would like to take a second to pull of the slides and ask members of the collaborative to stand as they do-you will may not recognize them by face, but we have members of academics and members from the department of health and the school system and wick and kaiser and different medical dental organizations and societies all in support of the common goal. it is also something supported by the [inaudible] kaiser, united way, california department of public health and [inaudible] this is because dental carries [inaudible] it is unique and all most entirely preventable as a disease and can be dealt with efficiently

and cost effectively. far too long oral health is considered the domain of the dentist. as a pediatrician it effects my patients every day. i want to prevent disease and so that is part oaf what we do. >> hi. [inaudible] and i think oral health is important because you get to eat only foods like [inaudible] teeth don't fall out when you are adults. >> no bias here being raised in my house hold. tooth decay as you will be able to see on the next slide effects health and developmentf this isn't just a kid with a tooth ache,

but the child with the tooth ache isn't able to [inaudible] they are also effected-their nutrigez is effected as a result of that. the pain not only prevents them from sleeping, but makes it hard for them to engage in school. it effects their overall quality of life. i would also like to highlight baby teeth are not just baby teeth. the greatest risk of adult hood is having trouble with the childs teeth. we know people with poor detection are less likely to be hired even with those of equal resumes. if they are not able to do well in school they fall behind and miss school because they are in the emergency room and that effectss the childrens ability to make the full potential. it not only

effects-the cost isn't only to the child, but you will see cost is also to the system and it is roorkable what a great impact it has on the system in terms of cost of care. there we go. in california alone we know that last year there was 26 thousand emergency room visits for a preventable disease. believe it or [inaudible] they die every year from this preventable disease and that is a minimum of a extra5 thousand per child. it also a impact on the school system. the schools are reemburseed by children being in the chair and if those kids are sick-children with a tooth ache are 4 times as likely to

miss school so the school doesn't get [inaudible] more than 5 million american children missed a diof school in the last year and have seen that here as well. i would like to turn it over to [inaudible] to talk about what the riskerize specifically to our city. thank you. >> hi. i am doctor [inaudible] director of dental services for dph. this slide gives an idea what is happening in san francisco. each year [inaudible] partner with volunteer dentists and staff from the san francisco dental society and we screen kindergartners in the schools. we get to 100 percent of the school. epidemiologistss take the dat awe gathered, analyze

it, these are epidemiologistss from dph child and adolescent health and we come up with the graph. the graph shows [inaudible] from 2007 to 2012. the orange bar wepts prooimary teeth or baby teeth. the blue bar represents permanent and primary teeth. you see we have made progress, there is a dental decline over the last 5 years, but still [inaudible] remains a major public health problem because in 2012 you see 37 percent of the public school ind caner gartners had one decayed filled or missing tooth. the national-[inaudible] is thurth percent. 37 percent we do have a ways to go and you can see that in some parts of san francisco over 50 percent of

the kindergartners had tooth decay. the highest in the city are red are china town and the surrounding area. that is where 50 percent of the kinder gartdners had [inaudible] also quite high is the area in orange in the southeastern part of the city where 40-49 percent of the kinders [inaudible] the yellow area throughout the city are also quite high, 30-39 percent of the children showed [inaudible] experience. this graph shows the disparity in oral health and by race. the highest line, the blue line shows [inaudible] in asian children. the red line shows

in hispanic and green in african american and the purple line shows in caucasian children. again, though we have seen a decrease in [inaudible] experience the gap between caication cheern and african american and latino and maegz children widened from 14 percent in 2000 to 21 percent in 2012. >> [inaudible] teasing out the data of children with color are chine ease children, 3

times as likely as white children to have untreated decay. african american and hispanic twice as likely to have untreated decay. showing that childrens oral health is a primary part of overall health and well being which requires timely access to preventative is sirfbss and timely treatment. the kids that are 3 times as likely have to have just as much access as their counter parts in the city. illustrated the data firther. low income children and children with color wait times at dental clinics that accept med cal or medicaid can be as high as 2 to 3 months including

nigh clinic in the mission neighborhood. we are building a wait list. these children who will be seen in the 2-3 months if their parents are persistent enough to be calling us and staying on the phone and getting their kids seen. as a result in san francisco less than half dent cal children 0-20 see a dentist in the past year. it is [inaudible] poverty is associated with greatest risk in the unified school districts in the city. while dbtal decay is decreasing in the city, it is in the neighborhoods, the red and orange where we still see a increase. the chart shows that if your school is less than a

quarter of the children receiving free and reduced school learns than we are doing a good job getting you care. your numbers are going down if your school is 50 percent or greater or 3 quarters, you are seeing as high as 40 percent increase from 2000 to 2008. that is 8 times as murch as the more affluent schools. the good news, this is a preventable disease, 100 percent. the decay of dental tissue is preventable. some of the strategies [inaudible] where we apply a plastic layer into the groove of the biting surface of the moller teeth preventing carbohydrates from being packed in the grooves and

not being brushed away and beginning the decay process. as we see all those grooves they are shown to be 88 percent effective. unfortunately in 2013 only 19 percent of our 16-8 year olddant cal kids received sealants. that is less than la, sacramento, san diego, cont rucosta. another strategy to prevent dental decay [inaudible] meaning rdha or dental hi gentest [inaudible] a dentist or dental auxiliary. getting those tools into other medical providers are just as effective and it is reimburseable by med cal.

>> good afternoon, my name is lisa chun, i'm a public health dentist and [inaudible] this now bringstuse the strategic plan. as mentioned earlier we spent a year long process engaging the community, formed a committee and we first developed a set of guiding principle which you see before you and these reflect our values and serve as guidelines in terms of decision making. we refer to these throughout the development of the plan and they are listed. you want to focus on prevention. the unioner age children, of-10 and pregnant women [inaudible] we want to focus on sustainable efforts and efforts that make change on the policy and systems level and also coordinate city wide efforts. there is a lot of activity going on and we want to coordinate all that and

importantly include the community. many rounds of revision including 2 community wide retreats and monthly meetings resulting in these 5 areas. increasing access to oral health prevention i treatment, integrating oral health within over all heth, promoting good oral health with parents and [inaudible] evaluation, development a on going oral health [inaudible] lastly coordinate and over see the implementation of the strategic plan. parallel to the development of those stat aejz we also developed our indicators. these are targets where we would like to be 3 years from now. this informs the data we need to collect and measure to determine if we have acheesked our goals. i won't read them in detail, but there are 3 goals related to carries

and there is carries experience, untreated decays and also the disparity that we want to target those that are a birdb with the most common childhood disease dental carry. then we have 3 indicators or targets related to accessing dental care as well as pregnant women. lastly we have a dental sealant indicator to increase the percentage of the low income children that receive the sealants >> within the plan and i hope you have a copy available to you, that is our overall plan that was in each tactic [inaudible] we worked over the past year breaking them down into specific subtactics and performance measures. we know we moved from a

>> student b. where will give you some examples because it is about a 5 page grid, but some examples in access is that every head start and early head start family advoicate and center director participates in a training this is headed by a head start health director within the mission area. we have in each of the next tactic integration policy is developed and implemented to include fluoride varnish [inaudible] by the san francisco helt plan, which is med ical managed care plan. within that particular performance measure we have a san francisco health plan advoicate that helps us work to produce mutually reinforcing goals and results so you'll see in the next slide that dph is

also working on. promotion, one performance measure is have at least one high need neighborhood experience oral health marketingcome pain and evaluation which is sth cor of the plan and a surveillance tool designed and a dash board is completed. the department of public health has a unique role in the plan. we are actors, one of the community members like native american or the san francisco unified school district, but we are a over arching group and agency that we work to insure the health of our children. within the plan itself, we have some recommendations. the first one is the integration and institution of fluoride varnish applications in all the primary care settings. this is a epfdt

benefit to which all med ical children are eligible and should be offered, but are not. because a child will see a dentist, a medical provider eleven times before they get to a dentist, med icade-this is reemburseable benefit, they believe in thisb.. that is some of the other recommendation is integrate oral health into all the campaigns. you will see that in the sugar free and sodey free summer it prevents decay. key to sustainable is the cost. colocating dental services. this is a nation wide new effort that is happening across the country where we bring dental services to our kids. now we are already bringing

sealants, our dental services bring sealants into the school and a hand full of children receive that bah we are not getting reembursement. the river of money is flowing by and part of the plans goal is explore the billing and feasibility. we had the great benefit of the hellmen foundation of the collaborative and seeing the effort we put in that gave 400 thousand dollars to do this planning piece and we hope we will crack that nut and figure how to bill and share it with 24 rest of the city. i thank you. we also have a resolution that we are hoping that you will approve. i will read you the [inaudible] be it resolved that the san francisco health commission is

concerned about the chronic epidemic of childhood carries and result of health disparity in san francisco and committed to improving the health of san francisco children. the san francisco health commission recognizes as a priority the work of the [inaudible] oral health group and endorses the [inaudible] the san francisco heth commission sports the collaborative work necessarily for successful implementation of the plan by all stake holders including but not limited to [inaudible] private medical and dental clinics, university and medical school, med ical health plans, community based organizations, school and policy makes and community leaders and advocates. be it further resolved that the san francisco commission request [inaudible]

oral health strategic plan goal reducing carries experience in kindergartners to [inaudible] to increase the institution of fluoride varnish application in dph primary care clinics, integrate oral health [inaudible] and the ability to increase access to dental care in non traditional settings with funding. health commission requests the [inaudible] provide peerodic updates to the health commission. thank you so much for your time. sorry, are there any questions? >> thank you very much. was there any apublic comment? >> i didn't receive public comment >> questions. >> having read this at the subcommittee i have seen it and the prez rbitation is moving.

dental problems are preventable and there is a easy fix that you identified we just need to get out there and really impressed with the effort and the collaborative that you come to-earth. i also like the map that helped try to understand and hope all the presentations we have with regards to public health issues will have the neighborhood spinge density issues. i want to offer that as i understand it the 4 part solution and you had 5. it is claberate, educate, varnish and smile. that sound like a no brainer so you have my vote on this and want to thank you for the collaborative effort. dph is served as a [inaudible] there are multiple entities in this and i think what you are seeing are the universities and

schools and community clinics and other partners-sorry if i leave people out-that are coming together to solve the neighborhood issue throughout san francisco. i think we are getting good leverage and that is a good thing and i'm smiling about that. >> thank you. commissioner >> is there money dedicated or available for a educational program that would get a lot of community education out on this? >> part of the plan is to be a road map and the money that we receive from hellmen is targeting for the [inaudible] billing consultant to figure out the money flow so we can get the sealant programs and get the location of services. the promotion and educational programs, that is something we hope this pl