that was what the chronic plan attempted to do from just focusing on the chronically homeless and look at the 6300 who are in our system, or more, we don't necessarily have that much of a targeted approach. we do -- barbara might talk about the acutity index we like to use at time. hsa got away from [speaker not understood]. i think it's worth a discussion sort of around prioritization around resource he. should a woman -- she has needs, we want to help everyone who has needs. someone who is here from ohio six months jump into really coveted affordable housing in the city maybe for someone who all their life got moved out in the bayview, and i think it's worth a discussion. >> supportive housing, again, we use supportive housing well. when i say we, i don't mean the city alone. all our nonprofit providers, [speaker not understood]. they do a fantastic job, they do a good job providing quality housing, housing, and keeping folks housed. we wanted to get as many people as shelter as possible. people didn't need to get housing ready. they needed to [speaker not understood]. the vast major

how many homeless people, chronic and not chronic, live in golden gate park? do you have the ability to hone in on that geographical area? that data would be helpful to me. mr. rohr shared one-third of the population is african-american. is that consistent with your numbers? i know when the census has done its counts, there is a civil rights battle to under count for low-income and african americans. how do you do your count? they use the census and other ways, but how do you adjust for maybe an under count of your numbers especially reaching non-english speaking populations like the undocumented population? >> [speaker not understood] will come up with the other questions you had. i do know one number off the top of my head. you mentioned the ethnicity issue. our survey indicated that african americans represented 24% of the homeless population in our survey. and in your profile of 6% in the general population is accurate. relative to making adjustments for under count, the hud guidelines that are put out for the count are very prescriptive and they actually

according to the homeless count there's 2000 in the chronic homeless. it puts us in top 10 in the country and it was 3,000 at the time this report was done. and i think trent can elaborate on some of these numbers, but i'd say we've come down about a third in terms of those numbers with the investments we've made. >> in terms of chronickness, but the homeless count on our streetses a you stated earlier, stayed flat the last 10 years. how do you think about that or how should we think about that as a city where we have built more housing and housed people, thank goodness, but the numbers have stayed flat? are there more additional reasons? people are homeless at this stage and numbers haven't doctionv down even though we've added people into our housing? >> well, i think again, given the city's fiscal situation, the fact that we've been able to achieve this level of new permanent supportive housing is laudable and i think amazing. i think it's unquestionable that 3,400 people being on the street tell us that we need more. the most dramatic change you've

it leads to chronic illnesses as we talked about. you can make a different kind of argument for most of the other products that you've mentioned. having a healthcare organization, a his where healthcare services are delivered also selling a product that is universally harmful is a conflict of interest that you can't ignore. >> while you check out your lipitor as well as looking at a quarter of ben and jerry's. >> not quart, but you can have some. >> the company acknowledged from the very beginning that it's going to trim $2 billion from its revenue. yes, it's a north of $100 billion growing concern, how much of a big deal is this as a business decision? >> not necessarily a lot. when you look at what they're bringing in terms of revenue and profitability and cvs is a healthcare servicer, meaning they help plans, health surers employers manage their healthcare costs. that's a key piece of their business. it makes logical sense to take these products out of the retail side. it's not a big hit to the bottom line. what they can do now is

crisis intervention resources, and then chronic mental illness. and this is around the area of laura's law. i am very supportive of the cipp court that the health department and our courts, our public defender and our da have been involved with. i think it is a very important model. there is push for more tools in the tool box which i think are appropriate. i think the tools in laura's law that allow family and friends petition when they're concerned about the well-being of a loved one failing in and out of the mental health system is very important. there are other tools around intensive case management and also our mobile crisis team. you know, our health director is not able to ask for more resources because of the difficult budget environment. i've got to say for me, the mobile crisis team which obviously struggled during the different year for the city is an area we can staff better. i would estimate from their high point they're maybe at 50% right now. they've got a grant application for a couple of vehicles because they only have one vehicl

the chronic numbers are as a percentage fairly consistent. hud had been narrowing down the definition on chronic homelessness. as i said in their rules, definition every two years. so, that contributes to the reduction in the number as well as the services and interventions that are taking place. >> so, the count we have, that was like 4,000, it went down to 1.9 thousand,000. [speaker not understood]? >> some of it is. i'm not going to say all of it or whatever, and i don't want to lessen the contributions that have been done by different programs, but there's absolutely definitional impacts on the numbers. and that's not just true of the chronic definition. that's true of the overall count. communities have done better job through the years of doing the counts, but there ha been a lot of clarification and technical assistance by hud provided to communities and a lot of that technical assistance has resulted in the elimination of a lot of data sources. >> so, that doesn't change the definition. how about the information that's collected, is t

heart failure, hypertension, diabetes, cancer, stroke, those kinds of chronic illnesses. when you get them in your 30's and 40's and you have them into your aging process, you are not going to have a comfortable old age. you are also seeing in terms of epidemics, an increase in alzheimer's and it is going to increase as the population increases. there are quite a few seniors who have mental health problems but they are also, the majority of seniors, who are hard-working, who had minimum wage jobs their whole lives, who paid social security. think about living on $889 a month in the city of san francisco needing to buy medication, one meal a day, hopefully, and health care. if we could provide health care early on we might prevent (inaudible) and people would be less likely to end up in the emergency room with a drastic outcome. we could actually provide prevention and health care to people who had no other way of getting health care, those without insurance, it might be more cost effective >> welcome to the san francisco historic preservation commission regular meeting. f

between acute and chronic. you're going to deal with chronic. >> yeah. i think the thing is, we can address allergies directly through suppressive techniques. that's what modern medicine does. i would like to really cause the body to express and get rid of the things we're suffering from so we don't have that in the future. that's my goal. >> today's medicine actually deals with symptoms, not with the cause of what's happening. and what you want to deal with, and address today, is the cause of these allergies. >> right. >> so people can get right to the cause and not have to take a medicine for a symptom. >> as an example, you can take homeopathic medicine, like the pungent red onion, chop it up in the kitchen and it causes a drainage, congestion. you can take that homeopathically and reverse the symptom. but why did the allergy appear? really, why have you reacted to the allergen? that's the trick that seeming these allergy doctors don't necessarily ask. if you put two people in a room filled with dust and mol

with caregivers of alzheimer's victims, you have a really severe long-term chronic stress. in some ways, it's analogous to bereavement work in that some caregivers call the process one of continual bereavement as they watch parts of someone they love dying. to study caregivers, we would look at not only caregivers, but then controls-- people who are the same age and sex but who don't have caregiving responsibilities-- so we'd know if it were the caregiving responsibilities versus the absence of them. over the course of several years of study, from the first to the second year in the study, immune function declined, particularly in spouses who are careving for a spouse, who tended to be older and tended to be providing more extensive care. what makes this study noteworthy is that the caregivers were ill more days than the control subjects. the researchers, with the subjects' permission, contacted their physicians to validate this data. we find that there's really excellent correspondence, that when caregivers report certain symptoms, we have a good match with physician recor

chronic loneliness is chronic, it's not just something that is a weekend or after mourning the loss of something or someone. this is something that just goes on and on and on. you literally have no one that you talk. to there were people that i interviewed for this article who said it is toxic, it is unceasing, it is brutal. and when they're describing it like that you get an idea of how painful that type of loneliness is. there were people i talked to who said they hadn't spoken to anybody in two weeks. >> in two weeks. >> in two weeks. >> you know what, guys, it's easy to do that, though. you go to the amount these days, you can do it at a kiosk. go to the drugstore, check out all by yourself. you can go to the bank and use an automated machine. >> work from home. >> you can order anything you really need online. >> without talking to people. >> without going to old-fashioned stores. >> sanjay, two weeks in a long time. >> that's a long time. the thing is we humans are tribal creatures. evolutionarily we survived and thrived because we were tribal. we took care of each other. so i th

host: what are chronic diseases? guest: diseases like heart disease that promote ongoing disability. for example, heart failure makes it difficult to walk from exercise, creates chronic shortness of breath and has a negative impact on their quality of life. part of what we are trying to do is to develop preventive strategies that can keep the heart healthy so that it does not fail to act as it should as a pump and to keep people healthier, so they live longer and more productive lives. causes, andre the how many causes are there of heart disease? guest: the major problem with heart disease is the clogging of the blood vessels that feed the heart. as you are probably aware, the research done with the heart study that we funded identified one-week all risk factors for the development of those clogged arteries. it relates to things like high blood cholesterol, high blood pressure, cigarette smoking. and these risk factors injure the blood vessels that feed the heart, clogging the arteries come and up writing the heart o

they have all come together to get all 222 chronic homeless veterans off of the street. they call it housing first. and that means getting the veterans into permanent housing first before they're treated for substance abuse or mental illness. this is a program that they launched several years ago, but all of the organizations tell me as of today, they have every one of those 222 veterans placed in permanent housing. >> we have reached a critical milestone, and we have a lot of work ahead. we need to continue to have the political will and the collaboration to not only address homelessness, but all veteran homelessness. >> and organizers say that this is the key. they have found this program that works, and they want to make sure that's phone number just the chronically homeless veterans housed but all homeless veterans, and here in this state, they have others. >> akiko, are there other cities doing this? >> we know there are other cities, like salt lake city and philadelphia, who have adopted the same kind of program and ended veteran homelessness as well. and they are

. >> they are claiming to be the first city in the country to eliminate chronic homelessness. the city healed the arizona stand-down event, designed to help homeless vets regain a sense of independence. >> this is the largest stand down in the country. we are expecting more than 1500 veterans, who are homeless or at risk to come through the doors. take a look at the line. i can sense how big the need is. that's the line for a meal. this is really a one-stop shop where veterans can come in, get services it needs. they have showers, beds where they can rest comfortably, and desks set up so you can talk to experts about sucial security, medical benefits. it's getting so much attention. the city has become the first city in the country to eliminate chronic homelessness among all veterans. the federal government, the city, all local and nonprofit groups have worked partners to get everyone of the 222 homeless veterans off the street scrks they have done it through a unique approach, called housing first. getting the veterans in homes before they are treated for mental illness and s

and part of that responsibility will be to do the right things to prevent chronic illness, and acute illness, tobacco does both. >> dr. wender, thank you for joining us. when we come back, after a quick break, we will continue our conversation about cvs's decision on tobacco and try to understand the public health and branding business decision that's go into stopping a product. >> welcome back to "inside story." i'm ray suarez. cvs just announced it will phase out the sale of tobacco products. it will cost the company $1.2 billion in annual revenue, but what does the decision mean in the fight against smoke something the nation's health? dr. steven schroeder in san francisco joins us in washington. he's the director of the smoking cessation leadership center. from chicago, morning star equity research, where he focuses on the healthcare services industry. and the president and ceo of the robert wood johnson foundation, joins us here in washington. dr. schroeder, is this a symbolic move or one that results in the end of the process with fewer people smoking cigarettes and. >> it's cl

. >> chronic homelessness among veterans, arizona cps stand-down event event. akiko fujita has more. >> this is the largest stand-down event in the country. we are expecting 1500 veterans at home or at risk to come through the doors here, by the end of the three days of this event you take a look at this line here, that gives you the sense of how big the line is, that's for meals. but this is really a one stop shop where veterans can come in here get all the services they need. they've got showers, beds where they can rest comfortably, they can talk to experts about social security benefits, medical benefits. it's an annual event but it's getting so much attention this year because this has become the first city in the country to end chronic homelessness among veterans. all groups have worked as partners to get every one of the 222 chronically homeless veterans off the street. and they've done that through a unique approach. they call housing first. that means getting the veterans in permanent homes first before they're treated for mental illness or substance a

and that chronic can be a totally sint infection. it can be a very mild form of hepatitis, or it can be a very severe form of hepatitis that's quite progressive and leads to cirrhosis. we also know that if the infection occurs peri-natally, around the time of birth, that the likelihood of developing a chronic infection is much, much higher. some of these chronic infections will also lead to liver cancer, and so the burden is quite significant. another std that affects newborns is chlamydia. jane davis: we have a fairly high prevalence of chlamydia in the clinic and most of that is probably because of the young age of our patient population. chlamydia is a quite common std in adolescence. chlamydia by itself, does not really pose a problem to the pregnancy vis-a-vis looking at pre-term labor, premature rupture of membranes, but it can cause some problems with the neonate, the newborn. it can cause a fairly significant conjunctivitis. in fact, it's one of the leading causes of blindness in this world, chlamydia conjunctivitis. at deliv

i know this is about chronic homelessness, you know, but we kind of prefer to look at it as a holistic issue. so, one of the things we want to do and we made some leeway, we need to go farther. we need to halt all preventable [speaker not understood] in san francisco. legislation and budget action. there is a lot of stuff that's being discussed here. we'll be coming forward with budget proposals around this, but we shouldn't have anybody else lose their rent control apartment in san francisco unnecessarily. we need to develop eviction standard in nonprofit housing and public housing. we talk a lot about eviction in the private market. we need to really kind of set the standard in our nonprofit and public housing and have a mediation before it goes to eviction. since 2009 the eviction collaborative said there's been [speaker not understood] human agency funding alone. since those folks are coming out of homelessness, presumably we can say a good proportion of those rushed to homelessness after eviction. it is so much harder to get back in housing. that is something legislatively we can

host: what are chronic diseases? diseases like heart disease that promote ongoing disability. for example, heart failure makes it difficult to walk from exercise, creates chronic shortness of breath and has a negative impact on their quality of life. part of what we are trying to do is to develop preventive strategies that can keep the heart healthy so that it does not fail to act as it should as a pump and to keep people healthier, so they live longer and more productive lives. causes, andre the how many causes are there of heart disease? guest: the major problem with heart disease is the clogging of the blood vessels that feed the heart. as you are probably aware, the research done with the heart study that we funded identified one-week all risk factors for the development of those clogged arteries. it relates to things like high blood cholesterol, high blood pressure, cigarette smoking. and these risk factors injure the blood vessels that feed the heart, clogging the arteries come and up writing the heart of --od

there are lots of different ways to treat comic pain -- chronic pain. you need to be offered more than shots or pills. there is also various kinds of yoga, thererapy, are all kinds of other methods to begin to try to bring down the pain. it is really a tough problem. you should have access to a of different kinds of treatment and not be dictated to. host: there is another tweet -- guest: absolutely. peopleow, millions of have access to our records. let me give you a very specific example. i think thesnowden analogy is very apt. it is really a tough in a typical hospital like here in austin, the population is about 2 million people. we have two major hospitals. maybe three. we have a public hospital, a catholic hospital, and then we have a hospital corporation of america hospital. records on most of the 2 million and all of them 5-7000aff, at least doctors and nurses and everyone of them can see the records of all 2 million people in this area. these are just hospital employees. this does not include insurance notany employees, this does include electron

i should mention that while the city of phoenix has reached that milestone of 222 of those chronicallyeless off of the streets, organizers say it is important to remember that there are still a lot of homeless veterans, and del here in the state of arizona alone, there are still more than 1200 still out on the streets. >> thank you very much. ♪ >>> investors seemed to be in a good mood ahead of the long president's day weekend. the blue chips on track for a second straight week of gains. the nasdaq is down slightly today. >>> the missouri house has been asked to investigate the soaring price of propane. propane suppliers say the harsh winter has send demand skyrocketing. >>> the stuff winter also affecting u.s. factories. manufacturing output in january has its largest drop since may 2009. >>> and we made know tonight the outcome of that vote involving union labor. workers at the volkswagon plant wrapping up the vote on whether or not to join the union. opponents say unionization will be bad for business and make the area less attractive for companies. >>> in northern ireland local off

so when my moderate to severe chronic plaque psoriasis was also on display, i'd had it. i finally had a serious talk with my dermatologist. this time, he prescribed humira-adalimumab. humira helps to clear the surface of my skin by actually working inside my body. in clinical trials, most adults with moderate to severe plaque psoriasis saw 75% skin clearance. and the majority of people were clear or almost clear in just 4 months. humira can lower your ability to fight infections, including tuberculosis. serious, sometimes fatal events, such as infections, lymphoma, or other types of cancer have happened. blood, liver and nervous system problems, serious allergic reactions, and new or worsening heart failure have occurred. before starting humira, your doctor should test you for tb. ask your doctor if you live in or have been to a region where certain fungal infections are common. tell your doctor if you have had tb, hepatitis b, are prone to infections, or have symptoms such as fever, fatigue, cough, or sores. you should not start humira if you have any kind of infection.

i myself had to deal with chronic health issues through high school and college. you covered what it was. managed time, medications, hospital visits, all of those things. it's a huge order for people at such a young age. i appreciate you touching on some of those issues. >> other councilmembers? i have a question for each of the speakers. dr. wiel first. you described peritoneal dialysis very well. i wonder how much discomfort is this person in. you show them lying peacefully in bed, but is there discomfort involved? >> there is very little discomfort involved in peritoneal dialysis. the abdominal cavity holds a lot of extra fluid and there is at the first few exchanges when the catheter is first put in that stays there, there may be some adjustment discomfort, but the actual fluid going out which is the first phase, emptying out what's there and then putting fluid in and the fluid staying in is essentially asymptomatic. it's very free and as you saw there are patients who sleep and at first, i thought i wouldn't sleep with this business going on. i had a patients

this is to eliminate chronic homelessness among veterans. thathey've done it through a . >> traditionalcally people need to be taking their medication and clean and sober before we consider housing, so people who have been on the streets for many, many years, we put them in housing and then provide the wrap around services, a social worker will go to their home and provide those services to them and see how they you pull them in for that care. >> we should mention while you have all th the chronic illnesss out now, the work continues. >> absolutely. we have so many services going on here. we have courts, va benefits, the idea is if anyone is homeless, we can continue to work with them so they can improve the quality of their life and not return to the streets. >> we're wrapping up for the day out here. again this event goes for three days. organizers say it's important to mention while all the chronic homeless veterans have been housed there is still more than 1200 homeless veterans here in the state of arizona alone. richelle, back to you.

but when we toured the chronic care unit, which houses mentally ill inmates, we walked in on a quiet drama. >> we were there for our scout week, which means we can't even have a sound guy with us. but we knew we had to roll when we came upon this scene. >> we came upon this inmate, michael steele, who was sitting outside his cell with his items all packed up. he was convinced he was going home that day. and it was becoming a problem for the prison, because nobody could dissuade him from this notion. >> i've been in prison since november 3rd, 1988. for a crime that i was charged with and i'm not guilty of. >> okay. what's going on today? >> that's why i'm leaving prison. >> is it time for you to leave? >> my prison time has expired. >> what are you doing sitting here? >> to be released from prison. >> how long have you been waiting here? >> approximately 14 minutes. >> in reality, he was nowhere near his release date. he's serving 110 years for murder and attempted murder. >> which one of these cells was yours? where did you sleep at night when you were here? did you sleep in one of t

but it's the chronic cases, people homeless for more than a year, who kanis says are most in need off friends who will let them sleep on their couch. they're out of friends who will help them get a job. they've burned the bridges of the friends, or they just didn't have them in the first place. >> cooper: more than 60% of the chronically homeless have drug or alcohol addictions; 30% suffer from severe mental illness. kanis says many of these people have such serious medical problems, it costs taxpayers more to leave them on the streets. how is it costing more? >> kanis: the inability to tend to your basic healthcare needs results in people on the streets ending up in emergency rooms and ending up in in-patient hospitalizations. and one night in the hospital is a whole month's rent, on most places. >> cooper: so you're saying it's more expensive to allow a chronically homeless person to live on the streets than it is to actually subsidize an apartment for them? >> kanis: yes, we are paying more as taxpayers to walk past that person on the street and do nothing than we would be paying

because in this country too little is known about treating chronic pain the idea. visit the world health organization says that every year five and a half million people die in extremely painful conditions it's an untenable situation for dr lucas melody on a president of the indignation pain association. we got there the time we have to work towards better education in the area of pain therapy in indonesia. when the gas my doctors shouldn't have to shear prescribing more thing i'm not about our day. that will come too late for a ridiculous thing. she died shortly after filming this report. this is just in the process of launching a nationwide health insurance scheme which it is hoped will also address the question of access to pain therapy. we had to south america to the border region between guatemala and mexico the byzantine and not about the most tactile place to go it was immediately pointed towards the volcano nearby that's because it's thus provides excellent conditions to grow all sorts of crops including very good coffee we follow one on trying to keep this

we heard about this grommet -- chronic illnesses. you can't leave out mental health.it cannot be a purview of psychiatrists and the like. it has to be the purview of all of those treating health conditions because those of you who were interested in outcomes, arerevor is, the outcomes going to be better if you are treating the cardiovascular -- cardiovascular patient who has depression, therefore ties were likely to have a heart attack. if they have diabetes and tricking alcohol, forget about. sure really about making that it is seamless and if i don't have to go down the hall is, i'm the psych ward not going to be obsessed about whether i have a mental health issue or not because it is going to be a routine part of my checkup and will not be so unusual when the doctor says, what is your anxiety level? how many drinks have you had this week? questions that we do not get asked in the health care system. [applause] important that anyone out there that is needing or wanting access to mental health care -- number one, you are public about your own struggles. mental health