Partnership Develops Ambitious Public Health Policies on Sugar, Alcohol and Children’s Dental Health

By Laura Kurtzman

UC San Francisco has worked strategically with community partners in the San Francisco Health Improvement Partnership (SFHIP) to enact high-impact policies, such as banning sugar-sweetened beverages from hospitals, to improve public health and reduce health inequities in the city, according to a new article published by the organization.

The study by SFHIP, which includes UCSF, the San Francisco Department of Public Health (SFDPH), the San Francisco Hospital Council, ethnic-based community health equity coalitions, and other stakeholders, examined progress on three prevention initiatives: reducing the consumption of sugar sweetened beverages, regulating retail alcohol sales, and eliminating disparities in children’s oral health.

The researchers found that SFHIP influenced policymakers by presenting scientific evidence and also by activating a coalition of community partners in support of their proposals. The policy makers then enacted regulations and policies with the ambitious aim of reducing health inequities in San Francisco.

“Getting people from diverse sectors and perspectives to get out of their comfort zones to work together towards shared community health goals has been the key to the success of SHIP,” said Kevin Grumbach, MD, chair of the UCSF Department of Family and Community Medicine, Hellman Endowed Professor of Family and Community Medicine, and an author of the study in the March 23, 2017, issue of Preventing Chronic Disease. “We realized we needed to do better to improve the health of our community, and invested the time and good will to figure out how to do this together instead of continuing to work in siloes.”

Taking Action to Change Policy on Sugar Sweetened Beverages

Researchers and community health workers at SFHIP educated policymakers about the health effects of sugary beverages, which are consumed at particularly high rates by low-income people. The San Francisco Board of Supervisors put a sugar tax before voters, which passed in 2016. The City and County of San Francisco also enacted an ordinance prohibiting the purchase of such beverages with local government funds, and the SF Public Utilities Commission installed new tap-water filling stations at public venues in low-income communities.

Meanwhile, UCSF, the second-largest employer in San Francisco, adopted a campus-wide policy eliminating sugar-sweetened beverages from patient menus, cafeterias, retail food outlets and vending machines. With this step, in combination with similar efforts at other local hospital facilities, San Francisco is set to be the first city in the United States in which virtually all of its hospitals prohibit the distribution and sale of sugar-sweetened beverages.

“Sustainable health improvement projects require a strategy on how to change public and private policy,” said Roberto Vargas, MPH of UCSF, a coordinator of the sugar sweetened beverage work for SFHIP and co-chair of Shape Up SF, and a co-author of the study. “Consumption of sugary beverages is associated with many health problems, and we know that if you change the environment to make it more expensive and difficult to get sugary beverages, and easier to get clean tap water, people’s behavior will change.”

Tackling Alcohol Harms and Disparities in Children’s Oral Health

When Taco Bell and Starbucks tried to get liquor licenses in San Francisco, SFHIP demonstrated the association between alcohol-related harm, such as injuries, violence and public disturbance, and having a high concentration of alcohol outlets. The SFHIP Alcohol Policy Partnership Working Group (APPWG), composed of community-based organizations, the SFDPH, the San Francisco Police Department, and other stakeholders, used mapping tools and research studies to communicate this to policy makers, and also raised safety concerns about the emergence of powdered alcohol.

SFHIP’s community-driven response, in concert with efforts by local law enforcement and other public health partners, helped pass a state law banning the sale of powdered alcohol, a unanimous resolution by the San Francisco Board of Supervisors urging the state not to issue licenses in San Francisco to a specific class of alcohol retailers, and the withdrawal of alcohol license applications in San Francisco by Starbucks and Taco Bell.

To prevent dental caries in children, the most common chronic disease of childhood, and one with prominent disparities among minority populations, SFHIP created CavityFree SF (formerly Children’s Oral Health Collaborative). Through community feedback and support, the CavityFree SF developed a plan for the routine administration of fluoride varnish during children’s primary care medical visits at community health centers.

CavityFree SF enhanced programs for low-income families, adding nearly 400 5th and 6th graders to the school-based sealant program. As part of this effort, UCSF and the SFDPH have trained more than 70 medical staff at local primary care clinics to administer fluoride varnish during well-child visits.

“We still live in a city where wealth is health. That is wrong and it has got to change,” said Estela Garcia, DHM, executive director of Instituto Familiar de la Raza, co-chair of SFHIP and a co-author of the study. “SFHIP is working to eliminate these disparities through a collective impact model that mobilizes our city’s resources and provides the structure needed to get results.” 

Tomás Aragón, MD, DrPH, the County Health Officer and director of the SFDPH Public Health Division, and an author of the study, said, “SFHIP has made San Francisco a national model for innovative, policy-oriented strategies to improve the health of our communities. The San Francisco Department of Public Health deeply appreciates the public-private partnerships that are at the heart of SFHIP.”

Additional authors on the paper are Paula Fleisher, MA, Lisa Chung DDS, MPH, Colleen Chawla, MPA, Abbie Yant, RN, MA, Amor Santiago, MPH, Perry L. Lang, Paula Jones PhD, Wylie Liu, MPH, MPA, Laura A. Schmidt, PhD, MPH, MSW.

Funding support was provided by the Metta Fund, the Hellman Foundation, the San Francisco Foundation, and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.