testing testing testing testing. >> i also don't want to repeat what people have said before, it is important to let the director know, we are very humbled. she's very community focused and also entered disciplinary with humility. she brings people together, whether it is from the high hospital setting. it was important with the whole system of care.

one of the things i also want to share is often times we go with, not only compliance but with models that the government instills. as you no kak often times research is done on the population that don't necessarily reflect the folks that we have here in san francisco. with ongoing immigration, people are coming in emerging groups. folks who come from other countries do not see our health care. we need to outreach and educate and adapt and all the practices being used to ensure we are reaching care and talking about it and including it in to the settings. we think it is important to work with the coalitions which ramsey is part of. health services network, the council, and the a.p.i. health services and disparity coalition it is important to talk to folks and we do appreciate the

opportunity to share. >> thank you. >> thank you, very much. next, please. >> president, commissioners and director waggoner. my name is mary and i'm the executive director and c.e.o. of the san francisco medical society. the san francisco medical society represents over 2,000 physicians from san francisco and marin. medical society is the only association in the two counties that includes in his membership, positions from all modes of practice, specialties and hospitals. thank you for the opportunity to address the commission regarding the next san francisco department of public health, director of health. we will also be submitting comments in writing. san francisco, as we have heard, is a unique city with a diverse

population. we believe the uniqueness should be taken into account when choosing the next director. such an individual should understand the diverse needs of the various racial and ethnic groups and communities that make up san francisco. we believe we have been extremely fortunate to have great leaders in this area from previous directors including barbara garcia and dr katz and dr sandra hernandez. there are a number of other qualifications that we would like to see in the new director. the obvious qualification would be someone who has proven leadership ability and insight into the current healthcare system and the public health needs of san francisco. the next director should be able to tackle the complex organizational and community challenges that we continue to facing our city. we believe that it is imperative the next director have a thorough understanding of clinical practice and what is involved in treating patients as he or she will over see

zuckerberg general hospital, laguna honda and numerous clinics. they should also have expertise in clinical integration, access to care, quality of care and cost of care issues. as you no kak this is an enormous job with enormous budget and we understand the desire to conduct a national desire -- a national search for the next director. we are fortunate there are candidates within the department to possess all the qualifications listed previously and they are also physicians. san francisco has a great track record of promoting candidates from within the department and we recommend that it continue in this tradition. thank you, very much. >> thank you. next, please. >> hello, everyone. i am a student at the academy of art university majoring in product design. i have a question about technology.

my question is, what new technology is conceptual in general with san francisco? thank you. >> thank you, very much. commissioners agree. >> my name is david singer. thank you very much for the opportunity to speak today. i am motivated by the same thing that motivated me to sit on this commission with many of you which is the desire to make our city services better for the most vulnerable among us. because that is developed -- that is what values the city of san francisco. i will start by reminding us why we have a health department. though we all intuitively understand, it is worth going back to principles to be our northstar as we select a new leader. if you look at the department, it is about delivering

healthcare. the vast majority of the budget is on direct healthcare services and the public health requires to store sophisticated understanding of healthcare. so medical care is at the core of everything that we do. in some form or another. and the only point i want to make today to contribute to this conversation is that you consider -- you only consider candidates to put forward to the mayor who are physicians. there are many other requirements. we heard a lot of them and some of them conflict. they are all logical. you will be able to satisfy all of them. but i think table stakes is that someone is a trained position. i have reasons for that. first, they will have a better appreciation for what the court work of the department is on the challenges and the opportunities for delivering care every day and to deliver on the department 's mission.

if you think about the list of responsibilities that miss howard put up, they all involve complex and nuanced understanding of the delivery of care. legitimacy among the senior staff. our staff, the people who drive by, by and large the largest departments within the public health department are physicians and the ability to have street cred with those people in the discussions, i think is incredibly important. thirdly, budget dollars. the vast majority of our dollars go to patient care to direct patient care. i know all this sounds obvious. painfully so, even. but i personally believe that the city has a real opportunity to take advantage of the great tradition and move us to a different level in terms of public health. i also think there's a tendency as organizations grow to lose sight of the core mission and

the insight and skill needed to run the effort optimally. it is one of the reasons we don't organizations tend to lose their way as they grow. they tend to attract leaders and convince themselves through strange sets of logic that they need somebody besides what is the core mission of the department. if you look at the top 20 cities in the united states, the vast majority of the departments are led by physicians. i would encourage you, as you go about the work, which i know is a lot of work, to put that as primary care first. thank you. >> thank you for sharing your thoughts and coming today. is mere proceeding, let me name another five -- as we are proceeding, let me name another five. deborah elin, sandra makovsky,

brenda story, sarah larson, and alex crawl. >> thank you commissioners and acting director waggoner. i am from ucsf. i am a former member of the city family and the new director of local and state government organizations for ucsf. we appreciate the opportunity to comment on the selection of the new director of health for san francisco. several speakers have mentioned partnerships throughout their remarks. we are extremely proud of our very long partnership with the city and county of san francisco , specifically the department of public health and we are committed to the success of that relationship. we believe the selection of a director of health can support and enhance ucsf partnership with the city is very important. we submitted a letter for your consideration who is a device to dean for san francisco general,

who i am sure you know well. i will highlight a few key issues. first, zuckerberg san francisco general, for over 150 years, it has been ucsf positions that have provided the direct patient care at the general hospital. today, as you no kak it is the only level one trauma centre in san francisco at the city his sole provider for psychiatric and emergency services. on any given day, there were over there over 2,500 faculty and staff that are providing clinical -- clinical care, research, education and administrative services at general. our care is inpatient, outpatient, emergency cat diagnostic, psychiatric services at the general. a former commissioner mentioned our san francisco county jail. it is positions that provide the care of the san francisco county jail. our doctors and staff work very closely with all levels of

d.b.h. from leadership, clinical and administrative staff at the general every single day. a strong relationship between ucsf and the director of health is critical to the continued success we believe of both zuckerberg san francisco general as well as ucsf to provide education, research and patient care in san francisco. outside of zuckerberg san francisco general, apartment we partner with the department of public health on a really large number of community programs. i will highlight just one. the new generation clinic, which i know you are all very familiar with. ucsf partnered with d.p.h. as well as with the homeless prenatal centre to provide reproductive services and education to loosely mobile inc. -- low income and young women from colour from the mission and bayview. a lot of referrals from the high school and a lot of schools and community organizations around the neighbourhood. the clinic was in danger of

having to close for financial reasons. at the director garcia worked very directly and personally with ucsf and homeless prenatal to save the clinic so ucsf will provide the clinical care and d.p.h. provides administrative support and homeless prenatal provides the location. that is one example of a variety of partnerships while we work together and we hope that you will take that partnership into strong consideration as you make a selection for eight future director of health. thank you, very much. >> next, please. >> president to, commissioners, acting director, thank you for providing an opportunity for the public to comment today and to provide input to the selection process for the next director of the san francisco department of public health. my name is debra. executive director for san francisco dental society and i'm a member of the cavity free s.f.

coalition. the san francisco dental society believes it is important that the future director, like barbara garcia, value and support oral health and dentistry in the relationship to total health for the san francisco citizens. in this effort, it is equally important that the next director is committed to supporting the funding recommendations and allocation of the sugary drink distributors tax advisory committee. and recognizing how oral health is important to our community. the health commission, in it's resolution recognizes the importance of oral health to overall health. the impact of poor oral health on our children and supported improving oral health of all of our children in the city and county of san francisco. we would ask that the city's next director be equally

committed to improving access to awareness of and have a strong understanding of the importance of preventative oral health services to our community. additionally, the san francisco dental society partners with project homeless connect to provide oral health services to our most vulnerable citizens. it carries and other serious dental problem among the homeless and they have reached epidemic proportions. the city and county of san francisco stared -- stands at the forefront of tackling the problem and we are working with project homeless connect and the department of public health dental services to make a difference. we would ask that our city's next san francisco department of public health director, like barbara garcia, be committed to improving access to awareness of and have a strong understanding of the importance of oral health services to our community.

as community partners, we care. thank you. >> thank you. next speaker, please. >> director, president and the rest of the commissioners, we appreciate the opportunity to speak. i am the c.e.o. of the san francisco community clinic. our members represent the 11 nonprofit community health centres in san francisco. we serve hundred 13,000 patients , most of whom are under the 200% poverty level. we are a grantee for the federal healthcare for the homeless program. we manage a mobile outreach that provides urgent care to homeless and the marginally housed people throughout san francisco. for the past eight years, it has been our pleasure to work with the director with her mindfulness of the diverse needs of our san francisco population as we work collectively and collaboratively with the s.f. d.p.h. and staff and community

partners to make progress in many areas, including progress to access to services to help all san francisco residents regardless of immigration status , reducing deaths and h.i.v. and aids and protecting our community. in order to continue the progress, we ask the health commission to recommend candidates for the new director of public health who have the following attributes. a proven record of accomplishment and working with community-based organizations that provide health services integrated with wraparound services such as transportation, support groups, food, housing resources and other services that help modify the determinants of health. as a leader, is similar to director garcia, someone who incorporates the experience of diverse communities in the work of the department and has experience in making sure that input from the people served by the department of public health

is incorporated into the strategic planning and daily work of s.f. d.p.h. we also request a director who continues to maintain san francisco's long-standing practice of providing primary care and other services are independent neighborhood based community health centres in addition to the d.p.h. clinics. finally, similar to barbara garcia and in concert with her staff, many of whom are here, that recognizes that we all have responsibility to look at the total system of care in terms of cost, quality and the patient experience and that each of us has a role to play and we need to work together in order to achieve lasting improvement. thank you. >> thank you, very much. next speaker, please. >> good afternoon. my name is brenda. i am the executive director of nation -- mission neighborhood health centre.

i am here representing the latino health equity coalition and we have submitted comments in writing. first of all, i want to take a moment to acknowledge the hard work and the dedication to public health that barbara garcia has demonstrated to her professional career. from her early days as executive director, and being the director of homeless services in the city of san francisco, to being deputy director and director of health. she exemplifies a life dedicated to service. thank you for the opportunity to give perspective on the qualities needed in the director of health. we would like to offer three specific qualities. first, experience with key populations. second, cultural sensitivity and third, a spirit of collaboration with the nonprofit sector. as you no kak the responsibility of the director of health is to

improve the health of all san franciscans. at the same time, the director of health must be keenly aware that special attention is needed for those communities of colour, immigrant and marginalized communities, such as the homeless who experience significant health disparity and disease burden. we need a director of health who has demonstrated experience in developing innovative and effective programs for the low income and disenfranchised communities. the current project, such as homeless connect, and the zero h.i.v. infection efforts, as well as the integration of trauma informed practices are examples of such innovation. secondly, we are looking for a director of health who is it driven and get brings cultural humility and a sensitivity that understands that some cultural or indigenous healing practices and interventions may not be as amenable to the scientific

approach or have not been given the attention and financial support by research institutions to prove their efficacy. we need someone such as former director garcia who will support and invest resources in community driven and culturally specific models. lastly, collaborations with the nonprofit sector. nonprofits often emerge from the strobe of the community and their vision and determination to resolve those struggles. community-based organizations are parts of the fabric of this community. they create opportunities for members of that community to enter the professional workforce and develop leadership and contribute time to their community. they provide cost-effective health and healing services and the continuation of this public-private partnership are key to the health of our communities in san francisco. thank you for this opportunity.

>> thank you. next, please. >> i am sarah larson. i have worked for d.p.h. for 22 years. i'm not a commissioner or a director. honestly, i would like to see somebody that comes from someplace, another city from san francisco because i would like to see a director who is directing the directors. i watched as the electronic medical system, a very clumsy arrangement that was dehumanizing to the patients that are mentally ill and homeless because it was so rigid if you just had gotten somebody who had worked there for a while and work with the developers and what would work well, it would have been so much easier and less traumatic for the staff to learn the system. i feel like the front line workers are so often left out. there is so many new initiatives and programs and they will get up and running for two years and then they will fall apart again.

those are the same people who have dedicated their lives working with the city to having to reapply for the job they have been doing for so long because their department is now folded into another department. i want somebody who will not just realize the impact of that on the people who are actually giving front-line care. i think that is really important and somebody who isn't like all, caught up in the system and the politics. i have been on panel sensing people on panels who would talk about who they wanted to hire and their input was completely disregarded. i have seen that happen again and again. i just think that things could happen so much smoother and you would get by and from the employee is so much better if their opinions and input were actually welcomed instead of tolerated. thank you.

>> thank you, very much. before our next speaker, let me call some names. tracy shaw, jackson bowman, lizzie belton, frannie wong, and joseph wilson. >> i am an epidemiologist. and thank you commissioners for having this forum today. desk dot this is a wonderful tradition. that you are doing. i would like to also thank barbara garcia for her exemplary service over so many years. the work that she did is continuing on in san francisco and much because of the work that she did. one of the commissioners asked a couple of questions and one was

about new initiatives on the horizon and another was about some of the unique qualities of this particular position as opposed to the other cities. one of the things i wanted to touch upon was the whole idea of safe consumption sites, which i know i presented in front of you ten months ago or so when you all enthusiastically approved these sights but here we are ten months later and obviously with the mayor and also with this and barbara resigning. a couple of different things. that is obviously quite a unique endeavour. one of the things that hasn't been talked about is the amount that the director of health has to work with so many other departments within the city. that initiative may be a small initiative but it is an important one. they need to work with the police department and they need

to work with public works department. they need to work with the district attorney and the city attorney. there's a lots of other departments and places in the safety that this director needs to work effectively with as well so i think, given the science of the homeless problem, of the opioid crisis, of all the substance use issues, these are important issues that we need to think about and make sure that the next director has a long history of experience with this particular issue his. and also in making bridges, not just with nonprofit organizations, which are really important to, but other departments within the city. thank you. >> thank you. next, please. >> good afternoon. my name is tracey and i live within the bayview hunter's

point community. i want to make sure that i emphasize on the black african-american health initiatives that we do have going on for the black african americans here in san francisco. that is me speaking on behalf of that and working within the primary care so we can look at that and continue that's. and looking for the next director of the department of public health, we could really consider that if commissioners could really consider that. that is something important. seeing how the average -- the percentage of african americans living in san francisco is pretty low. we can keep that on the forefront and keep that work moving forward to. that is something that has been going on for over a year or so now. if we can keep that going, that would be something really important. i know for the people of my community, that is important. along with the other issues that involve african-americans and homelessness, drug abuse, the opiates and all of those things, if we can keep that moving forward, i would appreciate that

and you looking for the next candidate. thank you. >> next, please. >> i am a health services director for huckleberry youth program. we are a 50-year-old san francisco organization that serves both minors and transitional aged youth with four main program areas, health, education, justice and social services. i wanted to present a little bit this afternoon around feedback that i gathered from the staff at the health centre and more broadly from the community partners around what our priorities would be for a director of health. first, it would be a deep commitment in terms of harm reduction. both broadly as as dutch as a model, and it is something that is supported in the city, but more specifically, wanting to seen a proven track record for someone who prioritizes the interventions of a harm

reduction intervention in a major city, either in san francisco or someone -- somewhere else in the united states. specifically the interventions that are most important to us our needle exchange and the accessibility of narcan and similarly, safe injection facilities being available in san francisco. that was something that really was championed by barbara and we saw a lot of important change happen in the last few years in that regard and i would like to be able to consider see that championed by a new director. second, i think people have spoken a bit about what experience they would like this person to have. there are many different kinds of educational backgrounds that would be important. for those of us to provide direct service, what really feels important as knowing that somebody has an understanding -- understanding of what it means to provide the services or what it means to access the services. i think sometimes educational

benchmarks are important. certainly having certain kinds of education open some kinds of doors but we really feel like experience, both providing direct service but also accessing services is important. somebody who is a former drug user, someone who has done sex work, someone who has been homeless, all of these are experiences that a lot of must share with our clients and we find it is -- it means that we are able to provide services in a way that is most accessible and we think that having these the experiences that are shared by someone in a position like this are important in terms of looking at directions for policy or intervention. and then thirdly, somewhat selfishly, but not altogether, making sure this person has experienced or has experience working with or prioritizing services that directly affect

transitional aged youth and minors. particularly homeless youth, youth who are graduating out of the foster care system, and youth with significant mental health and substance abuse issues. thank you. >> thank you. >> next, please. >> good afternoon president, commissioners and director. my name is lizzie nelson. and the community -- community advocacy director for the american heart association in the bay area and a member of the shape up san francisco coalition the american heart association mission is to be a relentless course for a world of longer and healthier lives. the -- we are proud to have been a part in your community organizations across the city and advocating for groundbreaking public health policies like the sergi drink of sugary drink tax and the sale of flavoured tobacco products. i urge you to remember the precedent of san francisco as a national leader when considering

the qualities of the future future of public health director and their support for these initiatives as proven critical. shape up coalition is a unique partnership stopped and supported by the d.p.h. and ed includes agencies across the 50, health care providers and nonprofits dedicated to improving public health and reducing health disparities in reducing chronic disease advancing evidence-based healthy eating and active living strategies. evidence-based strategies to improve the health and well-being of all san franciscans. we are a city of great health and -- inequities. we have unique communities and neighbourhoods that suffered just disproportionately from various chronic diseases. it is essential that all city departments advance health equity, especially the department of public health and that directive should come from your next director. to someone else mentioned the ability to work with other agencies and departments in the

city. i echo that and to bring a health in all policies perspective and champion that across all agencies. the director should be a strong advocate for and have experience implementing health equity promotion programs and policies including those that improve access to and support healthy eating and active living opportunities in the diverse communities and neighborhoods with special consideration for communities with the greatest help inequities. i agree with other folks that there are different educational backgrounds that can lead to got kind of experience. when you look at the cost in your department going to health care versus prevention, that is echoed all over this country. and there's a better return on investment from preventing chronic disease and preventing all kinds of illness that having to pay for the care of all those individuals later on. i urge you to remember that the public health and prevention side is at the best interests of the people of the city of san francisco. thank you for your consideration when selecting candidates.

>> next, please. >> good afternoon. my name is ronnie. i'm a bay area native. i work in the mission as a health and nutrition manager. i am also one of the cochairs for shape up san francisco coalition. as a woman of color, i would like to see another woman of color take the place of the next help director who understands the barriers that minorities face throughout the health system. there are huge health disparities in san francisco and the next health director needs to ensure that every person has the resources and opportunities needed for optimal health and well-being. the color of your skin, where you live, where you were born, how you express your gender, who you love or how much money you make should not predict your health status or life expectancy i would like to see the next health director embrace preventative health strategies that pivot fixing people to fixing systems where would benefit some communities but

disadvantaged others. they need to focus on supporting policies and systems change to ensure health equity for all san franciscans. the next health director needs to be a community leader and participate in partnerships that honour community voices to build internal capacity with us to create an equitable health culture throughout san francisco thank you. >> thank you, very much. next, please. >> good afternoon. my name is joe wilson. and executive director of hospitality house. i want to give a shout out to a commissioner who is a former member of our board of directors thank you for taking this opportunity to seek the public input. it is a good thing for the department to do. i want to go on record as saying that i view director garcia's departure as a loss for the city and communities like ours, in

particular. you may want to check in with the director on this but i see no reason to rush this process. i would also say that, first and foremost, if you are looking for a person who is a forward thinker and a risk taker, those are complementary skills but they are not the same thing. as far as the requisite for being a physician, i would say well, there is the unmet -- american medical association and there is also doctors without borders. you can probably guess where i land on this but i would say that we approach that requisite very carefully. first and foremost, i think the director of health has the unique opportunity to beat the keeper of the city's moral compass on a number of issues.

they are very important and integral to community health. particularly, representing an institution that above all else, must not replicate the same institutional racism, gender bias and other obstacles related to class that really have a direct finding on health disparities, particularly in communities of color. ultimately, this must always be a welcoming institution, first and foremost. as a formally -- formerly homeless person, i'm applauding your efforts to invest very serious resources into tackling the homeless problem and the impenitent health implications but it also requires continued leadership from all of you and the new director. lastly, i would say that above all else, feeling every

community, every person as a potential asset worth the investment, not a number, but a former -- forward thinker, solely invested and uplifting all communities with this institution, that has far-reaching implications for the city and sets a standard of acceptance, welcoming, and it defines, very clearly, what we claim to be as a city. that is the person that we are looking for to proudly represent that and to push us forward as we tackle some of the more problems in health disparities. thank you. >> thank you, very much. before we have the next speaker, let me call the last three names that i have. if anybody else would like to also make public comment. the last five names. if anybody else would also like

to, and certainly want to thank the public for the great interest that they have shown and the thoughtfulness of all of your testimonies. sarah larson, adam, you can let us know if i mispronounce this. natalie, and jenna. >> hello, commissioners. my name is zeo. i'm a pediatrician in san francisco. i am also a black resident of san francisco, born and raised here. is in that capacity that i am speaking to you today because i want to make a request that you please find a director who is really ready to take black health outcomes serious in this city. we need somebody who will prioritize resources and operationalize an ambitious racial health equity plan for

this department. here in san francisco, of the ten leading causes of death, black people have the highest rates in nine of those calls is. black children in san francisco have two and a half times the right of hospitalization related to asthma. of the ten maternal deaths that we have had in the city over the last few years, six of those women have been black and that is pretty striking when you consider that the population of san francisco is only three% black. black women have twice the right of preterm births as white women as a pediatrician, i'm tired of having to help my students recover academically after multiple hospital admissions related to asthma. i am tired of having to try and help my students and my patients recover when they are reeling after the death of a loved one who has died from a preventable illness. i am sad for my patients who follow me from clinic to clinic, to clinic as i changed jobs because there are so few black providers providing high quality care in san francisco to black

families. there are so few black providers providing services to other families. many of my family's report when they see other providers in the system, they feel disrespected and judged and humiliated and they would rather not seek health care then have to face that on a regular basis. so i cannot fix these issues alone as a single pediatrician. it requires an institutional approach. that is why i am asking you to please, please ask the future director that you are considering if they have the capacity to really do this work. we need someone who doesn't just talk about equity but someone who has a viable plan and a passion for this work so we can actually see a difference. these statistics that i cited are not new. they have been going on for a very long time. in case you don't know what this communicates to the black residents of san francisco, is that their lives don't matter. how we can we make san francisco the kind of city where black lives do metrically we need a

director will make san francisco the city who where everyone has equal opportunity for health. thank you. >> thank you, very much. next speaker, please. >> president, commissioners and director. my name is jenna and i may public health professional and i'm here speaking as a private citizen from my heart. i wasn't actually going to speak today but due to the bravery of other speakers before me i felt compelled to come up and talk and take advantage of the opportunity. some of the things i have heard about today including h.i.v., incarceration and jail health, oral health, heart health, chronic disease, preterm birth, all of these issues have in common a very deeply rooted and racial health outcome. every single one of them can be linked back to racial and sexual inadequate -- inequities in the system and the environments in which we grow up. i'm here today to implore you to seek a new director will advocate for and put racial

equity at the forefront of every single aspect of the work that they do. it is important to look at the history and how our system has perpetuated inequities if we are going to change the status of the health of our community. it is also important to look internally at the department of public health and the racial inequities that show up into who is hired, was hired, who gets penalized, additionally, when talking about educational requirements, we have to have a critical eye of looking at the educational institutions as well who gets hired and who becomes position his plea racism and racial inequities are persistent at every level of every institution in our country. lastly, i encourage us to look at someone who is willing to be brave and to take risks when leading the health department. as we have heard today in, we have consistent health inequities that have existed for decades. while we have had wonderful leadership at varying levels of the health department, i think

that something needs to change and someone needs to take risks and we need to ask ourselves what is the cost of inaction we thank you. >> thank you. next, please. >> hello president and commissioners and acting director. my name is natalie. i am here on behalf of the asian-pacific islander health parity coalition, as well as the regional pacific islander task force. with me, next to me is kathy park. in our pacific islander way, we do not go alone. we go in groups and we represent in groups. our voice is stronger that way. and that is how we are received by barbara garcia. and how our work is initiated

with her strong support. as a representative of the health parity coalition, we would like to say, some of the qualities we are looking for in a new director of health in the city, to be accessible to community providers. to have genuine interest to learn and hear our concerns, to be thoughtful in advising communities of what is needed to address their health issues or health assets and how to strengthen those in order for the city to support us in our work, understands the importance of communities in all things that is related to health, and she asked, and such a critical

role, in affording a.p.i. communities an opportunity to address key health issues that impact our communities. for other qualities that we would like for them to have, is really listening. it is a skill that is often not thought of as important, but the capacity to listen with your heart and soul. and then also to take directions from communities. to really take direction from communities on how to address health disparities that continue to persist. and to look around the room and always asking, who is missing from the table? we are grateful for barbara garcia because that was always what she has done for our communities. for the regional pacific islander communities, she has been instrumental in bringing the pacific islander communities

and our needs to be as visible as possible. that is in cooperation or collaboration with alameda county and san mateo county. she has been that critical role in bringing the leadership into those other counties so that the health needs and health assets and the assets in general of pacific islanders across these three counties are recognized and also utilized to build and resources and support for the community. kathy? anything else? thank you so much. >> thank you, very much. >> next speaker, please. >> hello. i am with the east policy advisory committee for the san francisco. it is a community of local homeless boards. and i am here to bring awareness

towards -- because the new director, i believe has many of the trades and the different backgrounds that would come through of whoever they are, would definitely be something that is important. i am hoping that you would pick someone that actually would champion, in many ways, the different walks of life for the people who have -- to actually our people who are young and for people who are going through a hard time. and in many ways, some of those people, because of the circumstances of our city being so expensive or the foster care being, in many ways, very broken that we don't have enough foster homes for them to actually stay in san francisco, and having to come back to the city because on

the youth study we have seen, even relationship status, their income, a lot of different things and all those factors, they have, in some way a handicap. it is not a handicap because of who they are but handicap because of what the situation they have gotten into. in san francisco, being out of the city in general increases handicap because it is eight study for all californians. what i was about to say is that even though i would love those traits and everything, i would also love that whoever is a director to tell them that they need to, in some way, go with the community and talk to people i actually, myself have experienced homelessness twice in my life and when i first came to the city, i had no money and i had nothing. i was going through a hard time.

i was also undocumented at that time. i was also going through so much stuff. i ended up being able to find myself. i was able to do so much. i was able to seek asylum. i know i'm talking a lot about those things and they're not even relevant because i don't want them to be keywords but i also want them to be more like -- these are my experiences and i had to go through mental health. i had to go through different things. does that door simple substance abuse stuff as well. in many ways, they can be misled as well. they can be overstated. at the same time, they can be understated. i do want to say that because i believe that conservation, sorry , conservatorship, i can't pronounce it very well is something that i am very wanting

to -- it should be a very delicate thing whenever it comes towards it. i do support it in some ways and i also do think that it should be. >> time. time is up. >> your time is up. thank you, very much. >> thank you. has anybody else -- i believe everyone i have called spoken that wishes to speak. but if anybody else wants to at this point, here is your opportunity. if not, once again, we would like to thank everybody who gave testimony today. it has been very important for us. the commissioners really appreciate it and we know that you have taken your time to be able to tell us what you feel are important qualities for the director of health. we will go on to the commissioners and have questions or comments from the commissioners so we can also incorporate those into a job description.

we will continue to work with d.h.r., and our colleagues in order to create a description that we will bring back on october 4th for further discussion and adoption. commissioners, if anybody would like to speak. >> yes. first of all. i want to thank all the members of the community who spoke to us today. this has been helpful and informative. because of who you are and what you represent, we have the ability to create a job description, as well as hire someone who makes sense to all of us. it may not meet all your criteria and it may not meet mine but is important to acknowledge community members coming in and giving this testimony. i have comments and i also have some characteristics that are important. first of all, all the things i heard today from members are

really important and should be taken seriously in terms of our determination of who the next director of health should be. but i also wanted to make sure that we understood that a health director who operates from a deficit model of health is not a health director. we also need to operate from a place that celebrates the assets of community and helps build community around those assets. we have to also recognize that the health department cannot empower community. the health department can facilitate the community using its power to generate the help that it needs and requires. we want to make sure that someone understands that philosophically. i would also be encouraged -- encourage our health director to be someone who has experience in addressing the intergenerational impacts of health on communities we talk about seniors, youth, kids, that is all important.

but in fact it is recognition of the intergenerational impact of health on our community is critical and essential. it is grandma, it is because in, at his aunt, his brother, at his sister and her sister. his all the folks who might reside in a household who have disparities in terms of health and we don't look at the whole household, we will miss an opportunity to improve the health of a community and improve the health of a household. that is critical and essential to me. but all that has to be informed by trauma informed care. because many of our communities who are, in fact having a deficit model as you have identified, are trauma cases. if we do not recognize the trauma in communities and help that community built on its assets and build on the ability to heal from within and for the department of public health to facilitate that, we are at a

loss. i encourage us to recognize all the issues that have emerged in addition to the ones i just articulated. >> all right. >> thank you. i want to add my thanks to commissioners and to the public who has come and express your concern and taking time out of your day to provide us with your inputs. it really is valuable. we do listen and we are, to all intents and purposes, striving to incorporate the input that you have provided to us. one of the things i wanted to speak to is, you know, beyond the uniqueness of san francisco city and county department of public health, what is happening in the structure and financing of healthcare as a whole over the past decade, and moving forward. even additional pressure is put on the leadership and the

navigation in the planning and the strategy of the department that has it's responsibility to public health of a community like san francisco. but it is not the department and the leadership alone. i thank you for coming out to speak today, what is important is for you to how to -- hold accountable the commission and the leadership of the department of public health all the time. not just in the one or two instances where there may be a particular issue of importance, because we need to hear from you as much as possible. what i have seen in the time that i have been here on the commission, so far, is a good representation of the public but

it is not the complete representation of the public that is necessary in order to weigh in on the decisions that have to be made. i think it is a partnership and many of you have said, it is between the leadership, the director, who will be hired, the department staff and it's leadership, the commission, and the public. so just an appeal to those of you who are here, and those of you who are providers and advocates in the community. don't forget that. thank you. >> thank you. your thoughts so that our staff can also help incorporate some of your thoughts clearly. >> one thing we are so proud of in san francisco like public health as we are bold and entrepreneurial and innovative. many of the great ideas come out of public health that have been adopted by the rest of the

country start here. i can think of medical homes, roma guide was a pioneer when it came to medical homes. we had healthy san francisco and we are the first city in the country that committed to providing health coverage for all of our children and then for all of our citizens and then along came the affordable care act and we were in a position like no other city in the country to be able to enrol our citizens in san francisco into the affordable care act and into the medicaid expansion based on the structure that we have put in place, beyond that, the community response to h.i.v. and aids is something that ended up being the basis for the ryan white care act on the national level. you are seeing over and over again, san francisco being bold and innovative and being entrepreneurial spirit we have seen results. we just had a presentation on our h.i.v. new infection rates where we, if you look at the

data over the last few years, san francisco has made more progress in one year than the rest of the country made in over 40 years in reducing the number of new infections. there are still very important and persistent disparities when it comes to the african-american community, transgender women, people who use i.v. drugs and i have faith that that is something we will continue to take on aggressively. my thought is that we do need a new director that has bold leadership and is innovative and is entrepreneurial. i also wanted to speak to the importance of the community-based organizations as partners. we have heard that from a number of people today. that was a hallmark of director garcia's leadership and that it wasn't just a compliance approach that she would take to the critical work that our community partners were performing for our community. but she took a support approach.

if there were community partners who are struggling -- there was a cascade of support that the department would provide to them in order to assist them in meeting their goals and meeting the work that they were doing for our communities. i would urge again that we seek a director that has visionary old leadership and is entrepreneurial and innovative who will work with the mayor to continue to put forward bold initiatives and that would really value the role of our community-based organizations and partners and the phenomenal work they are doing. >> thank you, very much. >> thank you. as with all types of leadership, it is really important for the next director to be accessible for the entire department of public health, not just for the managers or the immediate people that he or she supervises. it just dawned on me talk when

staff have to come here and make public comment to look at what have we been discussing about building? i think this should be information that automatically is communicated with everyone, who is under the department of public health. the other thing -- although i don't think that is necessarily a sufficient thing that needs to lead d.p.h., because a lot of the work that happens is very administrative. so, you know, i think that it is parts of different brains for physicians to be able to diagnose the problem and also, at the same time, be the administrator that they need to be. so for me, i think of finding a balance is important. there are lots of great it