>> it's tuesday, august 3rd, 2021. [roll call] >> i didn't quite hear you. i am calling roll call. [indiscernible] [roll call]. >> i think i got everybody. can you just verbally give us

that you are here? okay. i see you, but i need to hear you. >> thank you. just for the record, we need to have everyone on record. thank you very much. >> i would note that some commissioners are feeling under weather and will not be on camera with us today, as much as we would like to see them in person. we wish them good health and that they feel better soon. the second item his approval of the minutes of the health commission meeting of july 20th , 2021. commissioners, you have before you before -- before you those minutes. there are no amendments. do we have a motion to approve. >> if i may, commissioner, i did send out or only heard recently three minor corrections. may i read them? >> yes. >> commissioner green and child, thank you for helping me do my job better by pointing out these

mistakes. on page six, i'm sorry, on page six, there is a commissioner comment without a name. it is commissioner guillermo. it should have that name there in the bottom of the page. directly underneath it, commissioner green, it is a second line. the word probably should be probable. the final correction -- final correction is on page seven. it will say commissioner kristian supported the desire, not supports. my call. -- my fold. >> with those corrections, do we have a motion to approve?

>> so moved. >> second. >> is there any public comment on this item? >> there is nobody on the line at the moment. so there is no -- here we go. i'm sorry. there is one caller. if you like to make comment on the minutes, item two, press star three to raise your hands we can acknowledge you. may i do a roll call vote? >> yes, please. [roll call] >> the item passes. thank you. >> thank you. the next item is the director's report with director grant kolfax.

mr. director? >> good afternoon, commissioners. i'm the director of health with the director's report which includes a member of covid related items that i will cover with the update that i will give after this item, with regard to noncovid related issues just to highlight some things. i'm very pleased to announce that the public health department budget was approved by the board of supervisors on july 27th. as you know, lots of work went into the budget. it was a two billion-dollar budget for fiscal year 2021-2022 and 2.76 billion for 22-23. i also wanted to call to your attention that on july 22nd,

the d.p.a., in partnership with alameda, contra costa, santa clara, announced # deliverable justice. a regional public awareness campaign that puts justice for black families front and centre in the fight for racial justice in the bay area. it highlights racism is a crisis that results in the death of an infant and a disproportionate rate compared to other racial groups. for more information about the campaign, i encourage you to visit the website. i also just want to highlight that on july 22nd, the mayor and d.p.h. announced our continued expansion of behavioral treatment beds for behavioral health. in 2021 alone, we are planning to see 140 new beds opened to address the very important needs

of our community in regards to behavioral health. and then there has been a lot of d.p.h. in the news recently. you can find that at the bottom of the director's report. that concludes my summary. i'm happy to take any questions and proceed on with the covid update. >> thank you. commissioners, before we go to commissioners questions or comments, do you have any public comment? >> on the public comment line, let us know if you like to be acknowledged by raising your hand and pressing star three. >> all right. commissioners, any questions or comments on the director's report before we go into the covid-19 update? some of that will also be covered in the equity proposal. >> i see commissioner chow's

hand. >> commissioner child? >> thank you, director. my question was in regards to the public health budget and it was great to see that we were having two additional positions for the case management and case advocacy in 21-22, but then it appears -- does that mean that it's being dropped? there is no budget listed on through their -- there is no budget listed under their. it seems to be it would be an important function. >> commissioner -- can you hear me? >> let me double check on that with our budget people on that. it's possible that it may have been an oversight. let me find out about that and we'll get back to you on those positions. >> thank you. i'm glad that they are there.

>> any other questions or comments for director kolfax? we can go into the covid-19 update. >> thank you. next slide. so commissioners, providing an update on covid-19, i will run through the slides and invest any questions or concerns that i might not have raised during the update. next slide, please just emphasize that the san francisco covid cases continue to rapidly increase. you can see it on the graph here the history of our cases during the pandemic the last 18 months. a very high climbing rate now. almost one per 100,000 in june until now and almost 22 per 100,000. dramatic increase.

we're almost halfway to the peak that we were entering the winter surge. it is also fuelled by the delta variant. this increase is very, very steep. therefore, covid is spreading faster for people who are not vaccinated for covid compared to where we were before. this is a particularly challenging time for people who are not vaccinated. vaccines remain the way out of it. we will get some degree of breakthrough infections, that will be expected, but we need to continue to focus on the importance of that as our ticket out of this serious situation. next slide. in terms of hospitalizations, hospitalizations in san francisco are rising. you can see the steep increase. and as cases rise, it takes two weeks for the rise in cases to

go into hospitalizations. we are closing in on 100 people in the hospital due to covid-19. it is consistent with the numbers that we fell -- felt during the summer surge. they expect us to go higher. given our models, it's possible we will go above the winter surge in terms of hospitalization numbers. the vast majority of these people will be people who were not vaccinated for covid-19. next slide. this is the model that we have been working with since the beginning of the pandemic. this is looking at the scenario, assuming delta is about 80% of our cases as of july first, which is well within the norm of possibility. the vaccine current uptake,

delta is 50% more transmissible than the delta variant. the contact rate, the amount of activity that people are engaging in, is essentially equal to what we are seeing today. and the hospitalization rate is 85% higher than without. this is an important point on the increasing data that supports the fact that delta is not only transmissible, but more berlant in terms of its ability to cause more severe disease resulting in hospitalization and in talking with infectious disease experts, this is not definitive yet, but it's looking more plausible as time goes on from the number of reports in the -- infectious disease journals. it also sees no additional mitigation in terms of any shutdowns in the city or a decrease in our community overall. under these scenarios you can see on the green line that cases

work very deeply, just as i told you on the lot. and then actually, it falls pretty quickly that we would see a peek in case rates of over 500 cases reported a day on august 20th, and then you will see the hospital census piece on september 3rd with 326 people with covid-19 in the hospital. the vast majority of people not fully vaccinated. it really -- there are a couple of things. i try to hold two thoughts. one is that we are in a much better place than we were before the vaccines because san francisco is so relatively well vaccinated. these hospital numbers are not more concerning than they are. the hospital peaks are far, far less than what we were predicting and without further mitigation efforts that we saw in the fall and winter. it is inspiring that we've done such a good job and that many

hundreds of lives will be saved because of our vaccine efforts. the sad part of this is 95% of hospitalizations are preventable with vaccines in this scenario. the vast majority of these people who will be hospitalized will be people who have not been fully vaccinated. were continue to push vaccines out and supporting vaccine efforts across the city, in addition with our partners. the vaccines remain the ticket out. i will say, however, because of the widespread transmission of the delta virus and because there is consensus that people who are fully vaccinated can still transmit the virus, that the health officers across the bay area region issued an indoor mask mandate following up on an indoor masking recommendation that was reduced on july 16th, with the hopes that we will be able to mitigate the spread of

delta through indoor masking. this is being driven -- the spread is being driven by unvaccinated people. vaccinated people can also spread delta. next slide. >> with this model, we folk -- forecast 257 more deaths due to covid-19 due to the delta variant. the assumption here is concerning to us. 95% of the deaths are present -- preventable with vaccination. covid-19 would not spread if we had even more people fully vaccinated against covid-19. so compared to other parts of the country and other parts of

the world, we are in considerably better shape. i want to make sure that we take the big picture into account here. but obviously, obviously with the big picture, we need to be mindful of the death that potentially lays before us. and again, these are mostly people who are not vaccinated. next slide. in terms of hospitalizations, there has been a lot of media attention on the so-called breakthrough cases. people who are already vaccinated, fully vaccinated who do require covid-19. it is an important piece of data to follow. we are following that. the bottom line is, look at the difference between hospitalizations and people who are fully vaccinated versus not fully vaccinated. this is a remarkable graph. these vaccines are remarkable medicine. there are very few things in

public health that i can show you, even with the process -- the presence of a pathogen and work covid-19 is right now, we would have a market difference in hospitalizations. versus not being fully hospitalized. and to date, to my knowledge, we have had nobody fully vaccinated with covid-19 who had died from covid-19 causes. >> this is new vaccine administration and first doses. 550 a day is the rolling average. there was an uptick recently and we're hoping that the slight uptick continues. we are at about 450 a day couple of weeks ago. hopefully more people are getting vaccinated. this afternoon i was pleased to join the mayor in announcing a

programme which is basically a programme by which people contact the health department and if they have somewhere between five and 15 people in one location, we will send a team to their home and whatever locale to provide the shot. this is a programme that we are going to be running tuesday through saturday. it launched and right in -- right after that, we got a number of entities wishing to sign up. we're looking forward to making it even more convenient for people to get fully vaccinated. we know how important it is. next slide. in terms of vaccine administration, 77% are eligible residents. they are 12 years and up and

they have received a full dose of vaccine that translates to 70% of the population overall. remarkable numbers compared to other jurisdictions in the united states. the vast majority of jurisdictions in the united states still leave room for delta to spread. particularly among the adults who are eligible and not fully vaccinated. you can see, jerk -- doing some basic arithmetic, we have thousands of people eligible for vaccines in san francisco who have not received the full dosages. next slide. as we have seen through much of the pandemic, new covid cases are proportionately concentrated on the city in the south seas -- in the southeastern parts of the city. these are new covid cases over the last two months. you can see the concentration of cases, the darker shade of blue on the map, the higher the rate

of covid-19 cases. you can see in the neighborhoods there with the highest rate of covid cases per 100,000 residents. and the efforts in d.b.h. and working with the community partners continue to be concentrated in the moment -- in the neighborhood with the highest prevalence. next slide. vaccinations, by race and ethnicity. you can see on this side that our percentages overall are higher than the national metrics. you can also see, particularly among the black and african americans, people identify as white and their rates are lower. we are at 62%. it is not good enough. we are seeing significant improvements there. among the age group vaccination

rates -- the 12-18 is the lowest vaccination right in the city. we need to work with social media and taking other steps to encourage people to get vaccinated. our officers say that we have made it easy. we're supporting efforts to make it hard, not to be vaccinated. so supporting businesses, bars, restaurants and other entities that are requiring proof of vaccination status in order to go into business inside something that we think is a very positive step and we're supporting that as well. as you all know, the health department, the city, and many other providers and businesses across san francisco are increasingly requiring proof of vaccination status for people to

work. next slide. i do think from the commission, for you to be aware that the covid task force is working furiously. many, many hours a day with regard to the targeted response. i also wanted to be sure to share with you that the targeted response will not be at the size and scale of the response that we had during our prior three surges. and just to put it in some context, there is demobilization from the health department and other city departments in june. we plan for 30 new covid cases on that was advised at that point by many infectious disease

experts. we were down to as few as five cases a day. we are now averaging 206 new cases a day. and then in terms of staffing resources, because we have neglected so many other parts of our services and care for people who have multiple other health needs, we can see that the d.p.h. task force numbers in terms of f.t.e. available to do the work has declined significantly. we are now at 275 gsw his currently activated which is less than 25% of the total in 2020. and then you can see, because other city departments have interrupted, there are

incredible drivers who are up with so many of the operations, the paramedics who are working with us on so many efforts in getting vaccines. people have gone back to their other work. and therefore, you can see numbers are much lower. we are in a much better place. we have learned a lot. we can still be effective, but our response cannot be as robust as it has been. we are targeting and focusing our efforts on supporting school reopening, which we think is so key. we know it is so key. our work with the most vulnerable populations, ensuring that shelters have act -- have access for testing and support, in isolation and quarantine hotels, and working with neighborhoods with the highest prevalence of infections. we are focusing our efforts in this regard, shifting the way we are doing things like contact tracing, where we are focusing on these places to help management rather than attempting to focus on everything all at once, in which case we would not be able to be as effective as we are with the new focused strategy.

next slide. and then just to emphasize how much we are supporting and are dedicated to having schools open safely is just an example that we have our team working on this. this week, which we are going to schools safely hosted by d.p.h. and ucsf experts. working in concert with the child you the and families and also with the schools to make sure we are doing everything we can to make sure inprison learning is conducted in a sustainable and safe way for our community. i will stop there and take any questions. >> to be have any public comment?

i don't see any hands. >> all right. thank you. commissioners, any questions or comments for the director? >> thank you. have we seen, in the unvaccinated numbers, the increase within the cohort of folks the number of children? >> yes. we have been asking that question. i will get them the most updated data on that. the last time was not too long. we hadn't seen a significant -- as high as an increase in those numbers as one might have thought. that is good. we would expect potentially that to change since 12 and under are not eligible for vaccinations.

i can get you those numbers. there was not a pronounced shift and that percentage, to the best of my recollection. >> okay. thank you. i think that will be really important as part of the town halls, but also our media and encouraging families to have their children returned to school. >> absolutely. what i can say is we have seen a big change in the average ages of people who are hospitalized in the city, consistent with the severity of the disease. twenty-five% of our hospitalizations are people under the age of 25.

>> thank you, commissioner. >> commissioner christian. >> thank you for this update. i apologize if this is something you touched on a bit, and i might have missed it, but can you talk about the department's view in terms of testing and based on the utility of it and whether there will be an expansion of its availability. i understand exactly what you just said about the available resources at this moment and how much they have been decreased, but can you first talk about your view of the utility of testing to understand more of what is going on with this particular variant and the ones that are inevitably coming? and how we might decrease their

prevalence? >> thank you, commissioner. i think the way to decrease the prevalence is to make sure that people get fully vaccinated. i think testing is an important component of that. if people continue to get tested and not get vaccinated, that is not solving the issue. again, we are really focusing on, as we add to -- as we focus our response and strategically deploy with resources, we are integrating the testing and vaccine efforts. so that when people go out to test, they can also avail themselves of the vaccine and vice versa. we are seeing in uptake in testing of numbers as the numbers of covid diagnoses increase. right now we continue to focus on testing at our sites where there are patients and people who don't have health care

coverage and the drop-in centres and are working with other healthcare systems to prepare for potentially more testing demand. right now, d.p.h. has been conducting 40% of all the tests in the city, despite the fact that we provide health care coverage to only about 8% of the people in the city. we will continue -- right now, again, we have not exceeded our capacity. demand has not exceeded the capacity for the test. we're hearing from people's concerns about the ability to turn the test around. there are other healthcare institutions that can be around for 72 hours. we will see this continue to be a challenge as we saw in the fall and winter surge and is more testing ramps up, little -- labs get further behind.

the other thing i would add that we are encouraging, and obviously this is costly for people, so this is not a way to see it, but it is an option for some people. if there are home test kits available where people can self-test, so we are encouraging people to avail themselves of those options if they are available to afford it. testing is focused on combining testing for vulnerable populations, in shift and in shelters and working with clinical partners across the city to encourage and support broader testing implementation as we face the next surge. >> i do wonder how the private works and are entities that can

provide testing to their patients and their clients. they are responding to your request to increase the amount of testing that is available, and i know that many people -- and everyone knows this as well, people who have gotten vaccinated, and as you know, we have a high percentage of people in san francisco of people who have gotten vaccinated and then have gotten -- have contracted this delta variant, and perhaps did not even have any symptoms or not have symptoms if they had contracted a variant of covid. what do you say to them about the level of emphasis that the city is putting at this moment on increasing testing?

>> can you just say to the other providers, the c.d.c. just recently change the recommendation. that they get tested regardless of anything. that would increase the demand in the city. with the other providers in the city, we are working closely with them. >> can you hear me? >> yes. >> commissioner? >> yes, again. >> i am not able to see anybody or hear anybody at this time.

>> director kolfax, we can hear and see you. >> should i keep going? >> yes. >> we see you and hear you. >> okay. can you hear me now? >> yes. now we have lost you. secretary, can you hear me? >> i can. i just text -- tested -- texted dr. kolfax.

i am seeing the yellow triangle which shows he has bandwidth issues. i am wondering that if we can give this a minute and see what happens. if not we can move on to the next item and come back. >> can you hear me? i can hear you now. i apologize. >> it seems like you had a band with it to -- bandwidth issue. >> it's not showing an issue, but, to go back to commissioner christian, the second part of her question in terms of working with providers, we are engaging actively and thinking about how we can collectively expand testing options in the city and basing it on our work with the vaccine access work. i don't know that we would be able to expand to that level, but certainly we are having active conversations in working with them and how we could support these efforts in expanding testing. i would also add again, not that we have some issues, but we are

working on potentially expanding hours at the test site which is continuing, and looking at the possibility of expanding more drop in testing at the testing top up area, which are in communities with the highest numbers of covid-19, and expanding testing at laguna honda hospital and we are working with the shelter partners to encourage and expand more testing there. while i don't have any more specifics to share at this point, i assure commissioners that we are working hard on ensuring that we are supporting our other key healthcare partners in expanding testing to meet demand. at d.p.h. we are testing -- the demand for testing is not outweighed the demand for capacity at this time. >> thank you. i certainly believe completely that you and the department are working overtime and hard as

usual. please don't take my questions to go to that issue. i apologize if my questions haven't been very clear. i'm not feeling well as the commissioner noted. thank you so much. >> thank you. i apologize for the computer issues. i hope it has been resolved. >> thank you, commissioner christian. please do get rest and hydrate and feel better soon. vice president green? >> thank you so much for this update and the information. you talk about the workforce and one was stated and i just wonder what your projection is. first of all, we are all really concerned about the level of work and stress on the individuals that remain at covid command. and i think we would all ask if there's something we can do to support them. we certainly are concerned about them and the amount of additional burdens.

the other question involves burden and as we look at the projections for hospitalization and the concern that individuals could in fact, have the condition, and i think if you work in a healthcare facility and you are positive, you're supposed to stay away from patients. what is your projection about whether we will have an adequate healthcare workforce at a hospital level when the projected peak comes? is there concern there, and are we thinking through what we might do if we are stretched thin during this time? >> absolutely. i think there has been some articles in the press about healthcare workers who have become infected with covid-19. there are a couple of things. we know the people who become infected become infected outside of the healthcare workplace

setting, which i think it's critically important to emphasize. we also know percentagewise that far more people, healthcare workers are not fully vaccinated and are becoming infected compared to otherwise. and in talking with our hospital c.e.o.s and michael phillips, the c.e.o. of laguna honda hospital, while the numbers of infected continue to be tracked and are of concern, we believe, at this time, that we would have adequate staffing to manage the projected numbers of people in the hospital, and we are also working with our hospital partners to ensure we are doing everything we can to prepare for the event of these models translating into over 300 people in the hospital at the peak,

that we do have beds and staffing available to care for them. it won't be easy. it will be a huge strain on the system. it will be more people than we have in the hospital over the winter. again, we are in a better place than we were without the vaccines. >> thank you. thank you to everyone for this excellent work. >> thank you, vice president green. commissioner child? >> yes, thank you, director. the information you are providing is very helpful and tells us that this city and our health department is really working hard to respond to this new delta surge. i have two questions. one was that on your slide of the projection, you had highlighted the word, no waning immunity. i'm not sure -- did you mean

that that was part of the assumption, and you could -- could you talk a little bit about what you think might be happening and from what you might be seeing in your experience? in the second question related to the home testing, do you believe, or is the department considering that home testing actually meets the requirements that are being placed on employees and employers to do testing? i'm hoping that this will not be too consuming of your time to try to respond to those. >> yeah, in terms of the waning immunity. we are working with infectious disease experts to determine if there is any waning in natural immunity, particularly in regard with the delta variant if people were infected before. i can say that i have not heard

that that has been a major concern in terms of how the virus may spread. as we are looking at the decline in cases now in the united kingdom, one of the hypothesis is is that it is a combination of the high vaccine rate, and the high prevalences of prior infection that may be responsible for that decline, which would add on the more optimistic side that prior infection does confer some immunity on the delta variant. that is what that model essentially is assuming. we will continue to watch. in terms of the home testing, we can get to a more specific answer. there are obviously a lot of different home test kits out

there. i don't want to make a general statement. some of them are good, some of them are not so good, some of them meet these and some of them don't. we can certainly get a few more details on that, or at the next health commission meeting. i can provide a more brief update on how we see home test kits being used, not only in the workplace, but in the community as a whole. >> i appreciate that. i think on the home testing, you're exactly right. there are so many different products out there that are being pushed by the pharmacies, and it would be nice to have an expert opinion as to which ones people could most rely on, and perhaps, i know we probably can't say the ones that shouldn't be using, since they are a product that is allowed to be sold, but it would be useful

to have some recommendations in regards to that, just from the consumer side, and maybe you have also worked from an employer side whether any of these meet the requirements that the city and the state are asking for. i appreciate that very much. thank you. >> absolutely, commissioner. >> thank you, commissioner ciao. director kolfax, you can we go back to the slide with the d.p.h. covid task force for a minute, i believe michaela is ready to pull that up. i just wanted to put a double underline and an exclamation point under some of these numbers. they are significant and i would ask you to elaborate on that in any way you would like. we are less than 25% of our total d.p.h. mobilization in 2020, even though we are facing

a rapid increase, faster than any other surgery have experienced, and also that we are 72 known d.p.h. deployed staff compared to 62020. i would like to know, what is the told that that is taking both on our staff who have been working so hard and have been so committed, what toll is that taking on them in terms of the workload, and how hard they are working, particularly in the absence of other stuff you have been deployed or who have been demobilized, and what is the impact on the department and the other critical work that we need to be doing? please elaborate that in any way you would like. >> there are a couple of things. certainly people continue to be deeply dedicated to this work, as well as the other work across

d.p.h. and 18 months into the pandemic, we are also seeing the other health effects of the pandemic beyond covid-19. there are a number of behavioral health issues, a number of physical health conditions, that because of our massive deployment for 18 months, we are seeing really less than positive outcomes for it, in addition to having -- to catch up. for instance, within the health network, being able to remind people that they are due for a cancer screening. it is a concrete example of where we are juggling many competing priorities. i think that while people are incredibly committed, they are also exhausted 18 months into this. and within the covid task force, i'm showing the f.t.e., they don't translate these as working eight hour days. many are working much harder than that.

i'm also trying to make sure that we take care of ourselves, both our physical and mental health as we are in this for the long run. which is why we are really needing to strategically focus our approach, ensuring access to vaccines and testing among communities who are most vulnerable and ensuring that we are working to link resources with other healthcare systems in order to ensure that people have access to care. this is challenging. as you saw from the model, these numbers will peak really fast, and if the model holds, it will go down really fast. so trying to adjust the system while not completely -- while balancing the need to address other issues such as overdose deaths, and other key areas of health and wellness for the city, is the challenge in the next 68 weeks. the staff is dedicated their

time. they are committed and brilliant. this looks different in multiple ways from the last surges. not only because we have the vaccine, but we have delta and we know we have the tools to help address this. we also need to modulate some of our staffing pardoned -- patterns to address the other health needs in the city. >> thank you. i think for all of, this is disheartening that so much of this is preventable. we are grateful that san francisco is in a better position than most other jurisdictions. it's a challenge that must be met. the commission is grateful to all d.p.h. staff for your resilience, your commitment, your hard work, and thank you for continuing to pull through during the next surge. we stand ready to support everyone, including you, director kolfax. thank you. >> thank you. >> other questions or comments from commissioners?

all right. seeing no additional comments, we will move on to the next item. thank you, director kolfax. the next item, which is the land acknowledgement resolution. >> i apologize. but just to jump in, general public comment is first. i don't think we have any, but we need to check. >> thanks. i was shuffling through my papers to find my agenda. i guessed wrong. thank you. >> first of all, if you like to make a comment about anything that is not on the agenda, press start three to raise your hand. thank you. >> thank you. we will move on to the land acknowledgement resolution. before we begin and hand it over to patrick chan and to the

commission secretary who have worked hard on this resolution and engage really infect -- effectively with the community, i would like to acknowledge the community members who helped to shape this resolution and make it the excellent resolution that we have before us today. we may have dr. cordero on the line. thank you for joining us again, as with our previous meeting. i will -- we will hand this over to mr. chen and mr. morrow it's. >> hi, everyone. i will read the resolution, and then commissioners and members of the public, if any of you have comments or questions we want to say anything, than that is how we will move forward. is that okay?

>> yes. >> health commission acknowledges that these are the original people of the san francisco peninsula and where is the commission acknowledges that the area comprising the city and county of san francisco was originally inhabited by an independent tribe of the peoples and prior to the arrival of the spanish in 1769, there were 1500 persons and they lived in small travel groups. but the end -- by the end of the mission period, only a few families survived. the health commission acknowledges the association has actively worked to research and expand public awareness for their history and culture, and health commission acknowledges that they are not an unethical population of the past, but an integral and active community the bay area region and beyond, with ongoing exclusion and

disability that threatens the greater american indian community with inclusion and respect in san francisco. [indiscernible] and were as san francisco human rights commission published a report in 2007 title discrimination by omission, issues of concern for native americans in san francisco, detailing the ways in which american indian communities experience exclusion in san

francisco and identify numerous recommendations for improved outcomes and processes. it is important to counter the narrative regarding the doctrine of discovery with the acknowledgement that there always have been communities living on this land prior to the arrival of europeans, and where as the land acknowledgement is a formal statement the recognizes and respects american indians and storages of the land, and enduring relationships between the traditional territories, and where is the health commission recognizes the land acknowledgement resolution is just the first step needed in acknowledging and honouring the land and culture wisdom and contributions of the peoples.

be it resolved that the following land acknowledgement will be read aloud at the start of each health commission and department of public health meeting that is open to the public in accordance to chapter 67 of the administrative code. statement is the san francisco health commission and department of public health staff acknowledges that we are on the unseeded ancestral homeland where the original inhabitants of the san francisco peninsula. as the indigenous stewards of the land and in accordance with their tradition, they have never seated, lost -- [indiscernible]

-- we wish to pay our respects by knowledge and the ancestors and relatives of the community and by affirming their sovereign right as first peoples. >> thank you all for your time and commitment to this. >> commissioners, do you have any questions or comments? folks on the line, if you like to comment on this item, which is item six, please let us know by pressing start three to raise your hand. no public comment, commissioners. any questions or comments from you? commissioner brown i am turning back to you. >> thank you. i see we have a commissioner

comment from commissioner chow. >> yes, thank you, mr. president. i wanted to really acknowledge the work that mark has put into this, along with dr. cordero. and the concern and the careful consideration of the american indian community here in san francisco. i will look on your website. i am pleased we are now addressing these issues. i did ask in our last meeting to try and address those if we could. it is my understanding from the department that they have been trying to assess the needs along

with working with the american indian colleagues in doing this. i am looking forward to a future companion resolution that will help the commission also recognize the special needs that the american indians have and that we as a commission and department are dedicated to be sure that we are responding to those in the interest of humanity and health equity. i am supportive of the resolution. i know that my fellow commissioners will be also. thank you. >> thank you for your work, commissioner chow to carry this forward and take next steps for the commission and the department and the community. we look forward to an additional resolution coming back to be calendared at a future date. do we have any other questions or comments from commissioners?

seeing men, do we have a -- seeing none, do we have a motion to approve the resolution. >> i will move approval. [please stand by]

>> -- by the harm reduction therapist center is funded through a reallocation of their own funding, and you've already approved their contract, so there's no new contract, but i am presenting to you d.p.h.s [inaudible] for the proposed move. so the d.p.h. is proposing to move start from several locations to a single location at 21 marlin street in san francisco. and specifically, they work on

the [inaudible] their transitional youth homeless outreach team as well as their outpatient 48

attendees, including staff, and staff from harm reduction therapy center presented a powerpoint, and then outlining their program and their plan and their intent to lease the site, which is 3,412 square

feet. there were some questions that were all answered, and there were no objections raised. sometimes if there are so many questions, or there's objections that we need to follow up, then we do schedule a second or third meeting, but that wasn't necessary. so that is -- i'll stop there with my part, which is really to assure you and walk you through the department meeting its obligations to the prop i. i know, i believe, that pat denning is here from harm reduction therapy center, the clinical therapy director. if you did have questions -- i know that commissioner green did ask -- she had four questions in e-mail, and i don't know if the e-mail went back to you in a timely manner,

but i can just turn it over to pat, if that's okay. >> well, actually, i did forward those responses, just so you all know. >> okay. all right. well, then maybe we don't have any questions. >> all right. before we go to commissioner comments or questions, secretary moore, do we have any public comment on the line? >> folks who would like to make public comment on this item, please press star, three to raise your hand. star, three. no hands, commissioners. . >> all right. commissioners, any comments or questions on this item? commissioner chow? >> yes, and i want to thank michelle for forwarding a map, because now i know where merlin street is. and i know there were some questions about on-site services, but it sounded like

this was initially or primarily an administrative move to bring your offices into one site so you could also be more efficient. but could you also describe because there was some talk about trying to see -- i mean, outreaching to this more immediate community, what also you're going to be driving there, versus -- what does get moved, what doesn't get moved, or is this an expansion of services, keeping what we already have and adding the site? >> yes. you know, actually, i believe it will be an expansion of services. we are moving our clinical staff as well as our administrative staff to this one site in order to create a home base for people. our services are provided in a number of community agencies as well as in mobile outreach, and

prior to covid, we were actually -- we actually had a mobile van that would set up in different places and offer treatment services in neighborhoods. since covid, we have been unable to have those gatherings, but we have still maintained a presence in all of those neighborhoods as well as in our brick and mortar community partner sites. we -- what we will be doing even during covid with the merlin street is being able to offer the clients that we are seeing already seeing in our facilities or mobile treatment

sites, we will be able to see them more frequently. i can say, i'll be at the merlin street center on friday if you'd like to meet there. so all of the staff will have a certain amount of time that they'll dedicate to being on-site at merlin, with the commitment to those people that we have been seeing on the streets. we will, hopefully sooner rather than later, create a drop-in time for members of the community and particularly the sixth street corridor and members of the community. >> i certainly thank you for the explanation. it sounds like you're working

with a needy group despite covid, and as dr. colfax noted, with overdoses and substance abuse, so appreciate that, and glad to see that the community seems to feel that you'll be a welcome addition. thank you. >> thank you. >> thank you, commissioner chow, and thank you, also, pat denning. seeing no other questions or comments from commissioners, this is an item for discussion, not action, so we can move onto the next item. thank you very much, and thank you, ms. ruggles. >> thank you. >> our next item is an office of health equity update, and i know we'll have a presentation for this. thank you to dr. ayanna bennett, who will be presenting tonight.

i know all the members had an opportunity to do one of the training modules, which was incredible and so informative and directive of the work we need to do to ensure equity in health in san francisco, so thank you so much for providing that opportunity to all of us, and we look forward to engaging in that and your presentation now. thank you. dr. bennett? >> thank you. [inaudible] is going to do the slide for me. so this is your racial equity action plan update, which we are doing four times this year, but this is an update. i don't want to let the racial

equity action plan, which we have many amazing things that we need to do, but was developed outside the department, to overreach the obligations that we have in the department. we have lots and lots of obligations, but they aren't all encompassed there, so you'll be hearing those. next slide. there i am again. there's the office of health equity, so it's not just me. i used to encompass the entire thing, but now i do not. next slide. and just as an overview of the topics for today, so we're going to talk about d.p.h. health equity overview, expanding resources, the equity a-3 goals and their status, the health commission racial equity action plan items, and then h.r., our new director of h.r., is going to talk about the new

directive h.r. related ones. i will do the non-h.r.-related ones. many will overlap, but you'll see the division. so i've been trying to socialize our way of thinking about this equity work, and that means it comes in four quadrants, and i'm sure that many of them don't fit in any of them, but we're trying to change the way we think about this. we're trying to change the way we do this work with staff and partnerships and skills trainings so that people know what they're doing. we're trying to directly impact health disparities with community engagement, with service quality, and we're trying to deliver accountability on these issues because we have an enormous amount of goodwill, that goodwill doesn't actually make changes all the time, and so we are looking for accountability, and you are a huge part of

that. so report, reprint, making sure we're held accountable, and then data tracking, so we can deliver data to the community so we know what it is we accomplished or not going forward. next slide, thanks. so one of the things that is changing is we are investing again in our equity infrastructure? i will say the fact that we had equity infrastructure at all was very clear during the early part of the pandemic when equity work still continued? we released that training in the middle part of the pandemic because people kept working, so i think we are looking really forward to moving things along as we get even more staffed, so there are ten staff in the office of health equity. once we're done hiring this year, that'll add some trainers and some community based staff? the divisional equity staff, so

that's the equity staff at [inaudible] and laguna honda, and all of the site. that's going to actually be higher than that over the next few years, so that's 27 staff, but not all of them are full time? but if you look at that, many of them are in different areas of the department. funding has increased. we are at about $330,000. there's still a significant chunk in behavioral health that comes out -- that is part of the mhsa package. go forward? so that expansion will accomplish a few things. so it lets us have dedicated functions, and we have succeeded in being jack and jills of all trades, but maybe having a little more specificity will be effective, i'm hoping. so people that do data administration, that includes i.t. workers, administration,

those two events that we had this summer, one for antiasian hate, and the other for black african american workforce issues. those both took very little staff to do, and we wouldn't be able to do them without the existence of the g.i.c., which doesn't exist anymore. health and community, we're going to be having the training for covid staff that are being added on for community, and that same training and framework development will be carried forward into our staff, so we're going to take the opportunity to make sure our staff know the history of the neighborhoods that we're working in and various other things so that they can see the communities as partners. and then, we have the workforce

equity that's going to get some staff under him. we found that on-line actually worked, and there was much debate whether people could talk about this issue or would actually do it, and we got reasonable feedback that it has been rich and people have gotten something out of that, so you'll see more of those based on a set of competency skills that we're developing. next slide? so our 2021 goals and activities, the ones that aren't on the racial equity action plan, some of them do overlap, but they were previously in the chute. we added the health equity learning requirements last july, even though many people were deployed, were actually in regular basis, and our goal was for 80% of staff to complete.

we know that several section individuals have gotten 80 or 90% of their staff to complete, but we still need to get certificates for everybody else. the current learned systems aren't direction at the collection, that's why we need somebody to do that current data collection and analysis. the health equity impact tool, we are still developing that. we want to employ equity action programs, and questions about respect, so we're looking at all of those. the next iteration of the staff engagement survey should come out this fall. so we can't really say whether we succeeded in those things, but we're hoping to see some changes. and then setting up a process for equity so that we have some kind of process so that people

understand what's going to happen, what their obligations are so that we can go forward with a plan that hopefully would survive all of us and keep going. and then, we're preparing a health equity data report for next year. but go forward? next slide. all right. so this is the racial equity action plan overview? so we've done 81% of the activities? a lot of that is because we've done quite a few of the things already? we did not start from zero, as many departments did. we already had equity staff? we modelled our growth on the same thing they modelled theirs on, which are recommendations from dare and some other jurisdictions, and we'd already done some things, the training and everything. so we still have some things we need to work on. you're in here somewhere, the commission. you're about 60% done, but i think rapidly going to get to much higher than that. we still have things that we need to do, but i think the entire package will be done by

the end of the year, except for a couple of things that require data -- verp data development goals? because i can't imagine we're going to hire the staff in time to get those fully done, but i think we'll have made progress. next slide? so i'm not going to go over this in detail, but just a few of the things that are -- activity that's i think are key and have actually had an impact? so we have an equitable inclusive hiring policy that h.r. has put out that they'll talk about? the director of workforce equity produced a guide for hiring managers that i think they can do their part of the process more equitably, and we have seen that piloted by primary care in hiring directors? they had a unique opportunity in a bunch of empty positions that could possible help them rebalance what had been a very skewed group of employees?

tracking progression and professional skills development tracking both require a hiring. that's why they're in red, and what i'd like to highlight internally is 2.1 and 2.34 under retention and promotion? that means there's nine categories [inaudible] by the way. internally investigate classifications for dropoffs, so that was done. one was the health worker and health coordinator series, and those have been long complained about, because staff getted stalled in the program -- staff gets delayed and didn't move up, and that's particularly african american staff and latino staff that stop there, and so we actually have developed a project that's going to be on the union, equity, h.r., are going to look at these and make some concrete plans? and we've been complaining

about that for a long time and have not been able to do that, so i think having a set goal has actually been moving things forward. next slide? so these are your activities. i have almost everything down as done, with the exception of a few things. racial equity training, i think everyone in spirit is committed. i think having the resolution around how you're going to interact with community, i think, actually, is part of that commitment, and then having some decision around whether or not you take my recommendations or want to do something else or want to do more or less or something. some shared agreement, and i think we can fallback on that, as well. expanding diversity through voices. this is something we can say we're already on the path too. i think going to the community has been a really innovative

approach that the commission has had, and i think this will just push it even further, and then, the racial equity assessment tool is coming. all right. go forward? all right. so the availability of training at d.p.h. both impacts you for when you're deciding what kinds of training you want? but just, i think it's a general issue on behalf of the department? we don't have a large number of dedicated trainers outside the hospital, and those are very dedicated to a lot of regulatory needs around nursing and mental health. so we instituted the four hours a year learning requirement this year -- last fiscal year, sorry. we've made four -- there are four equity focused on-line trainings? there are multiple webinars, and there's a printout that i think you should have gotten of

that. there's a five-month health equity fellowship. i think it'll be in month three, and then, there are lots of self-education resources. so what we're going to do is take the competencies that we've developed and then map those things against them and look for where we have critical goals. go forward -- next slide? and the way we're doing that, the competencies, there are 100 of them so far, so we may be getting a little too granular, but they do come in areas, and i think there's a reason that we need each one of them. so structural competence is just explaining the [inaudible] on marginalized communities. extra, within that competency is the ability to extrapolate from that to the experiences of lots of groups which overlap significantly. that is addressed pretty significantly in the training that you took. it was directed to do that, so

that's kind of a baseline, do we have all the same vocabulary? do you actually understand a bit about the history that people hear? so all of those things i think are more or less covered. we still need to flush it out, but we've actually gone there. research and data analytics, program planning, quality improvement, equity policy and law, there are areas that everybody needs, and then there's areas that are more particular to managers. i have seen leadership competencies that we've just gotten to the point of finalizing, and those go to activities. holding management accountable goes with equity in your one-on-ones with your management and on your agenda, so we're trying to map the competency to the behavior and

then who's going to check what you've done in your behavior. next slide? can you still hear me? >> yes. >> so the ones that are currently available are intro to health equity and sexual orientation and gender identity? both of those, we've just developed in the last few years, and both sort of by borrowing resources from the general and a little bit here and there, so there was not much of a centralized process except we pulled everybody together. i think the production will be much smoother as we go forward? but both of those talk about structural issues, and they're really basic, so 101. knowing the terminology for racial ideology and sexual orientation and gender

identity, those are the ones that we want people to know coming in, so those are the ones that i would suggest for orientation, and those are each about an hour. and then, the standard i would suggest would be two hours for orientation. we may change what we do as we go forward and we determine things may be more appropriate? and then two hours of training for everybody else that's not in orientation. and then, the on-line trainings will change over the years? it will be probably more feasible to pick them every year, to pick ones and have a group agreement, and that'll be your agreement to doing them? and a way to understand what's available to the rest of the department. so at some point in the next two weeks, there'll be hopefully specific trainings for environmental justice and

so hopefully, the choices will get more and moreover the years, but we can always track ourselves through those competencies and see if the ones that you have defined as a commission are the most important. next slide. so that was all i was going to cover today before you hear a lot about h.r. racial equity action plan goals. any questions on any of that? i know i heard some before. >> thank you, dr. bennett. we have commissioner chow? >> yes, thank you, dr. bennett, and i think i really appreciate the clear presentation that you've made, and -- so this

helps with racial equity. when do we get to discussion asian american events? i know you talked about african american events, but is there a section that's going to talk about how we're handling -- that's kind of my mantra here. where are the health disparities? >> so there are a few things i think you should hear about it. first, everyone should be doing equity, so hopefully, the he can -- the equity tool will help them. so primary care has an entire dashboard. everyone needs to develop something in their toolkit that tells them whether they're dealing with equity. the other way is we are finalizing -- there's been a

lot of back and forth around the equity dashboard for the department, so we're getting it down to ten measures as the constant ones, and i think what we're going to do is have population measures, probably hospital based and a few others because that's what we have on at least an annual basis and match those within the process measures of the department. so for example, heart disease hospitalization and hypertension control within the department, so those are -- or tobacco use as a population and our tobacco control equity in terms of who's taking our tobacco control resources. so those kinds of match ups, we should be able to get by the end of the year on a dashboard, at least those ten measures? what i'm hoping we'll do every three years is what has been done with the community health

needs assessment in the attachment addendum section, which is to have much more health data. there were actually over 400 graphs in the 2016 one, which i think is viable, and i loved that thing, but it was too hard for anybody to actually get anything out of, so what we're going to do is bring those down to 50 to 70 measures and talk about them and how people are doing in terms of racial disparities, but also do i would say little supplement assessment for different groups. so instead of having an entire report that's talking about native americans have a report that shows the graph that talk about everybody, and then, one part of the report that does the narrative of what does that mean if you look at those graphs about how the community is doing, so those are hopefully going to come out around the same time as the

community health needs assessment next year around summer or fall. i don't know. i don't have a calendar, but i think we'll finalize the measures by the end of the year. we just need the data lead ins that they're having to match with process measures, which they're happening sometime soon, but that is going to happen one way or the other, and the next year, we will be reporting on how we're doing. so the dashboard, a couple on the dashboard, and then, the d.p.h. and a much larger report. >> well, thank you for that. i appreciate your enthusiasm, and i'm looking forward to those reports. thank you. >> yeah, thank you. >> thank you, commissioner chow. commissioner chung? >> yes. thank you, dr. bennett, for this amazing wonderful --

[inaudible] >> -- you know, to look at beyond just health outcomes, but if we look at the structural health issues that prevent some people from obtaining optimal health. one of the things that i was curious about, like, so these trainings are specifically for the department, and i was wondering, you know, if, at some point, you know, like, other departments such as the planning for events, you know, like, would be inspired, you know, enough to go through some of these training, as well. i think that, you know, in order to really see changes, you know, that are sustainable, we need systemic overhaul, not necessarily overhaul, but, you know, at least some systemic

changes need to happen. >> well, i have had opportunity to share the racial equity things with folks in other counties. we're trying to see if there's something we can do regional because our issues aren't so different that it might be better to pool resources? so we have been sharing those widely. i think we can spread what we're doing to other departments. i'm trying to pull together -- like, the human service departments, we're trying to get together around data at the moment, but i'm hoping we can make some more alliance around on going work, so we're talking about some community engagement shared activities, but part of what's happening with the racial equity action plan is everybody's been mandated to have some kind of training?

we have shared our sexual orientation gender identity training. we have earlier given it to the office of transgender initiatives a while ago, and they shared it for training for some other groups. health disparities are really everybody's problems? so i think they can listen to our training on health disparities because it's got a lot of structural issues that don't impact them or their health area, but i do think that people need to be more aware of that. so yes, i do think we need to share them, and hopefully, we'll get some more coordination and maybe [inaudible] will create the one or maybe even the department of the environment will create the department of the environment one. we're getting better coordinated, but many departments are just starting to put staff in place, so i'm

trying to find counterparts and do some shared discussions, but i do think we'll get there, though. the office of racial equity is doing a great job of bringing everybody together so we can do that kind of thing. >> like i said, thank you so much, and, you know, i'm really excited. and also, you know, like, i got some, you know, history lessons on the training because, like, i've been studying u.s. history for, you know, when -- before i moved to the country, so, you know, it's great, you know, that it really ties back into all these, like, historical contexts. >> well, we will keep that up. i'm hoping that we're going to do the histories of the neighborhood so that people can know a little bit about the neighborhood before we send them out to work in the neighborhood, both about the neighborhood history but also our history there because sometimes you're stepping on relationships you don't know you're on, so that's what we're

working on at the moment, so we'll see if we can get that next year, as well. >> thank you. >> you're welcome. >> thank you, commissioner chung, and i would have to say that the training was really effective in teaching about the long history of structural racism and inequity. i see we have a number of commissioners with questions or comments. next commissioner will be commissioner guillermo. >> thank you, dr. bennett and commission president. i offer my congratulations on the progress that we've made to date, you and your team. i actually had a question that was a good follow on with commissioner chung's that had to do with the training across

the department, and the obtain to do that is something that is hopefully a little less [inaudible] but something that we can definitely strive for sooner rather than later. i had a similar question with regard to the contractors that the department has. we -- you know, we do so much of our work with outside agencies and with community organizations, and, you know, just in really good partnership with some of the -- the different populations that we're concerned about. but given the intersectionality and the cross cuttingness of all of this, i wonder if we would think about extending some of this training to

agencies and community contractors that we have that, for now, focus on a particular population as their target population. particularly for san francisco, and the intersectionality and such, there's a multiplicity. >> we do work with contractors, and that it was made available, but there was something about where we were and everybodies requirements, but i do believe

it's available. if it's not, i will look into that and get back to you, or other agencies. to not honest, i was happy we did it. i really did not look that closely at anybody who did not ask for it, so maybe i'll be a little bit more [inaudible] with them about how useful it might be for them to have it. it's a little bit difficult to figure out how -- actually, they all use peoplesoft, so let me look into that because we certainly could make it more widely available to everyone in the city, so let me talk to h.r., and they can talk to d.h.r. about that. >> absolutely, and many see the same populations that getting

served as d.p.h. facilities, as well. it's just in the interests of making sure that this is as widely diffused and uniformly available as possible. i think -- and part of it is just that i think that the materials that we have that are developing are widely supervisor than most that we would be exposed to. >> thank you. appreciate it. i will also say that it is not the up front message, but part of it is really not about the facts any way. i certainly want them to have that, but part of it is sewing the seed of curiosity that there may be more to the story than you thought? even if people get nothing else, that there's more to this than i thought, and that's a skill that's widely needed. so anybody looking at that, and maybe they just get from it, maybe i don't actually know why they're late, maybe i don't

know why everybody is late about this bus stop leaving, but maybe a little bit more about lived experience and there's my differ, i think we'll get something out of it, so i will try that. let me ask around, and i'll see. i'll let you know. >> great. thank you very much. >> you're welcome. >> thank you, commissioner guillermo. commissioner christian? >> thank you, dr. bennett, for this training that's so clear and informative, and the explanation structural inequality and the impact that it has on people's lives because as commissioner chung

said, we're not going to move forward in any substantive lasting way until the structure is addressed, so just thank you for this important work. and as commissioner guillermo was mentioning, in the contracts with the city, [inaudible] and i absolutely think that -- that some version of this training, if not this one just with no -- maybe people in different uniforms should be required before people can be eligible to do business with the city, and since every department in the city, you've noted with us, i believe, tasked with creating a plan. i know as a city employee, there are multiple trainings that we are mandated to go

through each year, sometimes once a year, sometimes, you know, twice a year. this something should absolutely should be one of them, and what you've created is an extraordinary model, so i just want to thank you and thank you so much for the work. >> thank you. i just wanted to make a point that that would not have happened without putting people in place. i take credit, at least my slides for it. the equity lead at laguna honda, the equity lead at s.f.g., laguna honda, they did a lot of the editing. a lot of people had their hands in it. it's partly why it took so long to develop because we actually didn't have anybody who was their job, but i'm really glad

that everybody finds it so useful because there was some debate about whether doing anything on-line where people -- where you couldn't judge where people were feeling, and you couldn't have dialogue, had enough value, and i think there are value in the data and the facts, so i appreciate that that turned out to be a shared belief. >> yeah, thank you. a lot of the on-line training -- not a lot. on-line trainings can be as you described, but this one was not, and i am, you know, not surprised, again, about the -- your colleagues throughout the department that have such a strong participation in this. you know, once again, we're seeing the people at d.p.h. showing -- showing us their strength. so really excited.

again, the structural piece is very good, not overbearing, not too much, not too complicated, and i think it's a great foundation to build, so thank you so much. >> well, i'm going to see what we can give you all about the -- so we have taken in reporting about what each department is doing, and that's where you'll see a little bit of the health equity, commissioner chow, but i'm not saying they're saying it about themselves. so we've got an annual report that will likely be in the spring in normal years. it'll be late this year, but that'll be a public document, and i'll sent it to you all, and then, we're going to have an annual oral event, which we had last week. it was a test case, but there will be more opportunities for people to hear about what we are doing. >> great. thank you, commissioner.

we have commissioner giraudo. commissioner giraudo? >> yes. computer issues. thank you, dr. bennett. this was excellent. it was just -- first, the training was excellent, and i really second commissioner guillermo's request that others would be able to view that training out of d.p.h., as well. i, for one, have searched high and low for adequate training for my staff, and it's really not out there in what you had put together by far, so it's wonderful. and my -- my very simple question was, on slide 10, and i think you just alluded to it, the activities, there were three different topic

activities, and you said that they will be held, and my simple question, are they going to be held probably virtually now, but in person -- simple question. >> yeah. i think all have converted to being on-line at this point? i think at least some, particularly the discussions, ideally would transfer back to in-person. there was something about being able to talk about race is its own defined skill, especially at work in a not entirely emotional or personal way, so there's going to have to be something of that that we do in person, but all of those are available from h.r. those are h.r. trainings from h.r.s website, so they really have been adding more and

more over time. so those are available as trainings, although i think we're going to convert more and more to that format. >> okay. on the slide, it noted event, and i thought, where are we? it was on slide 10. >> the equity learning requirement on-line training, multiple webinar training. >> on the bottom of that, on the bottom of that slide? >> uh-huh. multiple -- develop multiple training, so -- >> so that's okay. i don't want to take that time. the effective communications for diverse teams, etc., and that it seems that those were going to be, i think, where it said events. >> yeah, those are -- those are still being held. the last one, the next one is august 11. they really are just -- you can

get on and schedule it now. >> okay. so [inaudible] it's virtual. they're live virtual events, though. >> okay. great. that's what i was asking. >> there was a live discussion. if they want to go on and discuss, which is great. okay. thank you very much. >> and we do still have the equity learning series, which now there are dozens of. there's a lot every day. i think there's at least one a week. i think there's multiple a week, where people can get media, sometimes a video, but often a podcast, and people can discuss it. the attendance has gone up now that it's virtual. i did not know that would happen, but now that it's virtual, we get a significant number of people, and we've been able to identify that.

>> it is its own separate definable competency, to be able to talk about it outloud, and it's one of the questions that we ask in the staff engagement survey, do you feel comfortable talking about race and racism at work? >> great. thank you very much. >> you're welcome. >> thank you. vice president green? >> yes, well, i just wanted to add my voice of enthusiasm. this is top notch, it's comprehensive, it's prioritized, and it's characteristic of the team work of the department of public health. i thought the training was superb, and that was not easy.

and the way you wove in the p.b.s. special was so special. i can't say enough about what you've been able to pull together, certainly what people have been saying about disseminating this and proliferating this as soon as possible. as commissioner chow brought up, i think the idea that we're going to be able to measure the progress in both systemic and structural changes that we're going to be able to be doing will be so useful and so valuable and so educational. i know i'm repeating what others have said, but this is a situation where i think it deserves all of our voices. just not able to say about the work and the enthusiasm that we have for what's coming as you move forward. >> thank you. >> director colfax.

>> thank you so much. i had the opportunity to attend a training last week, and it's exciting to see everyone working together to bring this together, and how people actually do the work is something that has been

challenging, and i just want to acknowledge dr. bennett's work and the team work that has gone on. it's not that there's not anything else going on in the department, but i think it's that we're starting to see everything that we do needs to be considered through an equity lens and advanced in that regard, so just, again, an appreciation and a commitment across the department to continue to support this work. >> thank you, dr. colfax. i will say, when i got this job, people said, we started this a number of times, and we always stopped it. i think it needs to be told that it's a priority, and i appreciate that you stayed with it and kept it at the top of people's lists.

>> thank you, dr. bennett. i want to acknowledge that you were still the director at the covid command center and managed to get this done. i want to thank hannah for doing the slides, so thank you for that, and thank you for these tools for engagement and learning and a plying what we learned for measures and to hold ourselves accountable, and grateful for the modules that are rolling out. i know that you and your team will also be called onto help increase vaccine uptake in the coming days and weeks, so we acknowledge all the different directions that you're being pulled in, and the great work that still continues, so thank you. >> thanks, everyone. >> thanks. i know we have a companion

presentation now, the d.p.h. human resources racial equity action plan update. director kim? >> thank you for allowing me to be here and present the components of the h.r. racial equity action plan, and i think it'll be one of the most important things that i work on in my career, and i'm really super excited to be working with the commission and dr. bennett and mr. wagner and others would have really supported this work and this effort, so thank you so much. next slide, please. i'm looking at all of you, so i don't know if you can see my presentation. >> we're looking at you, but

we'll get the presentation. >> okay. thank you so much. i have my own version of my presentation, and i realized that me clicking is not going to help you see the presentation. okay. thank you so much, i'm sure you're aware, but a bit about the team. the dphhr team comprises 140 dedicated staff serving 8,000 plus d.p.h. employees and there are seven major functions for h.r. i'm still on the next slide, please. since i returned back to d.p.h., i really have been deeply impressed by the h.r. team. most of us are members of the bipoc community, and we see this as a personal calling. we bring the richness of our own personal lived experiences

to the work that we do which adds to the importance of advancing equity because it's not something for others, it's part of us, as well, that we bring. and so i'm just honored to be part of the team that's so committed to this work, and i want to thank those on my team who are part of this, as well as part of this presentation as well as to answer questions. [names read] >> thank you so much for all the work that you're doing, as well. next slide, please. so although h.r. has been advancing equity through other training and coaching by expediting hiring for specific classifications, h.r.s priorities began with drafting several sections of the racial equity plan under the amazing leadership of dr. bennett and others. so in h.r., we started in 2021

with the creation of h.r. equity council, which has members from each of the h.r. team. the council strategizes with a racial equity lens through tools and training and finding a not always comfortable but safe place to have these discussions so we can learn and grow. currently, the h.r. council meets monthly and the members meet weekly to ensure that we can present the deliverables in a meaningful way. as we know, this racial equity work, there are a lot of decision points that different h.r. professionals make along the way, and it's really important that we are in alignment and have the right training and the conversations

and the tools for us to advance equity. so we will be having a training conference in the fall to make sure that we are all in alignment and advancing the city's goal in advancing equity. i can say while the racial equity plan has a lot, it's not -- we don't see it as a project, we see it as a paradigm shift on all the decisions that we make, and we make sure that we're a data driven team and look at ways that we can ensure that we're moving in the ways that we need to move. dphhr, even though we are 140 members, we are part of the

greater h.r. community, so we do collaborate and work with other stakeholders, d.h.r. and other stakeholders and others, because we're not able to do this by ourselves. we work with other members of the community. next slide, please. so there are four major h.r. focused areas? so in calendar 19-20 and 20-21, we have multiple stakeholders from a lot of great effort and a lot of work, so i'm going to talk about the key accomplishments and some challenges that we are going through in 2020 and 2021 just as a matter of putting in perspective. we have 15 this year, 15 in 2022, and 11 in 2023, so we

have a look to building in future years on this plan. next slide, please. as you can imagine, 2020 brought many challenges, but it also brought some accomplishments for us. so next slide, please. we defined four of the six parts of the racial equity plan -- i say we, but it's actually the part of many others. the diversity equity inclusion dashboard, it's drafted off 16 metrics, and that is a start, related to looking at key demographics at d.p.h., looking at hirings, terminations, by corrective actions, by salary

distribution, by pay equity, covid command activations, and others. and so this goal was really to continue to build in data sources so that we are, you are, and i am, through of work and all of us are able to actually ask multifaceted data points to help us have an understanding of us moving towards how we're doing and help us measure our accomplishments and our challenges. the dashboard has given us some initial insight regarding equity distribution of pay in some circumstances and started looking at covid command activations, and looking at -- and i'll talk about looking at

candidates and the pool selection, as well, so the dashboard is being reviewed by o.h.g. and h.r., and we plan to make it accessible to d.p.h. and others so that we can look at the different metrics in d.p.h., and we plan to do that soon. in terms of the training environments, i know there's a lot of conversation about the great things that have been done by d.p.h. the team at d.h.r. designed and implemented the work on the equity requirement, requiring d.p.h. employees to complete at least four hours of equity learning and documenting it in their performance appraisals. these are expectations department wide towards advancing equity on teams as they work with clients and patients.

on-line data point [inaudible] health equity, 4,757 have completed it thus far. sexual orientation and gender identity and cultural humility, [inaudible] 1,294 [inaudible]. next slide, please. so these challenges, as you can imagine, we went through a number of challenges because of the pandemic -- and we learned several things because of the pandemic, but one of them was h.r. was really reliant on personal interactions and paper. so during the pandemic, so much

of these systems and procedures that didn't necessarily speak to one another halted because we didn't really have a process that was digitized and didn't move without seeing each other face-to-face. and the d.p.h. did a great job and moved a lot of processes into docusign and there were 1,000 hirings done through the pandemic and others, so the hiring process continued, even though there were challenges regarding the reliance on in-office work. and the transition to remote work was challenging, like for everyone. it was challenging having access to equipment and some systems that needs to have v.p.n. access and things like that. but they are really resilient

and they're able to make it. they started their racial equity action plan in november. some key h.r. staff were deployed, which also impacts a little bit of the way in which core work was done while also helping to serve in the effort. as planned, the racial equity action plan was submitted last november, and while they are h.r. deliverables really rely on the larger h.r. community and others. so it was also having conversations throughout the city on being in alignment on things where we were interconnected, which is appropriate for us to be interconnects, but we also had to do that connection with one another, with d.h.r., with civil service, and when we do hiring, bringing it into alignment.

i think h.r. does not have -- h.r. has a lot of data. we have conversations on how we can store that data, and it's a conversation that's near and dear to my heart, and we continue to have conversations with colleagues to continue to move that forward. just an additional complexity is that much of the data that we need to collect is confidential and private because it contains demographic information, so how do we continue to put other pieces of

data together and working with stakeholders that many feel is highly confidential, so that's just some of the complexities. next slide. so of course 2021 has remained a continuation of some of the challenges in 2020. some of the things that we're coming into 2021, there are -- there is understandably a real tense up, need, and frustration of filling up all of those vacancies that we've had in the last 12 months, and there were things in h.r., like assessments and all those things that were slowed down while continuing to address the vacancies that continued to occur. so we're continuing to have discussions with our stakeholders and finding

innovative ways to do things differently. we need to start doing things differently with the equity lens to move us forward with the realization of the loss of 18 months of time. there have been -- i want to thank very much my finance colleagues and executive leadership by increasing my staff by three to help address this backlog. next slide, please. these are some of the highlights of the different priorities, and really, there are all of these different -- different action items, but in having conversations with other stakeholders, there are some key ones that people have continued to raise and i'm sure you've heard of, as well, the hiring recruitment, the need to

have a more fair, diverse, open, and transparent process of who gets hired and with where do we recruit from? there are some concerns regarding pay and equity. people should get paid the same amount for doing the same work, and really looking at that and finding ways, on setting goals, and we all are aware about collective action and the disproportionality that occurs with this collective action, and then, of course, data is key in my decision and collection making. next slide, please. also trying to be mindful of

time. so regarding recruitments, there's a lot of areas regarding the civil service process and assessment process and recruitment, and as dr. bennett had mentioned, in some of these areas, we received feedback about focusing on five clinical classifications and assessing barriers for bipoc applicants and really creating diverse pathways. so we have -- there are -- you know, the city has thousands of classifications, and we have at least 1,000 classifications, and we need to focus on the ones where we have the greatest issue, so we continue to sort of work on those. in case you are wondering, they are the senior position specialist, nurse manager, nurse practitioner, and health clinician are the ones needing a lot of work and support regarding that.

the other part that we continue to work and support is our behavioral health position. need to fill 100 positions in the upcoming year, so we have dedicated solutions to making sure we fill those positions. next slide, please. on the recruitment, we have drafted a hiring and recommended guidelines, and we continue to work on that on making sure we have concrete deliverables and guidelines and policies so that we -- we are actually making recruitments more diverse, and we are hiring

more diverse teammates at all levels. there's a lot of -- there has been some questions and concerns over the years regarding acting assignment opportunities because many acting assignment opportunities [inaudible] we can get an additional acting assignment which can then lead to another career path, so we are working on a policy to form a professional development opportunity. we know that the pandemic has impacted people in different ways, particularly communities of color, so we looked at updating our lead policies from an equity lens in making our policies clearer so that people understand that they don't have to decide between a job and the -- and providing for their families or caring for their

own health, so there are many opportunities that the city has done, and we're working on basically supporting them fully as those policies can get really complicated. i talked about drafting pay, the standard entrance process so that people coming into d.p.h., we have a common understanding in metrics about what step they're placed at? because one, we understand what salary are you at, but as you progress, it takes time to come to that equal pay, so we are committed to doing that work. this is all being done while we're continuing to support covid hiring through that pandemic. all right. next slide, please. labor relations? so the labor relations staff has unfortunately been understaffed for the last 1.5 years. so while it is a team that is

generally about 18 members, it went down to five, and so now, we are staffing up, and that will help really in providing advice, consultation, helping managers and supervisors and staff for success. as i said, we spent a lot of time and resources on boarding staff. we really need to have that level of effort and support to retain staff and continue to develop them professionally, and so we're looking at ways in which we can build up that team and really provide an equitable inclusive environment. we have started -- i know the department has started collecting information because that is part of the central h.r.s process, and we start looking at what we need to do -- to do, and what we need to do is have data inputted

consistently so we can address issues of disproportionality quickly and swiftly and not waste too much time so we have to come back to it, so that is an area. the people development team has also been working on a management training program and an academy to really provide skills. i read an article regarding people feel a sense of community and inclusion at the supervisor level. that's where you feel that's where you're a member of a team, so we need to work on increasing how all members can feel like they're members of a team. next slide. so payroll. so we have started to putting demographic data behind who gets premium pay, who gets those, like, acting pay, lead

pay, right? these are decision making pays about who would get a [inaudible] assignment, who gets an extended salary, and we're looking at these metrics as it results to pay and pay equity. and then people development team? so the people development team is a pretty small team at d.p.h., comprised of five individuals in an 8,000-person organization. next slide. so they have worked on creating and drafting a d.e.i. dashboard, and one of the things when i came on board, i really looked at building out and increasing the data team so that their workforce analytic

section, so really looking forward to doing that. i already talked about the dashboard, so i'm going to keep going. workshops on cultural humility, respect, how to do an appropriate performance appraisal. i'm going to -- so also, what i have been looking at, h.r. has its traditional functions. it has its silos and traditional functions, and not everyone comes into those traditional functions and buckets, so one thing i've been looking at exploring is how do we create bridges within h.r. so an employee can come to us with an issue and doesn't know

automatically where they need to go to get resolution, so we'll have somebody that's a step advocate, somebody that's a bridge and can help them advocate and navigate. it's someone who will make h.r. work for the end user. h.r. works for h.r., and it also works for others, but really sort of turning that around and making it sort of the end user, and making h.r. functions more relatively simple and that it works together so people don't have to say oh, is it this issue, is it that issue, but more, like, how can we help you navigate? we've been looking at career advancement. i've been having conversations with seiu 1421 to really think about ways -- and i've also had conversations with educational

institutions. how can we work together in being able to help our staff advance professionally in what they choose to do? they shouldn't have to leave d.p.h. to do that. they've made a commitment to us, and so we are looking for ways in which we can make a commitment to them through a partnership, through a modern partnership apprenticeship programs, so looking at people's lived experiences, having that credit towards college, towards some certification, and really having different pathways and finding opportunities for our staff to be able to advance.

we can help with existing members of h.r. -- i come from h.s.a., so i talk a lot about the clients and participation in social services and making that a generational change in life, helping people find ways through training and coaching, and also, we talked about how [inaudible] and leadership and finding ways we can have a formal process by which we have a leadership internship. we talked about other internships in the city, and it would be also great to look at ways in which we can foster that with emerging leaders, so lots more sort of on the great work that's being done on that? i think i have gal -- galloped

through my report, so if you have any questions, i'm happy to answer them. >> thank you, director kim. do we have any public comment on the public comment line? >> clerk: sure, we have several. if you'd like to provide public comment on item 9, press star, three to raise your hand. i don't see any hands. >> all right. commissioner giraudo. commissioner giraudo? >> thank you for -- it was an excellent presentation, and a lot of information in there, but i have just a couple of brief questions as just trying

to combine both presentations. my first question is what is the immediate training for new hires on equity other than new modules that a new hire could access at a point in time? is there a timeline to view the equity, the modules versus someday, sometime? is one of my questions? >> luenna, i'm happy to talk about it. so we added an additional training to the orientation for employees. first for nonhospital employees two years ago and then added the hospital employees in the last year? that section included sexual orientation, gender identity,

and trauma informed systems? and it's been a jump between all of them as we tried to find the compact version we can do all three together, and that is the version same as the orientation -- this is a day that's just designed to be about culture: what is the culture of the organization that you're joining, so it's all of those things together? it is a -- meant as a live powerpoint, and that's what it was precovid, and it will probably go back to that, but at the moment, i believe they were doing it remotely, and then, i believe it fell off at some point from pressure, so that was added at that thing, but the module is for everybody, live one contains that material but in a way that allows people to interact a little bit? >> that's where -- after that

additional update day two of the new hire, is, then, for the new hires any kind of follow up discussion with their manager or supervisor or is it confined to, let's say, day two? >> at the moment, it's confined to that, but that is not true everywhere because there is an equity lead at every site, so i know that they each have done different things about what is happening with new hires and how involved they are? i think we need to look at that list of four competencies and pick the core ones and give people some time to develop them, but we haven't given them the material to go with them,

but we will, and then, when we have them in place, i think it will be easy to build out what we want you to know. >> so that's great. that was just really, i guess my concern was someone would say okay, great. smr in the system, you know, that there is follow up, too, which is in the required modules, but i've just -- i just have a little bit of sensitivity to over and done with, so thank you for those questions. >> this is why we did structure first, so that is why we put that structure first, so we can take the position that it can't go away. >> okay. thank you so much. i appreciate it. >> thank you, and i just want to say thank you so much, director bennett, for that. and [inaudible] with the people development team, do you have

any [inaudible]. >> no, thank you. we initiated with dr. bennett's leadership about two years ago, the workshops. they were live, and we had some great discussions from folks coming from the various aspects of their journey. they were ready to dive in and making it a priority around their work at d.p.h., and others were just wrapping their head around inequality, and unfortunately due to covid, we were not able to extend that work. just like most of the spaces, we saw a part of our team activated, and we really struggled with how do we make this a reality? but certainly, we're looking

forward to going back to in person when conditions allow. in the meantime, before staff completing the on-line modules, we have a virtual on-line session with them where we prioritize that [inaudible] with advancing racial equity. >> great. thank you. all three of you were very helpful. i very much appreciate it. >> thank you, commissioner giraudo. commissioner chow? >> yes, thank you for, obviously, an extremely enthusiastic presentation. however, on the page under operations, and this goes to our issue for many years, decreased wait time, you don't have a delivery until 2023, when -- i know during our emergency period of time, we

were able to actually reduce that considerably, so i'm not sure why we could not try to find a more permanent fix sooner than what looks like another 18 months. i think you know, as we all do, the problems of that wait time in terms of a very competent candidate. >> thank you, commissioner chow, for raising that question. one of the things that i've spent, when i assumed the roll of h.r. director when i was at h.s.a., i focused heavily on decreasing wait times because i know the impact it has on an organization. every time you delay by one day a new hire, you decrease the services that are being provided. so while that is a date of 2023, please know that we are consistently and constantly,

and i am dedicated and committed to decreasing the wait time. we've had conversations within h.r. and with my colleagues in the city and each other on how we can decrease wait times. i'm part of the conversation that said i know the city can hire in one day. i know we can hire in a day. it might be a city day, which can be two or three days, but i know we can hire in a day. 'cause i had said, we do things the same way, we're going to get the same result. we're going to get 100 to 200-day term to hire, but i know that we can get it down significantly, so when we have positions open, we can fill them quickly with a robust candidate pool. so we are not waiting, and i

will not allow us to wait until 2023 to address this. i look forward to answering this with you because i know this is a critical issue that has a lot of impact. >> thank you. i'm glad to hear that you're going to continue to work on that. i understand perhaps the goal that you're going to get measured white be in the 2023 range, but that we haven't lost sight of the need to do this as quickly as possible. thank you. >> i don't think anyone would let us -- there are a lot of stakeholders who are interested or impacts by this, and that is a core function of h.r. i see this as a core function of the work that we do and the value we bring is the way in which we are able to on board people. i speak on behalf of myself and my team where we speak daily about this issue. >> i commend you, and i urge you to keep up your enthusiasm, and i'm sure that you're going to make it happen.

thank you. >> thank you. >> thank you. i believe that is it for our commissioner questions and comments. thank you again, director kim. we're very happy to have you on board. certainly, something that resonates in your presentation is that this work happens in a space that's not always comfortable but safe, so thank you for providing this work and thank you to you and others for your presentation today. >> thank you so very much. >> okay. our next item on the agenda is the finance and planning committee update. we have chair commissioner cecelia chung. >> hi. good evening, commissioners. we -- the finance and planning committee met prior to the commission meetings, and it was pretty short meeting because everything was pretty straightforward, and we have

heard presentations of, like, the contract reports for august, you know, which, like, includes some contract extensions and also one in particular i think that's worth mentioning -- actually two -- is with the san francisco community house venture and also the san francisco aids foundations. there is a one year new contract and the hope is that, you know, by the end of this [inaudible] cycle for that, the department would be able to, like, release, like -- would be -- would release the r.f.p. you know, a lot of things have been delayed due to covid, and i think, like, you know, that it's understandable, and so we are recommending that we

approve the august 2021 contracts report. and there's also a new contract for approval, and it is with the united auto systems, which is a coding service. >> secretary morwitz, do we have any comment on the line? >> if you would like to make public comment on this item, please press star, three to raise your hand. >> no hands. >> okay. also do not see any commissioner comments or questions, so we can move onto the next item for action, which is the consent calendar. >> clerk: so for this, all we need is a motion and we can move forward. >> do we have a motion? >> i so move to accept the consent calendar. >> is there a second?

>> second. >> clerk: great. and i just called public comment for that, and we don't have public comment, so i can do roll call. [roll call] >> clerk: great. the item passes. thank you. >> our next item is other business. commissioners, do we have any other business? seeing none, our next item is the joint conference committee and other committee reports. we'll hear a report from the sfgjcc meeting and its chair, commissioner chow. >> thank you. i'll try to condense this, but i thought it was important to at least discuss the presentation we had on the

caddy project, and the name actually will tell you what the project is. it's a centralized ambulance determination for low acuity 911 transports. using this to try to see if there was a way to handle a diversion, and while that is a mixed result through two phases, the attempt to try to bring people to emergency rooms that are less impacted than other emergency rooms is essentially what this is for low acuity patients. and so they seem to have had a

good satisfaction in being able to also bring people to the right locations related to the type of health systems they might be in. however, there has been some reactions that health providers were feeling they weren't being properly recognized in the course of the delivery of the advice, which is by way of a centralized system that looked to see which emergency rooms are impacted, and therefore, if they can more appropriately and earlier be seen in a nonimpacted or nondiverted, then that would be a preferable location, but it would finally be up to the paramedics to see if that would be true or not. but that's got to be worked out and see if we can get a better rapport with the central

station. the other complaint is on the other side, patients who want to go to a particular facility and aren't able to do so, even though one of our rubricks for the low acuity -- again, there needs to be education and working out with the patients. if we didn't have this, then patients might have to wait longer in order to be seen in an impacted emergency room. so all of this requires some work with the ambulance services, and dr. brown is committed to working with this

to enable people getting quicker care, and also they were able to get to the right place. so more to come on that, but this is an on going issue of ambulances, and so i thought that it would be good for you to know that. otherwise, we are working on this, and we look forward to another presentation in his next phase, phase three. we then also did our usually regulatory [inaudible] report, which is the service we've gone through in the interim. again, well -- i would say that we scored well. we had, of course, a good c.e.o. report, the human resource report which brought up the issue again of timely hiring, and the medical staff report. and in closed session, we

approved two other reports. so i don't know if commissioner green might want to add any things that i might have left out, but otherwise, that is my report, and i'll be happy to answer questions. >> you were very thorough, commissioner chow, and i think the committee report was fascinating, and hopefully, that will continue to go forward, and all of the reports that we've received, we are all pleased. >> commissioners, any questions or comments for commissioner chow? i do not see any public comment, either. all right. thank you, commissioner chow. our next item is adjournment. do we have a motion to adjourn? >> i so move to adjourn. >> and if i could add, i would

appreciate if we could adjourn in memory of janice mercatani from glide memorial. her contributions to san franciscans most in need are legendary and beyond measure, and we miss her artistry, her tenacity, her compassion, and she'll be very missed in san francisco. >> i so move to do so. >> i second that. >> clerk: a roll call vote. [roll call] >> clerk: i believe that's it. >> thank you, secretary morwitz, again, for managing an excellent meeting. thanks to d.p.h. staff, thank you, commissioners. for those of you under the

weather, i hope you're feeling better, and we will see you in two weeks. >> thank you, commissioner. >> thank you, director colfax. you're watching san francisco rising with chris manors. today's special guest is dr. steven zutnick.

>> hello. the show is focused on restarting, rebuilding, and reimagining our city. the director of the therapy center of san francisco and he's a professor in counseling psychology at usf. he's here today to talk to us about resocializing, and returning to the office. welcome to the show. >>. >> thanks, chris. good to be back. >> as we re-open, people are having different reactions. some are embracing the recent shifts while others are having a hard time readjusting. >> yes. i think it's an excellent question. my basic bias on this i think to give you a general overview is we ought to be following cdc suggestions and requirements, what they say, because that's where a lot of the things come.

should i wear a mask. should i not wear a mask. my answer is, yes, absolutely. i think we should wear a mask. i think we should social distance. it not only makes an impact on covid, it makes an impact on other diseases as well. as you and i were chatting, the deaths from flu usually average 30,000 a year. we've had 2,500 deaths from the flu so far this year, but at the very least, you need to be vaccinated. >> going back to the office is also an issue. there are some people are thrilled returning to work, others are nervous about it and there's a group of people who've been working onsite all along. let's start with those who are worried about returning to the office. what can be done to relieve their concerns? >> i think identifying a cohort

of colleagues, fellow workers who you can just talk to and share experiences with. you know, when you look at the advantages of groups, the major one is when we sit and talk to other people, we suddenly discover, oh, this isn't just me, i'm not some strange guy here. so everybody else i'm talking to is worried about the same thing. i think that will raise awareness among people. to say, oh, i don't know, what are we going to do? do we have fresh air in here? can we open some windows? does the boss care if i wear a mask? >> how about those who've been going to work all along. possibly the most traumatized. how would you talk to them about managing the possible stress and resentment they may have been feeling. >> the most at-risk population is the essential worker who

because they are also one of the lowest paid populations, have taken the biggest hits and the most risks. they're still at high risk. so they're dealing with a lot. they're dealing with depression, anxiety, insomnia quite a bit. and you've got a lot of ptsd by the way one last point on the health care workers. that's the tip of the iceberg. these are also the people who often have the least access to therapy. so we've got all these people out of there who've been in the trenches the entire time, never had a break, suffering a lot of trauma, and there are no services available for them. >> lastly, let's talk about management. with varying attitudes towards the lifting of restrictions, there may be some struggles in the work place. how would you advise management to ease the transition?

>> management can encourage vaccination or require it. they can keep masks, physical distance, hand washing, all of these things. and hopefully management will be responsive. i think, you know, given the title that the series, this is all new. we're all just moving in to a whole new phase. we haven't begun to see the research that's going to come out of what we've just been through. we've been through a terrible pandemic. there's been a huge toll and i don't think we've seen the tip of the iceberg on the impact. >> do you have any final thoughts to share? >> yeah. i think this pandemic has highlighted a lot of things. for me, certainly, is mental health professional and a behavioral scientist. it's clear to me, we need to educate people about science. this is not unknowable to

people. the basic of science is constant questioning. when you ask a question in research, you get one answer and about five new questions. things evolve continuously. so, yeah, when the cdc first came out a year and a half ago, they said, no, we don't need masks and then they said oh, we do and then everybody went crazy. oh, look how bad the sciencetists are. that's exactly what science does. we thought we didn't need it. then we discovered it was air born. i think we're seeing we have huge holes in the health care system and conversely, i think we're finding with the vaccination, what it means for everyone to have access to health care without worrying about how am i going to pay for it. so i think this is really forcing us to look at everything. it's been a very difficult

time. it's going to continue to be a difficult time for people, but i think that's also getting us to look at some really critical issues in health care. >> well, thank you so much for coming on the show dr. zlotnick. well, thanks again. we'll be back with another episode of san francisco rising shortly. for sfgov tv i'm chris manors. thanks for watching. >> we worked very hard with the san francisco venue coalition, the independent venue alliance to advocate for venues. put this issue on the radar of the supervisors and obviously mayor breed. the entertainment commission and the office of small business and

we went to meetings and showed up and did public comment and it was a concerted effort between 50 venues in the city and they are kind of traditional like live performance venues and we all made a concerted effort to get out there and sound the alarm and to her credit, maybe breed really stepped up, worked with matt haney, who is a supervisor haney was a huge champion for us and they got this done and they got $3 million into the sf venue recovery fund. >> we have represented about 40 independent venues in san francisco. basically, all the venues closed on march 13th, 2020.

we were the first to close and we will be the last to reopen and we've had all the of the overhead costs are rent, mortgage, payroll, utilities and insurance with zero revenue. so many of these venues have been burning $1,000 a day just to stay closed. >> we have a huge music history here in san francisco and the part of our cultural fab lick but it's also an economic driver. we produce $7 billion annual' here in san francisco and it's formidable. >> we've been very fortunate here. we've had the department of emergency management and ems division and using part of our building since last april and aside from being proud to i

can't tell you how important to have some cost recovery coming in and income to keep the doors open. >> typically we'll have, three to 400 people working behind the teens to support the show and that is everything from the teamsters and security staff and usualers, ticket takers, the folks that do our medical and the bar tenders and the people in the kitchen preparing food for backstage and concession and the people that sell key shirts and it's a pretty staggering amount of people that are out of work as a result of this one verne you going tarkanian. it doesn't work to open at reduced capacity. when we get past june 15th, out of the into the blue print for our economy we can open it

it 100% and look at the festival in full capacity in october and we're just so grateful for the leadership of the mavor and dr. coal fax to make us the safest ♪ america and this is been hard for everybody in san francisco and the world but our leadership has kept us safe and i trust them that they will let us know when it's safe to do that. >> a lot of people know about america is military stuff, bullying stuff, corporate stuff. when people like me and my friends go to these foreign country and play music, we're giving them an american cultural experience. it's important. the same way they can bring that here. it sounds comfy buyia, you know,

we're a punk band and we're nasty and we were never much for peace and love and everything but that's the fertilizer that grows the big stuff that some day goes to bill graham's place and takes everybody's money but you have to start with us and so my hope is that allel groups and people make music and get together because without out, hanging together we'll hang separately, you know. >> other venues like this, all over the place, not just in the san francisco bay area need to exist in order for communities to thrive and i'm not just talking about the arts communities, even if you are here to see a chuckle bucket comedy show and you are still experiencing humanity and in specific ways being able to gather with people and experience something together. and especially coming out of the pandemic, the loss of that in-person human connection

recovering that in good ways is going to be vital for our entire society. >> it's a family club. most our staff has been working with us for 10 years so we feel like a family. >> what people think of when they think of bottom of the hill and i get a lot of this is first of all, the first place i met my husband or where we had our first date and i love that and we love doing weddings and i expect there to be a wedding season post 2021 of all the make up we haddings and i hope that many people do that because we have had so many rock ep role weddings. >> i told my girlfriend, make sure you stand at the front of the stage and i can give you a kiss at midnight.

at this got down on one knee at the stroke of midnight. it wasn't a public thing, i got down on one knee and said will you marry me and is he she had are you [beep] kidding me and i said no, i'm dead serious and she said yes. we were any time homicideel of the show. we just paused for new year's eve and that was where i proposed to my wife. this is more than just a professional relationship it's more than just a relationship from a love of arts, it's where my family started. we'll always have a special place in my heart. >> venues, you know, represent so much. they are cultural beckons of a city. neighbors can learn and celebrate and mourn and dance together. venues and arts and culture are

characterized as second responders to crisis and they provide a mental health outlet and a community center for people to come together at and it's the shared history of our city and these spaces is where we all come together and can celebrate. >> art often music opens up people to understanding the fellow man and i mean, taz always necessary and if anything, it's going to be even more necessary as we come out of this to reach out and connect with people. >> we can sustain with food, water and shelter is accurate and does anybody have a good time over the last year? no. >> san francisco is a great down. i've been here many years and i love it here and it's a beautiful, beautiful, place to be music and art is key to that.

drama, acting, movies, everything, everything that makes life worth living and that's what we've got to mow proteasome no san francisco and that's what is important now. >> shop and dine in the 49 promotes local businesses and challenges residents to do their business in the 49 square files of san francisco. we help san francisco remain unique, successful and right vi. so where will you shop and dine in the 49? >> i'm one of three owners here in san francisco and we provide mostly live music entertainment and we have food, the type of food that we have a mexican food and it's not a big menu, but we

did it with love. like ribeye tacos and quesadillas and fries. for latinos, it brings families together and if we can bring that family to your business, you're gold. tonight we have russelling for e community. >> we have a ten-person limb elimination match. we have a full-size ring with barside food and drink. we ended up getting wrestling here with puoillo del mar. we're hope og get families to join us. we've done a drag queen bingo and we're trying to be a diverse

kind of club, trying different things. this is a great part of town and there's a bunch of shops, a variety of stores and ethnic restaurants. there's a popular little shop that all of the kids like to hang out at. we have a great breakfast spot call brick fast at tiffanies. some of the older businesses are refurbished and newer businesses are coming in and it's exciting. >> we even have our own brewery for fdr, ferment, drink repeat. it's in the san francisco garden district and four beautiful murals. >> it's important to shop local because it's kind of like a circle of life, if you will. we hire local people. local people spend their money at our businesses and those local people will spend their

money as well. i hope people shop locally. [ ♪♪♪ ]

>> i'm kate new director of the office of economic and workforce development. i want to welcome our mayor to make some opening comments. >> thank you, kate, i'm excited to be here in the mission with your supervisor, hilary ronen, and your new assessor recorder jaoquin torez, who