San Francisco Health Improvement Partnerships Tackle Public Health Problems

From left, Kevin Grumbach, MD, chair of the Department of Family and Community Medicine at UCSF; Amor Santiago, executive director of APA Family Support Services; Lariza Dugan-Cuadra, senior specialist with the Mayor's Office of Community Development; and Laura Schmidt, PhD, health policy professor at UCSF, participate in the meeting of the Coordinating Council of San Francisco Health Improvement Partnerships at San Francisco General Hospital.

UCSF and an array of community, academic and civic collaborators are wrapping up the first year of an ambitious effort to build partnerships to enhance the well-being of San Francisco residents and eliminate health disparities.

San Francisco Health Improvement Partnerships (SF HIP), a cross-cutting initiative of the UCSF Clinical and Translational Science Institute (CTSI), aims to connect the University's research capital with the expertise and needs of community partners. The goal is to implement strategies to measurably impact health in San Francisco — and to promote health equity along the way.

“In the past, research has often been seen as unilaterally serving the needs of the researchers rather than the community,” said Kevin Grumbach, MD, co-director of CTSI’s Community Engagement and Health Policy (CEHP) Program. “SF HIP is an effort to do it differently; to have the outcome not be theoretical, but rather a discrete and sustainable change in community health.”

SF HIP is conducted in a spirit of participatory research with oversight by its Coordinating Council. Community partners include representatives from CTSI, the San Francisco Department of Public Health, San Francisco Unified School District, San Francisco Hospital Council, Mayor’s Office of Housing and Community Development, and health equity coalitions representing the African American, Latino and Asian/Pacific Islander communities. CTSI’s CEHP program serves as the administrative core of the initiative and provides planning funds.

"SF HIP brings UCSF and its resources closer to the community, and all the important stakeholders together to improve community health,” said Amor Santiago, DPM, MPH, executive director of APA Family Support Services, and representative of the Asian/Pacific Islander Health Parity Coalition on the SF HIP Coordinating Council. “This effort has the potential to lead and coordinate public health efforts across the spectrum of providers in medical, mental and social health emphasizing prevention."

So far, SF HIP working groups have been launched to focus on four pressing needs: physical activity and nutrition, hepatitis B, alcohol abuse and dental caries in children.

“Part of this effort involves laying a foundation for long-term collaboration,” said Ellen Goldstein, MA, program manager of the CEHP program. “That includes developing an ongoing framework for UCSF to productively engage with a wide range of community partners to tackle our city’s most compelling health problems.”

SF HIP is part of UCSF's expansive community service efforts that span outreach in local, regional and global communities. See more about UCSF's commitment to the community. 

Building Bridges Between Institutions and Community

“SF HIP is a very conscious, active and focused effort on the part of UCSF to identify different ways for it to work with the community so that the community can take advantage of the many assets UCSF has,” said Christina Goette, MPH, a senior health program planner with the San Francisco Department of Public Health and coordinator of Shape Up San Francisco, a citywide initiative.

However, partnership building is a delicate process that is not always linear and seldom speedy. Trust is also a key ingredient. To build it, CTSI relies heavily on its navigators, who are skilled in bridging academic and community cultures.

Sudeep M. Rao, PhD, second from right, co-founder and designer of Beautiful Communities Design, speaks to fellow members of the Coordinating Council of San Francisco Health Improvement Partnerships at a meeting at San Francisco General Hospital. Seated next to him are council members Estela Garcia, right, and Randy Reiterle.

One of those navigators is Roberto Vargas, MPH, who has lived in the city's Bayview neighborhood for the past 22 years. Bayview is the setting for one SF HIP project focusing on obesity prevention.

The project began serendipitously with Vargas attending Shape Up San Francisco meetings, where he learned of efforts to identify safe routes to school for children. To help inform the discussion, he shared an article by UCSF’s Kristine Madsen, MD, MPH, whose research found that while there are health benefits when children walk or bike to school, the downside is that kids often stop at convenience stores for junk food, which can end up negating any gains.

“That’s a connection most people weren’t thinking about,” Goldstein said. “It’s a great example of how we all bring important perspectives to the table, and how, when it comes to research and the community, there’s value in having a two-way street.”

Vargas connected the Shape Up San Francisco team with Madsen, leading to collaboration on studies about physical education classes in San Francisco elementary schools, and the amount of time children spend commuting to school.

Maxine Tatmon-Gilkerson, health equity coordinator at Black Coalition on AIDS, speaks to fellow members of the SF HIP Coordinating Council at SFGH.

This collaboration set the stage for UCSF to partner with Shape Up San Francisco in the planning and assessment for the Bayview HEAL (Healthy Eating Active Living) Zone initiative, funded by a $1.2 million grant to the Department of Public Health from Kaiser Permanente's community benefit program.

In support of the HEAL Zone work, CTSI helped to fund the Food Guardians, a grassroots group of young advocates working for food justice in the Bayview, to collect and analyze community input at health fairs and other events. UCSF faculty members have also contributed reviews of research literature on effective community-based interventions. Together, these efforts are informing the Heal Zone action plan for the next three years.

"One of our challenges," said Vargas, "is that you've got to create policy change and interventions at the individual and community level in as many ways as possible to touch a particular population."

Meanwhile, the SF HIP working group on alcohol abuse is collaborating with the SF Department of Public Health to focus on high users of multiple systems—individuals with extreme social risk factors, such as a combination of homelessness, substance abuse and mental illness, that predispose them to unusually high and costly use of emergency, medical, mental health, criminal justice and related services.

UCSF’s Laura Schmidt, PhD, co-director of CTSI’s CEHP program, is providing expertise in analyzing complex population data sets to help guide and evaluate interventions to better address the needs of this population. Similar efforts are underway on the other SF HIP projects addressing Hepatitis B and early childhood caries.

Working Toward Sustainable Changes in Community Health

Goette noted some of the challenges involved in building academic-community partnerships. For example, even the way researchers use language, or jargon like “causal pathways” and “social determinants,” can be daunting and off-putting.

She recalled a discussion that followed a meeting attended by several UCSF researchers. “There were community folks there with varying degrees of education,” she said. “They were asking, ‘What are all these people doing in the room and why do they talk like that?’”

In situations like this, she said, she wants to be respectful of community members and ensure they feel like they have as much weight as anyone else and are not intimidated. She added that the UCSF team involved in SF HIP has been extremely responsive to these concerns

In regard to community-academic partnerships, Goldstein added, "We're building the boat while we're sailing it. Some days we're throwing out as much water as we can, and some days it feels like we've caught a good wind."

For more information visit www.sfhip.org, or follow progress on Twitter here.

CTSI at UCSF was among the first of the now 60-member Clinical and Translational Science Awards (CTSA) consortium funded by the National Institutes of Health. CTSI’s efforts aimed at accelerating researching to improve health include more than 50 resources and services, as well as online tools such as UCSF Profiles, in support of researchers at every stage.

Members of the SF HIP Coordinating Council are from left, front row: Kevin Grumbach, chair of the Department of Family and Community Medicine; Jim Soos, assistant director of Policy & Planning at San Francisco Department of Public Health; Maxine Tatmon-Gilkerson, health equity coordinator at Black Coalition on AIDS; Ellen Goldstein, community program manager at UCSF; and Amor Santiago.
In the back row, from left, are Paula Fleisher, Wylie Liu, director, University Community Partnerships at UCSF; Estela Garcia, executive director of Instituto Familiar de la Raza; Lariza Dugan-Cuadra, senior specialist with the Mayor's Office of Community Development; Laura A. Schmidt, PhD, MSW, MPH, health policy professor at UCSF; Randy Reiter, Michael Huff, director of the African American Health Disparities Project; Sudeep M. Rao, PhD, co-founder and designer of Beautiful Communities Design; Laura Starbird, health educator for the San Francisco Department of Public Health and James Rouse Iniguez, program administrator, Clinical and Translational Science Institute's Community Engagement & Health Policy Program at UCSF.

Photos by Susan Merrell

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