Innovative Health Coalition Creates Model for Community Health

Despite San Francisco’s advances in biomedical research, high-tech innovation and cutting-edge thinking, the city contends with significant health challenges and disparities across its diverse population – ranking 23rd in health outcomes among California’s 57 counties.

Since 2011, UC San Francisco has been a part of a broad coalition working under the banner of San Francisco Health Improvement Partnerships (SF HIP) that’s been trying to close this gap and achieve measurable improvements in health.

In support of SF HIP’s mission and goals, nearly 150 community, civic, academic and private champions of community health from across the city gathered at the Women’s Building on March 28 in the city’s Mission district to recognize and celebrate the group’s initial successes, and lay the groundwork for efforts of partnership working in five prioritized health areas:

• Physical Activity and Nutrition
• Hepatitis B
• Alcohol Policy
• Children’s Oral Health
• Breastfeeding/Lactation

SF HIP is part of UCSF's ongoing commitment to its public mission. Across the University, faculty, staff and students are collaborating with members of the community to improve the lives of patients and populations by creating and implementing urgently needed new practices and therapies.

In a keynote presentation, UCSF Chancellor Susan Desmond-Hellmann, MD, MPH, shared her interest in the mission of SF HIP and stressed the importance of both urgency and measuring success.

“I want to challenge you. It’s important that you maintain a sense of urgency, and that the work you do be measurable and scalable,” she said.

“This work is really important, and we can teach the rest of the world about the San Francisco model, which we have done, for example, with HIV/AIDS.”

Desmond-Hellmann also affirmed SF HIP’s approach of seeking answers from all around the community and directly from those who are affected. “You’re asking community members important questions and learning about how the world around them influences their wellness or their disease. That can be as important as the care they receive in a clinical setting.”

Some of SF HIP’s targeted efforts include:

• Improving care and coordination of care for patients with chronic Hepatitis B;
• Addressing safety and perceptions of safety in communities with a high density of liquor stores;
• Reducing the annual rate of emergency room visits for diabetes-related illness in the Bayview Hunters Point neighborhood, which has the highest rate in the city at 39 visits per 10,000 people;
• Servicing people in desperate need of oral health care and providing care to prevent problems in the first place through community health workers, or promotoras, who, for example, apply fluoride varnish at elementary and preschools.

Speakers such as Estela Garcia, DMH, director of Instituto Familiar de la Raza, co-chair of the San Francisco Chicano Latino Indigenous Health Equity Coalition and SF HIP Coordinating Council member, represented the depth of community leadership. Garcia shared how the group emphasized health equity representation early on and how “courageous conversations” on barriers to access still continue.

Kevin Grumbach, MD, a member of the SF HIP Coordinating Council and chair of the Department of Family and Community Medicine at UCSF, challenged attendees to identify lessons from SF HIP’s work that could be integrated into other citywide health efforts.

“It’s unbelievable what this city did in HIV care by getting the health department, UCSF, community-based organizations and activists from the community to work together and figure out how to move the dial on HIV in a tremendous way. Why haven’t we replicated that same model to other compelling health issues?”

Grumbach is also co-director of the Community Engagement and Health Policy (CE&HP) program of UCSF’s Clinical and Translational Science Institute (CTSI), which has provided administrative support and academic partnership for the development of SF HIP.

Bringing Health to the Community

After initial years of fostering trust and understanding between disparate partners, the time and effort appears to be paying off, according to attendees.

Lariza Dugan-Cuadra, SF HIP Coordinating Council member and executive director of the Central American Resource Center of Northern California, also noted a fiscal benefit of SF HIP’s model – it’s more cost effective to create jobs for community health workers and to have a “culturally relevant” approach since they live, work and play in the communities they serve.

“The SF HIP model is basically about bringing health to the community instead of trying to pull the community toward health,” said Dugan-Cuadra. “We’re testing and evaluating it to see what the impact is.”

Community-based organizations and civic partners also see SF HIP as an important way to connect with the extensive research and scientific resources at UCSF.

Pedro Torres, a steering committee member of SF HIP’s Alcohol Policy working group and director of Youth and Family Services for the Tenderloin neighborhood-based National Council on Alcoholism - Bay Area, pointed out that SF HIP has provided invaluable technical assistance and research information that community-based organizations may not otherwise have access to or expertise on.

“SF HIP really complements the work we do in the community. I’d like to see our relationship with UCSF grow and strengthen in aspects other than alcohol policy work – getting more research information and infusing that into our practices for treatment and outreach as well as prevention,” said Torres.

Others underscored that the partnership has provided a platform for information exchange.

“I not only share our expertise from within Kaiser, but I’m able learn things I can take to our medical center,” said Gene Lau, MD, of Kaiser Permanente and a member of SF HIP’s Hepatitis B working group.

Implementing New Health Interventions

During a final group discussion on lessons and strategic direction, Tomás Aragón, MD, DrPH, director of population health and prevention at the San Francisco Department of Public Health, commended the group’s efforts to bring the best of community organizing and translation of academic research to implementation. He noted that SF HIP’s partnership in the city’s Community Health Improvement Plan is a significant next step in this direction.

“Right now we have a draft proposal to integrate all the different groups into one big collaborative for the city and focus on collective impact. We’re picking a few key health indicators that we want to move the needle on,” he said. “The collective impact approach is going to be a great opportunity for us to work together on a few specific issues over time.”

To Clay Johnston, MD, PhD, associate vice chancellor of research at UCSF and director of its CTSI, the group has succeeded in pulling people together from all backgrounds into a well-coordinated partnership focused on collective action. However, Johnston echoed earlier comments emphasizing the need to show evidence pointing to improved health, and to implement interventions at a “scale that impresses.”

“We may realistically be able to see changes in Hepatitis B in San Francisco, such as the number of new cases, and rates of liver disease and liver failure in the city, which are very high here because of immigrant populations. 

“There are cost-saving activities and interventions to reduce cavities in kids that could be rolled out at a public health level. If we can get activities like this going at the right scale then we could show that there are fewer missed days at school, or fewer emergency department visits for dental problems in the city. That would be a major win.”

As the SF HIP Partnership Working Groups continue to meet and move their work forward, they invite interested parties to contact navigators to learn more and get involved.

UCSF's CTSI is a member of the Clinical and Translational Science Awards network funded through the National Center for Advancing Translational Sciences (grant Number UL1 TR000004) at the National Institutes of Health. Under the banner of "Accelerating Research to Improve Health," CTSI provides a wide range of resources and services for researchers, and promotes online collaboration and networking tools such as UCSF Profiles.

Photos by Cindy Chew