in relationship to addressing this issue, and i think the community will appreciate it, as well. >> thank you, commissioner. >> great way to welcome director colfax also. >> speaking of director colfax, any comments you want to make in relationship to the presentation you just heard? >> well, i just want to reiterate the appreciation for greg and his team for being on top of this so quickly and i'm hopeful short-term resolution will come forward, but also want to reiterate commissioner guillermo's comment, the most immediate solution isn't the best longer term solution, so i think 90 days is a good way to come up with some immediate solution, but i also don't want us to think after 90 days whatever we've done is set in stone. and i know that greg doesn't feel that way, and dr. irlick doesn't feel that way either, but just to reiterate that, thank you.

>> i think we can move on. >> thank you. >> secretary: item nine is the homelessness mortality in san francisco: opportunities for prevention. >> hello, everyone. thank you very much. i'm barry zevin, medical director of street medicine at shelter health, and it is an honor to stand before you again and to present this information. so we're going to talk about our homeless deaths today, and just to preface, what this report tells us is about homeless deaths that we've been able to examine after looking very

closely at medical examiner reports. it can tell us who the people are, what kind of demographics are represented in homeless deaths, what kind of services people received in our systems before they died. it can tell us about causes of death, locations of death among people experiencing homelessness in san francisco. what the work we've done doesn't tell us is causes of death that are directly related to homelessness. it also doesn't tell us about death rates, comparing people who are experiencing homelessness with other poor people or with other citizens in san francisco. and it doesn't tell us about deaths of cases that were not a medical examiner report. we've got opportunities from this information that we haven't had in the past.

certainly, it helps us with our clinical practice and the ongoing initiatives in the department of public health related to homelessness. it helps generate systems-level ideas about prevention. for our team, i'm getting information from the medical examiner at least once a week and we're able to then respond, for example, if we know of a location where somebody died, we can outreach to that location. other people who may have been close to that person may be quite affected by this death, we want to be able to be there to support them, and it may also be an opportunity for that person with that loss or that trauma, who this may be the time where they are ready to make a change in their life. so being able to respond. it helps us monitor trends over time, and you'll see this report as a three-year report. and then we're able to use this, along with all of the other

information we have about homelessness and homeless health in trying to determine policies within d.p.h. and across departments on how do we prioritize our scarce resources. so key findings. homeless deaths were steady during the time period 2016 to 2018, and likely unchanged from the 1990s. the last time we used any methodology like this was in the mid to late 1990s, where we were looking at medical examiner reports, and the numbers we have over the last three years are similar to the numbers we had then. i'll talk more about what those differences might be. i'm not sure whether that's a good thing or a bad thing, but i suppose that it is something that tells us we still have a lot of opportunities for

prevention. other key findings, high prevalence of alcohol use and an overlap between our patients with severe alcohol use disorder who are high users of emergency and urgent systems in department of public health, along with this being a common finding in the people who died, should, i think, direct us to this as a continuing problem. high prevalence of methamphetamine use and the overlap with criminal justice involved population, and again, our high users of medical and psychiatric services, methamphetamine use, clearly, one of the main factors that's affecting the health of people experiencing homelessness and having a profound effect in multiple ways in the health of the city. high prevalence of opioid overdose in this population.

but likely less than would be expected considering the national trends, which have seen overdose especially among homeless population rising at very high rates. our rates have stayed steady over a period of time and don't show that same kind of exponential rise, and i think that speaks to the very intensive efforts we've made in overdose prevention. high prevalence of violence and other trauma, and as a provider, that's something i hear from patients every day, exposure to violence, witnessing violence, being assaulted, seeing the number of violence and trauma deaths brings that home is very important. last key finding, role of shelter. what we know is that a similar methodology in new york city, other cities.

no new york city, there's about twice as many homeless deaths using this methodology as san francisco. new york city has ten times the population, certainly ten times the population of people experiencing homelessness, and there are likely many reasons why they are not showing proportionately dramatic number of deaths, but one of them may be related to them being required to shelter individuals experiencing homelessness, and we don't have currently the capacity to shelter everyone who would need to be sheltered. some responses, continue and enhance our d.p.h. response to the opioid overdose epidemic. the methamphetamine task force you heard about earlier, and their clinical and population health responses to methamphetamine use, we've got

to continue and advance our focus on that. we need to do an evaluation and a quality improvement on our very robust system of care for people with severe alcohol use disorder, but a system that may not be put together in such a way to reach the highest risk individuals. incorporate homelessness as a risk related to violence and injury. again, i've already met with the folks in d.p.h. who are working on decreasing pedestrian deaths, because a goodly number of the pedestrian deaths involve people experiencing homelessness, and supporting any work of how can we shelter unsheltered folks. okay, how did we do this and how does it differ from previous work? we are looking at a wide range

of reports from the medical examiner's office. medical examiner does not have a category for homeless. they have a category of people who they consider as no fixed address. that's been a stand-in for homelessness, but by asking them to give us information on a broader range of the deaths that they see, we've been able to find quite a few of the people who had some sort of address, actually were people experiencing homelessness currently when they died. so that is really an explanation why you may have heard numbers in the past and the numbers now are higher than those. it's not a matter of, oh, my god, the numbers have increased, this is a matter of we've looked much more carefully to identify who's actually homeless in terms of who died in san francisco and was a medical examiner case.

we've been able to also look at other data we have in the department of public health, data from our ccms database and from all of our clinical databases to have a much broader understanding of what is this person's health care history, as well as what is their history related to homelessness. there's no indication that we've had increases in the past few years related to deaths of people experiencing homelessness. how does it work? we get reports from the medical examiner, as i said, once a week or more often. medical examiner has quite a strict definition of what a medical examiner death is. they are what you would be expecting, accidents and injuries, possible homicides and suicides, people who die alone, number of other kinds of deaths, and deaths of people who there

is no one to pay for funeral expenses, what they call indigent cases. and not surprisingly, many of those are people experiencing homelessness, so we're able to look at all of those kinds. and then we're able to look in each of those cases at information from our coordinated care management system and information from the clinical records. 2016, 128 deaths, 2017, 128 deaths. i was sure that was a misprint, but turns out two years in a row that was exactly the same number. so far 2018, 134. i say so far, because there are some that trickle in, in the last -- in the next couple of months after the end of the year, particularly those that were indigent deaths, where they are really trying to track down family members and others.

the medical examiner reports on manner of death, and they describe accidents, and about 50% of our deaths were accidents. that includes unintentional overdoses, falls, drowning, somebody hit by a car, as well as other kinds of accidents. 11% were homicides. i found that quite higher than i would have expected, and yet i talk to patients every day about their exposure to violence. 30% were natural. in other words, the progression of underlying disease. that doesn't mean that only 30% of all homeless deaths were natural caused deaths, remembering that somebody who died at the end of a particular illness may not become a medical examiner case if they died in the hospital or died in a nursing facility or a hospice. 4% were suicides.

in discussions with medical examiner, they found that surprising, because their general statistics show suicide as a higher cause of death in san francisco than homicide. only 2% were undetermined, and the medical examiner does a very aggressive job at being able to ascribe a manner of death. looking at contributing factors to these deaths, and, again, this included whether it was listed as the cause of death or a contributing condition or something that was found in the toxicology report. 52% had drugs as a contributing factor. about a third had alcohol as a contributing factor. again, about a third was natural history of chronic disease, and over a quarter violence and traumatic injury. again, those can overlap. somebody can be -- have been drinking heavily and stumbled and fallen and died of a brain

injury from falling on their head. we would consider that alcohol related and a traumatic injury. i want to really point out the toxicology. in most cases, the medical examiner does a toxicology report. not every single case, but most of the cases and in the ones that we had access to, almost 50% showed methamphetamine present in that person's system at the time they died. another 45% showed opioids in that person's system. many of those people didn't necessarily die of an overdose. they might have died of any of the causes we talked about, but using opioids around the time of their death. still a lot of people died with recent cocaine use. about a third recent alcohol use, and still a quarter some sort of sedative. so alcohol and drug use, i

think, can be a very major focus of our prevention efforts. i'll stop and say i'm a specialist in addiction medicine, addiction medicine specialist, like to a carpenter, everything looks like a nail to be hammered down, but those are impressive to me. some demographics, 82% of our cases were male, 17% were female, less than 1% were described as transgender. again, the medical examiner doesn't even have a category of transgender, and for many of these cases, the -- that information might be found in a clinical record if we dig deeply enough. about half were white, about a quarter were african-american. that's actually slightly lower than the overall number of african-americans in our county

homelessness populations. for example, the number of african-american people experiencing homelessness is slightly higher than the 26%. 12% latino, and then small numbers in other categories. age was a spread, although in some ways older and probably compared to our work in the late '90s, this also reflects an aging of the homeless population. again, over half over the age of 50. housing status before someone died, we're able to look at that as best we can using our ccms, which pulls in information from the shelter system, from the department of housing and homelessness, and many people had been homeless quite a long

time, of the ones who we knew before. only a small number could we say, oh, they had been homeless only a short period of time. in terms of shelter or navigation center use, most people had no stay, not even a single night in a shelter or navigation center in the past 12 months, and even if we go back to past years, many of those people had a very scant shelter and navigation center use, and we had very few deaths actually occurring in a shelter or navigation center. so that may suggest that using shelter or navigation centers could be protective, or there's some association there in terms of risk, people who may use the shelter system versus people who are unsheltered. in terms of service utilization,

although we talk a lot about high users of multiple systems, most of the people here had very little use in an emergency and urgent systems and even less in our primary care, mental health, and substance use disorder treatment systems. most of these people touched our system in some way over the years, but were not well engaged with our system, and i think that's an opportunity for us. just a little bit of the geography of this, i think you can see that these deaths occurred all over the city. if people have a long memory and have seen these maps before, there used to be these giant dots in the locations of the various hospitals, especially san francisco general. we actually did a lot of work to get the location of the incident if somebody survived long enough to get to a hospital and then expired at the hospital, we actually were able to get where

did the actual incident occur that led them to be in the hospital. so you'll see this spread around town, the particular concentration within a mile of where we sit, and tenderloin, south of market, mission district. i want to thank the people who were involved in this study. this was a collaboration between the department of public health whole person care office, ucsf evaluation team that's evaluating our whole person care effort, and our street medicine and shelter health team. so thank you very much, caroline, with the evaluation team did a lot of the heavy lifting. i want to thank her for this, and caroline and i are available to answer any questions you have. >> secretary: did not receive any public comment requests for this item. oh, looks like there is one. dr. zevin, could you stand aside

while we have the public comment? >> i work for the san francisco community clinic consortium and as you know we are the federal grantee for the health care for the homeless program. one thing that is not directly related to the homeless deaths, but i think this report raises the issue again is the seaming lack of coordination between our housing opportunities, which i know are very limited, and people's health status. i don't -- it does not appear that the central access i believe it's called takes into account a lot of health issues when declaring who's a poverty -- who's a priority for that system, and i know as our clinics are working closely with the department of public health and whole person care, et cetera, basically people are diagnosed, they get frustrated,

no matter how they evaluate the person's care, it doesn't seem to affect their ability to get into some kind of housing situation, whether immediate or long term. so i just wanted to raise that issue about the coordination between the department of housing homelessness and the d.p.h. and everybody who's touching them, so that we could have a better understanding of how we could help patients become housed and hopefully avoid some of the preventable deaths here. thank you. >> thank you. commissioners? commissioner guillermo. >> commissioner guillermo: just want to congratulate you on a very comprehensive and very, very interesting report. i don't have a memory long enough to know and to compare with previous reports, but it seems to me that there are some

very interesting gems in here that will lend themselves to both policy and programmatic development within the department. and sharing that data, as was indicated by the public comment, with other departments would really sort of begin to lend to a much more hopefully i guess more strategic use of the data and hopefully also strategic outcomes, given that data. so my question then is, so what about the report? is there any -- i know it's relatively early and you have to probably dig a little bit deeper, but what recommendations sort of do you have coming out of the data that might help inform the department and s.f. commissioners for the future?

>> sure, i think there are a number of, again, this -- i think it's very fair to ask why do this if we're not going to do any response to it, and it's why we're really focused in this on what can we learn in terms of prevention for future deaths. i think the idea that we've been brought to a methamphetamine task force perhaps because of the visibility of people experiencing homelessness who are using methamphetamine and having behavioral health symptoms in the streets, but being able to say we're seeing this as a contributing factor in many of our deaths really, i think, makes the need for response much deeper. and so i think this is the year for methamphetamine response, and there is, i'm very

interested in that work. again, how do we improve bringing services for the people with the most severe alcohol use disorder and making sure that they are actually being held from the moment they go to the door of our sobering center to the possibility of detox, to the possibility of treatment program, and to the possibility of rehab, to the possibility of housing, and any time that there's a relapse in that, that they are actually supported and not going to the back of the line and the bottom, that's something we have work to do, and we've already started those discussions. and i think really holding on to our work with opioid use disorder. i'm already having discussions with the directors of our vision zero program saying, hey, how does this affect pedestrians and what we're trying to do for pedestrian safety. so i think that it's just -- it's already, i think, having an

effect raising a level of awareness where people are talking to one another who weren't necessarily talking to one another before. so that's pretty cool. >> i have one quick question, and it has to do with, is this report going to both the local homeless coordinating board and to homelessness and supportive housing, will they see this and will there be some sort of presentation to either of those two bodies? >> we presented this at the whole person care stakeholders meeting. many of the top staff of the department of homelessness and supportive housing came to that presentation. we had a lively discussion at that -- in that particular venue, and i think it is continuing to -- it's definitely on their radar screen, it's at

leadership level to make sure that response continues. for example, the public comment, how do we use this in learning better, how do we prioritize the highest risk people for housing? that's extremely important for us in the department of public health, unless we continue to show the necessity of that, it's not automatic, but that's important in other areas. but i think that the awareness is certainly there now, and what we've heard is a high level of interest in, okay, how do we work together to respond. >> president chow: well, i happen to sit on a local homeless coordinating board, one of my many boards, so i'll bring this report to the local homeless coordinating board and we can deal with it at our level in some way, so thank you very much for your report. commissioner? >> yes, i noticed that when you were talking about the gender,

the demographics when discussing gender use, there was no gender identity marker for transgender and given the transgender individuals' experienced disparities in terms of access outcomes, housing instabilities, i realize this is at a federal or state level, but is there a way we can address that and collect that data? >> i think we'll do better. i think we'll do better as we implement the wide-ranging plan in d.p.h. for collecting data. i think that it is also the least likely place to be able to collect that data is where people who we saw as cases here, where they hit our system. emergency room, psychiatric

emergency. that, i think, the same effort that we need to work on, how do we get those folks who are at highest risk actually in front of our -- all of our systems that can bring those people more toward health? those are the same systems that are going to be more aggressively able to implement the guidelines. so i hope that we're going to be able to see that as those guidelines go into place, that will see, i won't have to see -- really dig into somebody's chart before i can understand that actually this was the death of a trans person. so i'm putting my efforts into that. >> thank you. other comments from

commissioners? dr. colfax, do you want to make a comment? >> just want to express appreciation for the report and also acknowledge that you're not only looking at this high-level data, but this morning you were at the health fair treating people, so i think that's remarkable and speaks to the amazing staff that are at d.p.h. and also just to reiterate, the two pieces, one is that homeless -- people experiencing homelessness generally age about 20 years faster than people that are not homeless, so the kr chronological age is not respective, and again, i think we really see the disparities, particularly in the african-american, black population, while that number is not higher than proportionally with the homeless overall, it's much higher than it should be in terms of an equity perspective, in terms of the portion of african-americans in the city, so bringing that equity lens to

the presentation, as well. but thank you. >> thank you very much. i will say next steps, in addition to what i already spoke about, is looking at in another methodology deaths that will -- see how that will broaden our perspective on what that will do for prevention and we do need to look, and that we need to look at the deaths of formerly homeless people who are now housed in supportive housing or other s.r.o. housing, because we know from the medical examiner there are a large number of deaths in those settings and there may need to be responses that go beyond just people on the street. so thank you very much. >> president chow: thank you. >> secretary: commissioners -- [ applause ] item ten is other business, and

you have the calendar before you, if you have any questions. >> president chow: commissioners? >> secretary: hearing -- oh, yes, thanks. item 11 is report back from the february 12 laguna honda j.c.c. meeting, and i believe commissioner sanchez will make that. >> commissioner sanchez: yes, the j.c.c. laguna honda met on february 12. it was a closed session pertaining to review of the quality and credential reports. no actions taken, and that's -- that closes our meeting for laguna honda. >> secretary: any questions on that? all right, then we can move on to item 12, which is a consideration of a closed session. >> president chow: can we have a motion to go

>> yeah. >> president chow: all in favor, yeah. >> secretary: all right, then let's wait for them to let us know. great, then please consider -- >> president chow: motion to not disclose the subject matter of the closed session. >> so moved. >> president chow: all those in favor say aye. we will not disclose the subject matter in closed session. >> secretary: now you have consideration for adjournment. >> move to adjourn. >> president chow: is there a second? >> second. >> president chow: all those in favor signify by saying aye.

- working for the city and county of san francisco will immerse you in a vibrant and dynamic city that's on the forefront of economic growth, the arts, and social change. our city has always been on the edge of progress and innovation. after all, we're at the meeting of land and sea. - our city is famous for its iconic scenery, historic designs, and world- class style. it's the birthplace of blue jeans, and where "the rock" holds court over the largest natural harbor on the west coast. - the city's information technology professionals work on revolutionary projects, like providing free wifi to residents and visitors,

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francisco. by supporting local services within our neighborhoods, we help san francisco remain unique, successful, and vibrant. so where will you shop and dine in the 49? >> my name is ray behr. i am the owner of chief plus. it's a destination specialty foods store, and it's also a corner grocery store, as well. we call it cheese plus because there's a lot of additions in addition to cheese here. from fresh flowers, to wine, past a, chocolate, our dining area and espresso bar. you can have a casual meeting if you want to. it's a real community gathering place. what makes little polk unique, i think, first of all, it's a great pedestrian street. there's people out and about all day, meeting this neighbor and coming out and supporting the

businesses. the businesses here are almost all exclusively independent owned small businesses. it harkens back to supporting local. polk street doesn't look like anywhere u.s.a. it has its own businesses and personality. we have clothing stores to gallerys, to personal service stores, where you can get your hsus repaired, luggage repaired. there's a music studio across the street. it's raily a diverse and unique offering on this really great street. i think san franciscans should shop local as much as they can because they can discover things that they may not be familiar with. again, the marketplace is changing, and, you know, you look at a screen, and you click a mouse, and you order something, and it shows up, but to have a tangible experience, to be able to come in to taste

things, to see things, to smell things, all those things, it's very important that you do so. >> i am so excited to be here to stand in this waiting room of this beautiful new urgent care center that will serve thousands of patients here at s.f. general. as our population continues to grow, it is more important now, more than ever to make sure our public health facilities are now up-to-date in the latest in technology and programming, but also, resilient and strong, and in the event of a major earthquake, or any other disaster that may come our way. that is why i'm grateful to the voters who passed the 2016 public health and safety bond that funded not only the expansion of the urgent care facility act which served more

than 20,000 people in 2018, but also the funding for the seismically -- for seismically retrofitting this entire building that we are standing in today. one of the key things we are doing with retrofitting this entire building is bringing everyone back under one roof. by recentralizing services into this building, we can improve services and coordination by our staff. this is key to better deliver healthcare to the people of san francisco, we have to be -- we have to do more coordination and be more efficient in that process. it is a major reason why i created the position of director of mental health reform so that we have one person whose job it is to bring everyone together to help coordinate all of the efforts around mental health in the city.

when we coordinate, we centralize services, we get better outcomes for the people that we are here to serve. san francisco general has long been a hub for our safety's disaster response. it has been a real leader, and i have spent days, particularly in this location in the emergency room for those who unfortunately have fell victim in some way to -- somewhere in our city. whether it is during the 1906 earthquake when the hospital serve not only as a place where people could seek treatment for injuries, but also as a place for refuge and shelter or a 1983 when the hospital led the nation by those impacted by the aids epidemic or throughout the years as san francisco general, and the staff, and the incredible people who work here have always been at the forefront of groundbreaking research and cutting edge innovation and in

the medical industry. the hospital's values reflect those of san francisco, inclusion, diversity, and most important, compassion. i know many of you here today are on the front lines of providing that compassionate care for residents, and i want to thank many of the people who work here at san francisco general, every single day, thank you so much for your hard work, and for your patience, and for your compassion in serving so many residents of san francisco. it really means a lot. especially to those who are experiencing homelessness or suffering from mental health or substance use disorder, i have seen firsthand the patient's that you provide in caring for those individuals, and it means a lot. your city supports you in these efforts, and the important work you do every single day, and i am committed to working with the department of public health, our

health commissioners, and all of you to tackle the public health issues that we face in our city, and to make it easier for you to do more. thank you so much to everyone that is here today for this new facility. i can't stop looking at the florist, because i don't know about you, but the walls are white, not yellow. the ceiling even, and the furniture, it is blowing me away , and i'm not always -- are not only happy for the patients that you are serving, i am excited for the people who are working in the facility every day. you deserve the kind of conditions that help you to better do your job, especially under the most challenging of circumstances. at this time, i would like to introduce mr roland pickens. >> thank you. [applause]

>> thank you very much, mayor breed for your ongoing support in making this project, and many others happen here. to the school of medicine, the c.e.o., acting director waggoner, thank you for your support in making this happen. he says change is the only constant in life. this statement highlights the need for all of us to always plan for and be ready for change in every aspect of our lives. i say that because having been a long tenured person here, i have seen the changes that urgent care over the years. when i first started 18 years ago, urgent care was on the sixth floor of the hospital, then it moved to the fourth floor of the hospital, that it moved across the street to building 80, and out is going back home to this one-stop coordinated care spot.

so to the staff who have been part of the change over the last 18 years, congratulations, into the patients who made that journey, they are to be commended. this urgent care center is a vital hub for our san francisco health network. if you are a patient at maxine hall in the western addition, or southeast health centre, when you can't get into your appointment, this is a place you can come for service. so to our medical director, we thank you for your years of service, and look forward to the great work that will go on in this new facility. thank you all. [applause] >> my boss just reminded me, i am going to introduce dr ron, our medical director. >> thank you, roland. hello, everyone, may agree -- mayor breed, distinguished guests, i am glad to welcome all

of you to the new adult urgent care center. we are very excited that starting next week, we can continue to provide quality healthcare now in this state-of-the-art facility where our clinic staff deserve to work , and where the citizens of san francisco deserve to receive the urgent medical care they need. we are grateful to the voters of san francisco who approved the bond measure that made this possible, and in doing so, recognize the value that our public health facilities provide our community. let me take a couple of minutes to share with you more about our clinic, who we are, and what we do, and what it means to move into this new space. the adult arts and care center started in january of 1999 as was mentioned upstairs on the sixth floor. wiring for rooms on the children's health center. last month marked our 20 year anniversary, and throughout these 20 years, the clinic has played a vital role in providing

care for patients for urgent, nonemergency medical needs. we offload our emergency department by caring for patients that don't require emergency level services. we provide urgent medical care for primary care services, and we care for other san franciscans who don't have primary care, don't have insurance, and don't have access to urgent care anywhere else. and for these patients especially, our clinic is a portal of entry into the san francisco health network, where they have access to a range of services to get them healthy, and keep them healthy. for thousands of patients over the last 20 years, the first step to getting primary care was a visit to the adult urgent care center where we met their immediate medical needs and help them get health coverage and establish care and a primary care medical home. it is our of ensuring that our patients get the right care in the right place at the right time. that is crucial to the success of any healthcare system, and

that is why we are also taking this opportunity to educate patients about urgent care, and how it differs from emergency care and primary care. that knowledge gives patients the power to navigate our healthcare system to their advantage so that when they have an urgent medical need, they know the right place to go for care. after the ribbon-cutting, i invite you to stay a bit and take a look around. our beautiful and newly renovated space is larger, has more rooms, it is more centrally located on the hospital campus. this will make the clinic more accessible, efficient, and patient-friendly, and result in a better care experience. finally, i am thankful that our new facility will enhance the hard work of our clinic staff, to every day provide quality urgent health care with a respectful caring attitude, and a compassionate heart. for the last 12 years, i've had the privilege of working side-by-side with these extraordinary colleagues, their

perseverance and dedication to our patients continues to inspire me every day to do my best as a physician and a medical director. in this grand opening celebration, it is a perfect opportunity to express our appreciation for our staff. unfortunately, most of them weren't able to make it because many of them are working right now across the campus. so in closing, i need your help. please join me in showing our appreciation for our staff and the outstanding care they provide our patients every day. let's all give them a big round of applause, so loud, so loud that they will be able to hear it all the way across the campus. [applause] >> all right. i think it is time to cut a ribbon. >> i need some company over here

are we ready? their ego. five, four, three, two, one. [applause] [♪] - >> tenderloin is unique neighborhood where geographically place in downtown san francisco and on every street corner have liquor store in the corner it stores pretty much every single block has a liquor store but there are impoverishes grocery stores i'm

the co-coordinated of the healthy corner store collaboration close to 35 hundred residents 4 thousand are children the medium is about $23,000 a year so a low income neighborhood many new immigrants and many people on fixed incomes residents have it travel outside of their neighborhood to assess fruits and vegetables it can be come senator for seniors and hard to travel get on a bus to get an apple or a pear or like tomatoes to fit into their meals my my name is ryan the co-coordinate for the tenderloin

healthy store he coalition we work in the neighborhood trying to support small businesses and improving access to healthy produce in the tenderloin that is one of the most neighborhoods that didn't have access to a full service grocery store and we california together out of the meeting held in 2012 through the major development center the survey with the corners stores many stores do have access and some are bad quality and an overwhelming support from community members wanting to utilities the service spas we decided to work with the small businesses as their role within the community and bringing more fresh produce produce cerebrothe neighborhood their compassionate about creating a healthy environment when we get into the

work they rise up to leadership. >> the different stores and assessment and trying to get them to understand the value of having healthy foods at a reasonable price you can offer people fruits and vegetables and healthy produce they can't afford it not going to be able to allow it so that's why i want to get involved and we just make sure that there are alternatives to people can come into a store and not just see cookies and candies and potting chips and that kind of thing hi, i'm cindy the director of the a preif you believe program it is so important about healthy retail in the low income community is how it brings that health and hope to the

communities i worked in the tenderloin for 20 years the difference you walk out the door and there is a bright new list of fresh fruits and vegetables some place you know is safe and welcoming it makes. >> huge difference to the whole environment of the community what so important about retail environments in those neighborhoods it that sense of dignity and community safe way. >> this is why it is important for the neighborhood we have families that needs healthy have a lot of families that live up here most of them fruits and vegetables so that's good as far been doing good. >> now that i had this this is

really great for me, i, go and get fresh fruits and vegetables it is healthy being a diabetic you're not supposed to get carbons but getting extra food a all carbons not eating a lot of vegetables was bringing up my whether or not pressure once i got on the program everybody o everything i lost weight and my blood pressure came down helped in so many different ways the most important piece to me when we start seeing the business owners engagement and their participation in the

program but how proud to speak that is the most moving piece of this program yes economic and social benefits and so forth but the personal pride business owners talk about in the program is interesting and regarding starting to understand how they're part of the larger fabric of the community and this is just not the corner store they have influence over their community. >> it is an owner of this in the department of interior i see the great impact usually that is like people having especially with a small family think liquor store sells alcohol traditional alcohol but when they see this their vision is changed it is a

small grocery store for them so they more options not just beer and wine but healthy options good for the business and good for the community i wish to have more

. >> i love that i was in four plus years a a rent control tenant, and it might be normal because the tenant will -- for the longest, i was applying for b.m.r. rental, but i would be in the lottery and never be like 307 or 310. i pretty much had kind of given up on that, and had to leave san francisco. i found out about the san francisco mayor's office of housing about two or three years ago, and i originally did home counseling with someone, but then, my certificate expired, and one of my friends jamie, she was actually interested in purchasing a unit. i told her about the housing program, the mayor's office,

and i told her hey, you've got to do the six hour counseling and the 12 hour training. she said no, i want you to go with me. and then, the very next day that i went to the session, i notice this unit at 616 harrison became available, b.m.i. i was like wow, this could potentially work. housing purchases through the b.m.r. program with the sf mayor's office of housing, they are all lotteries, and for this one, i did win the lottery. there were three people that applied, and they pulled my number first. i won, despite the luck i'd had with the program in the last couple years. things are finally breaking my way. when i first saw the unit, even though i knew it was less than ideal conditions, and it was very junky, i could see what this place could be. it's slowly beginning to feel like home. i can definitely -- you know,

once i got it painted and slowly getting my custom furniture to fit this unit because it's a specialized unit, and all the units are microinterms of being very small. this unit in terms of adaptive, in terms of having a murphy bed, using the walls and ceiling, getting as much space as i can. it's slowly becoming home for me. it is great that san francisco has this program to address, let's say, the housing crisis that exists here in the bay area. it will slowly become home, and i am appreciative that it is a bright spot in an otherwise

>> this is a reminder to silence all electronic devices, please. >> do you want to hit the gavel? >> our commission regular meeting, wednesday, figure 27th, and the five time is 5:00 p.m. item one, roll call. [roll call]