department of public health. two doctors came from los angeles and thank them for travelling so far. thank you for finding time to join us today and share your perspective. and i will now turn it over to dr. kraft. >> okay. thank you, i'm dr. colleen kraft, the immediate past president of the american pediatrics. we're going to measles outbreak 101, when it happened, and why immunizations for measles and other illnesses is important. the american academy of pediatrics is a nonprofit norjs with more than 67,000 peed i gos trigses, including primary care, and subspecialists and we're dedicated to the health and safety and well-being of all children, adolescents and young adults. we publish recommended childhood and adolescent immunization schedules along with acip, with the c.d.c., with the american academy of family physicians and the american college of obstetricians and gynecologists. let's go back to the history of measles in the united states. in 1963 the measles vaccine was licensed and in 1968 the measles va

that the congresswoman couldn't be here today, i want to thank her for being a true champion for public health. also want to thank the american academy of pediatrics for being such a great partner to us as we start this event. so, big cities health coalition was founded i was a former leaders for health departments to exchange strategies and address issues to promote and protect the health and safety of the residents. there -- we have of pediatrics will do a measles outbreak one oh one and why immunization is so important. the american academy of pediatrics is a nonprofit professional organization with more than 67000 pediatricians we are dedicated to the health and safety and well-being of children and adolescents and young adults we publish recommended elimination schedules with the cdc american academy physicians and gynecologist so let's go back to the history of measles in 1953 it was licensed in a 1968 the vaccine began to be over the country it is the acute viral disease by a cough and runny nose red eyes and sore throat and a rash that begins in the face and spread throughout the body

including data systems the need of modernization a trained public health workforce including the data savvy workforce. the cdc has made important recommendations to the public already including the comment that while it is ongoing, people that are concerned about health risks consider refraining from using products or vaping. people should not acquire products off the street. you shouldn't modify it further beyond what is intended by the manufacturers. a bold step e-cigarettes or vaping products because they've quit cigarette smoking should return to smoking cigarettes. fourthly, this outbreak reinforces the need to address the broader academic of -- cigarette usage. it's a striking young people. half the cases are under 25. about three out of four are male, but the numbers are changing as we get more data. we are getting new cases reported every day, and i expect this week's numbers to be hundreds higher than the reported last week. what we don't know unfortunately is the cost. we know that most of the reported cases with information available so far described the use of containing t

know the congresswoman could not be here today i want to thank her for being a true champion for public health also the american academy of pediatrics for being such a great partner as we planned this event. the health coalition started in 2002 is a forum for leaders of the largest metropolitan health department for strategies to jointly address issues to promote and protect the health and safety of the residents we have those jurisdictions whose health department serves nearly 62 million or one out of five americans we'll have two jurisdictions here today. you have bios in front of you i will not take up time i want to introduce the panel that i will turn it over to them. the order in which they are presenting doctor kraft is the immediate precedent of aat the commissioner of health in new york city the chief medical officer l.a. county public health both came from california so we have a special thank you to them to travel so far. thank you for finding the time to join us today to share your perspective and now i will turn it over. >> from the american academy of pediatrics will do a measles

it is a public health crisis. hundred 30 people die each day in our country from drug overdose we are making progress this year but with a long way to go. we need to stay focus. i remember when i started as an aids physician , my patients had a ten-month survival rate. look at where we are today? the same has to be said for those individuals that are confronting opioid addiction. you've heard me say this before . we need to recognize it for what it is , a chronic medical condition and we need to embrace it, is not a moral failing. we need to put that power of science behind us. to provide long-term solutions towards his medical condition. it's discouraging that methamphetamine is the leading cause of death in eight states in our country. i would encourage i want to realize that if you can do science it is a meaningful impact. that we should be able to figure out how to bring this against the drug use order. i want to reflect back on science, many people heard me talk. the most important thing is to see the possibl

so we encourage you to approve this facility as approved by the department of public-health and of course reviewed by the department of planning and the department of public works, three departments that have recommended approval of the site. >> i have a question, councilor and thank you. can you explain the difference between this antenna and the antenna that is generally before us. we're hearing the ones on the pole top. this is a more robust system. >> yes, so, as you heard me go on before, right now verizon is using three different types of radios in san francisco. the site that will be coming up later is on a light standard and that's a five-watt radio. on utilities polls we're using 40-watt radios. thes the same we're putting on every utility pole in 70 in north beach and elsewhere throughout the city. we have afour-foot- antenna and the difference here is that we're using only one of the directions. because of that, the radio signal is then concentrated in that one antenna giving us a higher effective radiated power than you would have. i spoke to the engineer and she explained tha

alcohol remains a persistent and enormous public health issue that impacts the lives and health of many san franciscans. our most recent community health needs assessment revealed that two out of five adults surveyed reported a survey of binge alcohol use. between 2014 and 2016, over 8,000 emergency room visits resulted from alcohol-related issues. we can help. we know how to care for alcohol use disorders. we've already begun to work on the kind of evidence-based approaches to chronic alcoholism that this report recommends and particularly exploring the development of a managed alcohol program. the research is very strong that managed alcohol programs, medications, and treatment can reduce the harms of excessive alcohol use. we can create safety and stability for people if we innovate on this problem together. we need to make sure that proven solutions are applied in a thoughtful way and extend their reach to people who have not had sufficient access to the help that they most need. we also agree with the report's findings that we should make it easier to get realtime data about our sy

i'm particularly proud of the department of public health. they continue to show their commitment to innovative and ground-breaking health solutions. i also want to thank ucsf and getting the goal coalition and all of those with us who continue to show their commitment to addressing this issue as well. even though we've reached this incredible milestone here in our city, we know that there are still disparities that exist, specifically by race and ethnicity, by age, by gender, and, sadly, by housing status. these disparities highlight the work we have to do to continue to get to zero and really trying to remove the barriers, the stigma, the discrimination, so that we can truly end new infections, which is our ultimate goal. in fact, in 2018, african-american men had the highest diagnosis rate. african-american women also had the highest diagnosis rate. fighting this should be our focus and we are taking steps to do so. this week the department of public health will launch a competitive bid process where we will allocate $8 million in additiona

is cathy chung, and i'm the director of facilities and capital planning for the department of public health. i just want to say that we're actually quite excited that after many years of planning we have three community clinics of our health centers going into construction by erl early next year. they are once in a generation-type projects. we've worked very hard, hand-in-hand, in collaboration with the public works team. so we would like to thank them for all their efforts, and just look forward to getting these done and being able two move back in. >> chairman: great. thank you. >> i'm terry schultz from the department of public health, zuckerburg capital planning. it is going to and transformational. the seismic project is going to be impacting, as joe said, there are 206 touch points in the building, but they usually have a column which impacts two rooms. so usually it is sandwich between two rooms. there are 400 changes or relocation that is we have to do enabling those efforts. so there is a lot of risk that is involved with that effort. and we spent a lot of time with joe's team and

why was that necessary to public health? public, nott the knowing what the actual etiology is, but knowing the commonality along all of our 69 cases was vaping. we know something with the activity, whether the product, the device, the brand, something they are in is the culprit. without knowing specifically, it seems safer to give a broader warning until we get more information out. >> before my time expires, reports show e-cigarettes aerosol is not harmless. why is it dangerous to individuals? >> the chemicals within the aerosol are usually irritants to the lungs. withungs then respond different kinds of reactions that we are seeing in some of the patients, which affects the oxygenation, the function of the lungs, which results sometimes in needing a breathing machine to perform that process of oxygenation. >> my time has expired. i want to confirm my understanding. the testimony of ms. porter is anecdotal related, specifically to her opinion and that she is not a public health expert. >> i think that's correct. grossman --c

grant colfax, who is the director of the department of public health, as well as dr. anton nagusablan who is the director of mental health reform. daniel leary, the c.e.o. and founder of tipping point community, and matthew state, the chair of u.c.f. department of psychiatry here in san francisco. i'm excited because these are incredible leaders in our community who are going to help us with some really challenging problems that we know we face as a city. last week we launched the mental health reform initiative to help those at the intersection of homeless, mental illness, and substance abuse disorder in san francisco. and through our detailed analyst, dr. nagusablan and the department of public health have identified the people in our city who are most vulnerable and in need of help. now, to be clear, we see it. but now we have clear and accurate data. of those 4,000 individuals, 41% frequently use urgent and emergency psychiatric services. 95% of those folks suffer from alcohol use disorder. 35% are african-americans, despite the fact that we have a less than 6% pop

you love public health. there are i love public health. there are i love public health.nothing that the public health experts think isn't going to kill it these days. i think the key here as it was a simulation, kind of like getting on a rollercoaster or fu n kind of like getting on a rollercoaster or fun ride, you kind of like getting on a rollercoaster orfun ride, you are in itfor rollercoaster orfun ride, you are in it for the thrill. if you cut in the simulator, you don't crash in real life. i'm not totally convinced by the methodology. you listen to music in the car? i do. fast muzic? i do. and i am music in the car? i do. fast muzic? ido. andlama music in the car? i do. fast muzic? i do. and i am a good driver, i was go the speed limit. i'm not convinced. if you listen to like using with a light tempo of below 80 beats per minute, it is like driving in silence because of the soothing music. but the flipside is it could send you to sleep! let's quickly move back to the telegraph, they have a story of these women who has crossed the channel 4 times. this is the most

joining in the conversation is being had jumped professor at the columbia school of public health and was for 12 years the chief medical officer for the new york state office of mental health. the nation's largest mental health agency where he was a psychiatric advisor. he's written many books including ones we have here tonight. addiction, solution, trading our dependency on opiates and other drugs. he is also written a family guide to mental health care and improving mental health, for secrets in plain sight. please doctor harding to the strand for this important discussion. [applause] >> first of all, nancy, thank you for having us and that beautiful introduction. it is an honor to be at this famed bookstore. i mean, really i didn't grow up in new york and the strand has this mystique to it to be sitting here and sitting among these books is just one of the highlights of my life so thank you so much. and to be surrounded by so many people that i absolutely love, this is just an incredible treat. so, i just can't -- i am seeing so many faces so thank you, thank you so much. because

the -- how is yet another public health problem widely talked about related; namely, loneliness. how do i you connect loneliness to this, to these problems with our health and these problems with reaching one another and kindness? >> so kindness comes down to really taking care of one another. and so when we think about it as a society, we're not doing a great job of this. and loneliness is a big piece of this. so, you know, there's all this data now that actually loneliness is as detrimental to your health as very well-established respecters like smoking 15 cigarettes a day, heavy alcohol use, even high blood pressure. but the question is, you know, how many times does your doctor maybe ask you do you smoke, do you drink, but are they asking you, you know, when's the last time you called ad good friend or saw someone you cared about? if things got rough, would you have somebody to turn to? it turns out that's really critical. it's time we started talking about -- >> and have you gotten a hard time from your colleagues for saying that we're missing the boat, that, you know, when w

haney and i are calling for a public hearing grade we are requesting that both the department of public health and the department of human resources be present at the hearing, and discussed the following areas. we've also sent an extensive public record information, records request to both departments. we want to know the timeline when the decision was made by the department of public health, and whether any alternative options were considered that did not require the closure of beds at the adult residential facility. we want to know why the board of supervisors, despite the numerous hearings and budget hearings precisely on this topic were never once informed that this decision was in the works, and that these beds were purposely being kept close, and unfilled for a year, which was extremely relevant to our consideration, and determination on whether or not to vote in favor of the conservatorship law. this would have been information i would have love to know, when i had voted in favor of that law. the reason i rationale behind close in the beds, stopping needs at the adult residential facili

i just want to emphasize that the san francisco department of public health shares the concern about providing trauma-informed care. that's been a commitment for a number of years. we strongly believe that you can't fully address someone's h.i.v., substance abuse, mental health issues, or in some cases their life on the street to get them into shelter or navigation center or housing without bringing a trauma-informed approach to care. that's a key part of what the department has been working on. we've actually trained over 8,000 people in the departments and some community providers in trauma-informed care. i also want to link the broader question of how do we approach the disparities in h.i.v. infections. if you look at the mental health, substance abuse, the housing inebbingiquities, this about the system. if you look at the focus on the 4,000 and the same principles and issues around inequities, the same focus on data and driving down the numbers, it takes hard work. sometimes we think, oh, there should be some fancy fix overnight and we should be able to reach into the sky and bri

i cannot emphasize strongly enough that this is a public health issue. and as an emergency physician and public expert, i am heartened to see a fellow emergency physician and public health expert on our panel today. doctor, thank you for sharing your moving story and thank you for your work to save lives. we have both seen the realities in being in the front lines when victims of firearm violence roll into our emergency departments and we work to save their lives, we've mourned with their families. when the medical care can't overcome the devastation of a bullet, we're the ones that usually have to tell the family members. there's no other group other than the victims themselves and he survivors that can really experience that who are dennis -- horrendous suffering that happens. but those are the stories that we take home and we contemplate for the rest of our lives as well. taking a public health approach to firearm violence makes sense. we've used a public health approach in this country before. we've used public health research to craft strong tobacco

chairman, i cannot emphasize strongly enough that this is a public health issue, and as an emergency physician and public expert, i am heartened to see a fellow emergency physician and public health expert on the panel today. dr. windermute, thank you for working to save lives. we have seen the reale tis when victims of the firearms roll into the emergency room departments. we work to save the lives and mourned with the families when the best medical care cannot overcome the blitz, and we have to tell the family members, and there is nobody other than the victims and the survivors who can really experience that horrendous suffering that happens, but those are the stories that we take home, and we contemplate for the rest of our lives as well. taking a public health approach to violence by firearms makes sense. we have used public health research to craft strong tobacco laws, and also for seat belts to prevent people from dying in car crashes. so to prevent these deaths, what is your definition to clarify of what a public health approach to gun violence is. >> thank you. the best artic

we need to invest more in public health and mental health. do, because we will do it. smallpox vaccines saved over 50 million people's lives. china put a public health initiative in for the largest cause of mental illness which is iodine deficiency disorder. the tobacco control programs we put in more recently over six years have saved an estimated 22 million people's lives. the context we need we talk about nudging people to do the right thing whether we like it or not we are being nudged. i'm furious that every time i went to the supermarket with my child when you check out you have to check out and pay all the sugar loaded candies were there. which appeal not just to her but to me because that was the environment i grew up in. now you don't have to go to the supermarket i suppose but it's not only in supermarkets. it's in all the stores. so we are being nudged. the question is, i call that nudging rather than nudging the bad kind. but we want to be nudged in the right direction. >> with that i could listen to you two forever but let's brin

can you tell us how you decided that recommendation was necessary for the public health? > as a role to protect the public not knowing what the actual etiology is, but knowing the only commonality of our 69 cases was vaping, we know something with the vaping activity, whether the product, the product device, the brand, something therein is the culprit. without knowing specifically, it seems safer to give a broader warning until we could get more information out. >> reports show e-cigarette aerosol is not harmful. why is it dangerous to people that vape? >> the chemicals within the aerosol are usually irritants to the lung. the lung then responds with different kinds of reactions we're seeing in some of the patients which obviously affects the oxygenation, which is the primary function of the lung, which sometimes results in needing a breathing machine to now perform that process of oxygenation. >> thank you. my time's expired. i want to confirm my understanding is that the testimony of miss porter is anecdotal related specifically to her opinion and she is not a public hea

we are joined by leaders from the public health community to provide a neutral assessment of the outbreak and provide advice to the public they serve. we have doctor anne schuchat from the cdc and the illinois department of public health and doctor albert rizzo of the american lung association. thank you all for joining us today. we look forward to learning more about how we can avoid more preventable deaths and with that i recognize the ranking member, mister cloud of texas for five minutes. >> thank you, mister chairman. it has been clear abusers of certain vaping products, some tragically to the deck of death. i greatly appreciate the authority to get to the bottom of what is causing serious illnesses. the centers for disease control and prevention update, the number of those sick reached 530, eight deaths have been confirmed. this is very concerning and it is clear that we need to examine the cause and what can be done to prevent it. the best information available, many of these cases use products that present themselves to be something they are not. based on the limited data availabl

in closing, i want to thank the mayor's office and department of public health for their help in craftings resolution. i also want to thank kyle for working on this. and i think ms. lindsay is here to give public comment. >> supervisor peskin: we'll open it up to public comment and then over to supervisor safai. >> i'm a senior health planner with the department of public health office of planning. i'm here representing the department and our support of the resolution imposing zoning controls for residential care facilities. so through our department's work on the master plan and -- we echo the findings of the long-term coordinating council assisted-living work group report. residential care facilities are a critical resource in our community for our vulnerable populations and as the population continues to grow and age, the need for long-term care, especially affordable long-term care will continue to increase. and in recent years, san francisco has experienced a loss of these important facilities. so dph is supportive of the legislation to preserve the current stock and control the conv

we vastly underestimate-- >> what does it mean to take a public health approach? >> what it means to take that approach is to study this as if it were a health problem, which it is, to understand what the risk factors are at the individual and as destini pointed out at the societal level. understand how to intervene between risk and outcome so that risk factors don't necessarily mean that bad things happen. one way to do that is to enact comprehensive background checks, which will identify people who have risk factors, prevent them from acquiring the firearms with which they would do firearm violence. can't shoot somebody if you don't have a gun to do it with. it is really that straight forward and as you mentioned, it is a time tested approach. we're using it at the moment for opioids. >> so in other words, we use the scientific evidence to identify high risk individuals and we make sure that those individuals, like people who have shot somebody else in the past, don't get their hand on guns, right? >> that's correct. >> okay, and so what else has the scientific e