For thirsty San Franciscans in many neighborhoods, the easiest way to quench their thirst while out and about is to pop into a store or a restaurant for a soda.
But soon, a new partnership will bring a healthier option to neighborhoods across the city — stations to disperse free drinking water.
Over the next year, 19 new public water stations will be installed across San Francisco, thanks to a collaboration involving the City and County of San Francisco, community groups, and UC San Francisco.
The new water stations, designed for easily filling bottles or cups, will be citywide, with nearly half in lower-income neighborhoods that have the city’s highest rates of obesity and diabetes. All will meet or exceed water quality safety standards. UCSF also is assessing the water stations’ impact on dietary behavior.
“If you can convince kids or even families to adopt water as their beverage instead of a sugary drink, this is a shift in the right direction,” said Anisha Patel, MD, a UCSF pediatrician who is leading the water station study. “Making sure water is safe, making sure it’s readily available in ways people want to drink it. All of these pieces fit together in terms of improving health outcomes.”
Health Benefits a Driver
The new stations are one of several steps San Francisco city officials are taking in hopes of curbing the consumption of sugary beverages such as soda, which are tied to obesity and related illnesses.
UCSF’s involvement includes the Community Engagement & Health Policy program of the UCSF Clinical & Translation Science Institute (CTSI). CTSI is helping to ensure that these policies are not only based on scientific evidence, but also reflect the needs and preferences of San Francisco’s diverse communities. This is key to their success, said Roberto Vargas, MPH, Navigator for CTSI’s Community Engagement and Health Policy program, whose mission is to bridge health research with policy and community practice.
The new water stations vision started by listening to residents, Vargas said.
“My job is to bring the expertise of the community to the table to ensure that all of our science isn’t for naught,” Vargas said. “How do we ensure that what we know about science fits what the community knows and needs?”
Community Focus Groups Show the Way
Two years ago, Vargas helped organize a series of community focus groups on sugary beverage policies, with the San Francisco Health Improvement Partnership (SF HIP), an initiative of health providers and community groups.
Focus group participants represented neighborhoods and ethnicities most impacted by obesity-related diseases.
The focus groups yielded detailed feedback on policy approaches to sugar-loaded beverages such as soda taxes, product labeling and advertising.
People were generally supportive of improved product labeling of sugar content and regulating sugary beverage marketing to protect children, such as banning ads or sales near schools. They also supported child- and family-based public education campaigns, and expressed skepticism of the roles of government and corporations.
[People] said they’d be willing to drink more water if they could access it in a way that’s affordable and if they trusted its safety.
UCSF Clinical & Translation Science Institute
They also identified the need for affordable alternatives to soda and expressed strong support for refillable water stations, especially near parks, libraries, transit hubs and community centers. Traditional water fountains were viewed as unsanitary. Some people said they also didn’t trust the safety of public water.
“They said they’d be willing to drink more water if they could access it in a way that’s affordable and if they trusted its safety,” Vargas said. “They said they often choose sugary drinks rather than pay for bottled water, which they considered expensive.”
Reaching Out to Policymakers
Findings were shared with the San Francisco Public Utilities Commission (SFPUC), which operates the city’s public water system, and has run a public water station program for a dozen years. The response was positive.
“We want as much involvement as possible from our stakeholder groups; they know their neighborhoods best. Having their insight is helpful,” said John Scarpulla, government affairs director for the SFPUC.
Former San Francisco Supervisor Eric Mar, a champion of policies to reduce sugary beverage consumption, helped secure city funding for the new stations, which are being located based on input from the focus groups.
Other San Francisco initiatives include prohibiting city dollars to purchase sugary drinks such as at youth events or senior centers; a ban of sugary drink advertisements on San Francisco-owned property and vehicles such as Muni; and a requirement for all other advertising to carry warning labels.
Concern over water quality has understandably grown since the Flint, Mich., crisis and part of the SFPUC’s job is reassuring its customers, Scarpulla said. Public water in San Francisco is continuously tested for safety including lead levels, and it is considered some of the safest drinking water in the nation, he said.
Evaluating the Impact of Water Stations
As installation of the new water stations continues, UCSF’s Patel is leading an investigation into their impact, working closely with Vargas and CTSI.
Using in-person interviews, the study is also looking at the impact of San Francisco’s other sugary beverage policies.
Data from three groups will be compared: people using parks near 10 of the new water stations; people using parks without water stations; and a control of 10 parks in Oakland without water stations or policies, demographically matched with other parks in the study. “We have three arms — just policies; policies and stations, and nothing,” Patel said.
Patel and Vargas are also ramping up for a multicultural, multigenerational health education campaign to accompany the 10 new San Francisco stations, working closely with community groups. The effects of the campaign will also be studied.
Pre-installment data shows people are concerned about water safety and sanitation. The educational campaign will strive to clearly address these, Patel said.
“It’s really important more than ever, after Flint, that we emphasize the safety of our water, along with its health benefits and the risks of diets high in sugar,” Vargas said. “This is what the community is asking for, and it’s an approach that’s evidence-based.”