my name is karen pierce. i'm a native san franciscan. i am a resident homeowner in bayview hunter's point. i have raised my kids in the city, and i am an employee of the san francisco department of public health. i spoke at the september hearing , and i just want to reemphasize the main points that i made. that is that the health departments is in crisis. and the way it is manifesting most is in the health of the people we serve. if you look at the statistics on african-american and black health in the city and county of san francisco, you will see that there has not been any progress and in many instances, things are getting worse. we don't need ptsd. we are in constant attack. we need your support to change it. this is not necessarily a reflection solely on the existing leadership. this culture has been built over more than the 20 years that i have been working with the department. we cannot expect the people who are now in leadership to step right up and make a change. but we need you to make sure that the department takes a look at w