days before the measles rash appears which is a reason why it tends to spread very easily. the good news is there a excellent vaccine against measles that is available and it is extremely effective. we think about 97 percent effectfb if 2 dose are received. most in the united states and san francisco are expected to be immune to measles because they are vaccinated. there is a outbreak in cam that began in laest december 2014 and continues. this also seems to be slowing down. last week there were 110 cases state wide and at this time there are 113. most of the bay area counties have had cases in their

residence, so we haven't had a san francisco resident associate would thes outbreak, but it wouldn't surprise me if we do have one. we have done a lot of testing and fielding inquirys from local providers so we have been looking for measles. i'm going to go back for a second here. basically we are one of the only bay area counties that hasn't had a measle case. [inaudible] what about san francisco schools? we have data on imueization dates among school children in all schools in san francisco and if you look at the total population of school children and specifically cichbder gartners you receive the second

dose of measles before kindergarten entry, san francisco school children are immunized at the same rate as children state wide, which is about 90 percent and that is the threshold you need for heard immunity. that sh the vaccination you need to stop the spread of measles epidemic within your community. the good news is san francisco has a very low rate of personal belief exemptions so thaes are vaccine refusal. [inaudible] because of concerns that have been debunkted around autism. we have school children in the system that are called transitional entrance and these are children that don't have evidence of complete

imueization at the time they enter school and they are allowed in with the understanding they will go to the medical praider and get their needed immunizations. now something that has been extremely pauseive to come out of the current measle situation is our department is working with san francisco unified school district to provide free measle vaccine for children not up to date. this being done through the school health clinic, but there may be school districts health clinic and they are in the process of individually contacting families of students who are not fully iminized in order to let them know about the availability of the measles vaccine. we recently had a incident that occurred last week where a con trucosty

resident road bart with measles. this person was known to work in san francisco and we have been working very closely with the employer. the name of the employer was released in the media but not by our department, but we had very good quaperation. it was a large exposure and a large employer. there may be secondary cases that result from this exposure. we have to hold our breath and wait through the inkbation period in order to know for sure, but at this time there are not any cases associated-any additional caseess associated. because of this we did issue a helt advisory to the medical community on february 11th of last week. just a couple words about seasonal flu and then i'm done and happy to take any

questions. so, it looks as if the seasonal flu is starting to taper off a little bit, just in the last couple weeks. i'm thinking we'll look back on this as a medium to severe flu season. we don't know until the season is over and look back to see how bad it was, but that is the sense that i have. as you probably heard, the vaccine efficacy wasn't great because of the mismatch in the vaccine strain of the predominant strain was h 3 n 2, but there were differences in the h 3 n 2 in the vaccine and what was circulating that made the vaccine not work as well as hoped. when there a predominant h 3 n 2 season this

happens every few years. it is a regulary circulating flu strain the elderly tend to be effected more severely. that is in contrast to h 1 n 1 that effects middle aged individuals. last year we had several death. so far this year there one reported death in a individual under 65. we suspect there are deaths in older individuals and those are not reported to us so don't have a count of those. we responded to many outbreaks in long term care facilities, many more than in other seasons that i think speak tooz the tendency of the virus to effect the elderly more severely. we have sort of standard protocols and procedures that we work from to help these long term care facilities control the spled

flu that helps to isolate the patient and give antiviral etreatment. that is my last slide and i'm more than happy to take any questions if you have them. >> thank you very much. questions, commissioners? doctor [inaudible] >> [inaudible] thank you very much doctor hoover. i want to thank you on the basis-i talked to several colleagues that are [inaudible] you have a hard job because there is a always a outbreak of something and there is one in every facility and they are busy. nob [inaudible] they give you a call and always

get a good response. i still get the faxes and find it useful to know the status of the various infexs epidemic. i want to thank you on a personal basis. with your expertise as a public health doctor are and physician, what is or what should be the policy regarding vaccination? it keeps come up in the news and i want to make sure that we have a uniform view on what it should be. i think i have my thoughts, but i with to hear yours as a expert >> sure. when you think about policy around vaccination are you this caning specifically about childhood vaccination and personal belief

exemptions? >> what are the main policy points? [inaudible] televised presentation. there have been questions and people ask me questions and i think as a expert i would be interested in yours >> this is a interesting year because there have been a couple vaccine preventable issues that are in the news and renewed taensh to vax seens. there was a pertussis outbreak in 2014 that was significant and a measles outbreak that is occurring now and in both cases the outbreaks have been said or fostered by the presence of

individuals that are unimue nizeed. it is a complicated issue and think there is a important relationship is the one between the patient or the parent and the medical provider and i think a lot of the dialogue and kind of perhaps helping people to kind of reconsider the decisions that they may have made is probably more likely to happen in the context of that primary care relationship. i think a very-that said, i think a very important role that the department can play is just general promotion of immunization and the importance of immunization in the community and the removal of barriers to immunization. i'll give a example, there is a program called vaccines for children that provides free vaccines to clinics that serve

uninsured and med ical children and this has been-this program has been around for quite a while. it is a federal pramp administered through the state and we work to enroll community clinics and providers and all the health networks are vfc clinics and this is key increasing immunization rates among low income children. another example is the collaboration of the school district is push measle vaccination into the scol so they can be delivered are the children are. i think things like that can be constructive to try to eliminate as many barriers as possible and i think dialogue within the individual patient provider relationship is also really key. >> other questions? >> questions for-- >> i do want to thank doctor

hoover for oo excellent update on the communicable diseases and encourage the director to have these on a regular basis for what is the current item. it is good that we are getting the heth advasery because it alerts [inaudible] not just as a practitioner but through the commission and i would like to continue to encourage that so we can track what the topics are out there rather than just reading it in the chronicle >> never a dull moment, that is my new phrase >> we are appreciative to your presentation and look forward to updates from the department >> i'll note there is no public comment request on that item. item 10 is the dph black african american health

ainitiative. mr. pickens >> good evening commissioners. i'll rollened pickens director of the san francisco health network. i'm here on behalf hof myself and my cochair from [inaudible] who you heard is away with director garcia at the conference [inaudible] have the pleasure of cochairing the black african american health initiative. we have a few members of the smaller design team in the audience and will ask if they

stand and be recognized. there were others. you note from the previous presentation we have 2 main groups. we have a small design team that consists of staff from the population health division and the network. there are about 17 or 18 of us and there is a much larger black african american health think tank that has over 70 individuals from throughout dph that helps to guide the planning and dlib raishzs of this group. i won't speak long because i want you to hear from the people doing the work, but just as a overview, many know over the past 2 or 3 decades there are several attempts to try and tackle the health disparities and outcomes of our african americans citizens of san francisco. many of them had great ambitions, but as we have seen in the data, the most

recent data pulled together by the population health division across the city, despite all the efforts we have not moved the dial in a significant manner on all most every indicator of health. when director garcia became head of the department at the same time [inaudible] towards a public health accreditation a, in their strategic plan they call out to improve the health of our african american population being the lowest in the city. i will turn this over from john grimes from the san francisco health network that will share some hof the updates from the last presentation and following john will be [inaudible] from the population health division that will also share with you.

>> good afternoon commissioners. my name is john grimes and i'm the [inaudible] i wanted to do just a little history around the initiative. i think probably you have heard a lot about it, but for some we'll go through it quickly if it is a new thing, but for probably most it is a refresher. it started about a year ago. how do i do this thing? cool. about a year ago, march 2014 and it was really actually started because of a number of horrible statistics that were done that looked othow african americans were doing in the community and second st. tarted because it coinsideed for the public heth division [inaudible] i think at

that time they were looking at 3 thingsism african american health, mu turbl child health and hiv. 2007, did a study to look at premature death in san francisco residence and at the time african americans it was shown died sooner than any other group. fraub fraub heart disease, blood pressure, diabetes, hiv and aids and a category called death of one owns hand. it was found african american males died 20 years sooner than any other group. women 18 years. barb raw garcia wanted to come up with a way across the both sides of the house to address it is h in a systematic way

which is no small feat t. is dedecided the department would look at and focus on 4 main indicators that were seen as problematic. deaths due to card ovascular disease, high rates of death for alcoholism for african american men, higher rates of death for women due to breast cancer which is important in that we found african american women got breast cancer in smaller rates, but died in larger rates than the average population and sexual health among young african american women. [inaudible] first look at our own health and clean our house first before weopeten up to the general population. as roldened talked about she put toort a advicery committee called the think tank that looked at 75 people across dph and that group had full

discussion around what they thought were the root causes for some of these horrible stats. when you have 75 people give you opinions you need to figure a way to curtail that. she came up with a design team that is part of the leadership to many shared by rollened and tomaus that sets and guides the agenda for the larger meetings as well as integrating both sides of the house. slide 2. part of what we did-we got together is look at 3 main areas. cultural humillty which is the group i chair and i'll talk about that and touch on work force development and collective impact and jacquie will talk about those 2.

cultural humillty is actually a concept that was designed by 2 african american doctors. [inaudible] it was designed for medical educators to train new physicians to train in the process of critical self reflection, critical self critique and look at ones own beliefs that may impede the treatment of the patients you see. as well as looking at practitioners taking and considering they are actually life long learners around culture and [inaudible] expercent in the culture with which they don't belong. the second group is looking at work force and work force development issues. it is looking at hiring practices, supervision and the way we recruit and retain staff. its

charge is support the current work force and look at that through a cultural lens and also how we are looking in our clinics and how our staff reflects the population we serve. now in community behavioral heth in the primary care clinic, but 30-40 percent we see are african american so want to make sure we do justice to those populations. collective impact looks at how we put this together and make sure the work is aligned and have metrics to measure things and improve outcomes. for cultural hull millty the group i'm in, we really started to look at a number of things in the group. we wanted to spread the principles that [inaudible] garcia and [inaudible] developed across the system which looked at how we can

bring cultural humillty in the work force and how we treat our patient squz each other. the work with the patients we look at how the providers can listen more to patients. listen to the story about their illness and nob naib [inaudible] they are having clinicians are life long learners. we also wanted to look and make sure the clinics were-what we did in behavioral health is we started to look at-with the 30-40 percent of the people we are seeing, we noticed affric americans dropped out of treatment at a larger rate than any other group. we wanted to look at how we welcome people in so we did a project to produce up the clinic jz make sure all the clinics across the programs were cull charl welcomeing and we have culturally significant decor

that would represent the groups of the folks whiching in. the other thing we did, we looked at smoking sessation group jz look at the behaivl health clinics, putting blood pressure cuffs in and clin ics and have lay people learn how to use it and once they see something alarming bring it to the medical professionals [inaudible] we have done a lot of training around clinical issues related to other groups. african americans, latino, asians and gay lesbians and we found these groups were growing in number. people likeding come to the trainings and saw the supervisors and staff coming to the groups, but we didn't see the partners in upper management coming in so

we talked with barb raw and we looked at how can we train some of the senior executive staff that report to her on racial humillty. last year we had a training with a man named, kenneth hardy who is a professor at [inaudible] university and he wrote a proposal to look at how to train the senior staff, so now we have about 60-70 pepal being trained. we have the [inaudible] coming up next week. these are people cross the department. we have 32 cohorts with 25-30 people each and they meet 4 time said to do intensive work on issues around race. we are also-we found this has been very helpful in a number of ways because there

have been a lot of conversations across the department with managers around issues that x up with diversity so this is a way we addressed that. each of the trainings we had, one looked at the dynamic of racial oppression, the development of a racial informed lens, recognizing and working with racial oppression and managing racial dialogues. that is it. the last thing i want to say is we are working closely with the [inaudible] initiative and many of the initiatives that they are working on really work nicely with what we are doing with cultural humillty. i talked with them and to date we have trained about 1700 folks in trauma informed system of care. thank you. jacquie will take

it over. >> good afternoon commission. i would also like to thank tailor [inaudible] she is also a part of the design team and we really appreciate her participation. one of the work force development is & the goal is have a work force that is to be able to be culturally praficient and reduce the numbers of adverse helt conditions. the work force development group, once we [inaudible] we met and came windup a priority grid. our

director is looking at a analysis of the african american staffing in the deparchlt. next is the cultural compitance [inaudible] we will look at tools available that we can utilize that addresses the cultural comp tense within the department. that looks at the history and culture and experience in working with population. next is the manager training. we will provide leadership with ongoing training to address power, authority race and class and how it may impact supervising. it will bring a consciousness to our supervisors within the department. the meantering, this is to identify strategies and mentoring models out there for existing employees. this

is something that we had years ago and we want to relook at that and look into the history and see how it can be utilized and applied to what we do now. last, staff satisfy angz. this is how we provide value and recognition and appreciation for the african american staff that we currently have. this is a exciting slide, this shows how we are really integrating across the department and this is part of a large rb commitment of work force development plan. this will go beyond the next 10 years. this is in the future of probably our grand children if they want to work for the health department of what the work force will look like. so far we have-we had a african

american health initiative collective impact working group and that group looked at improving the health outcome. develop implementation plan and we'll report back from each working group. they received-there was a group of at least 40 people that receivered training on result based framework completed on december 10 in 2014. we are irking with quality improvement team and ambulltory care and have line indicators. there is now 4 work groups that are addressing persons of blacks with heart disease and this has been leskerage-one example is the leverage of the funding we received from the cdc. we will implement to reduce heart

disease amu african americans in san francisco with a huge grant we just received for that effort. that's developing the heartscome pain come pain in san francisco. these groups are now formed and they will be comprised of people across the entire department from the san francisco side as well as the dhp side. [inaudible] mortality rate of black women with breast cancer and [inaudible] sexual health. this slide is last slide and it shows how all these are interconnected. the cultural humility and impact group and work force development, we are all working together and all aligned to address these 4 issues. it is no