The American health care system is ailing. It is inefficient, expensive, and worst of all, often inhumane. These long-recognized faults are once again receiving serious and widespread attention at the national, state, and local levels. At this point, however, the practical results of current efforts at “healthcare reform” on a broad scale remain to be seen.

San Francisco does not have to wait for broader action to improve healthcare access and quality on the local level. Local efforts have already embodied at least one aspect of true “San Francisco values” - that, as the famous Haight-Ashbury Free Clinics proclaimed exactly 40 years ago – “Healthcare is a right, not a privilege.”

How that “right” is ensured in policy and practice requires a very complex and sustained effort, involving commitments from many sectors and communities. Some examples of San Francisco’s commitment include the new “Healthy San Francisco” program to provide access to the 82,000 uninsured city residents; the already-effected policy of providing coverage to virtually every child in the city and county; the sustaining of our public hospital, San Francisco General Hospital, in a time when such community institutions are increasingly rare; our community and public free clinic network; our city’s unsurpassed innovations in addressing the HIV/AIDS epidemic; and the Declaration by San Francisco voters that our city and county must expand health coverage, with subsequent expansions in access for children, low-income parents, and contractors to government.

None of these efforts have been easy, inexpensive, perfect, or even complete. However, “the perfect is the enemy of the good” when it comes to addressing complex healthcare improvement. With that limitation in mind, we offer the following priority areas wherein our city is already a leader and can continue to improve in the coming years.

COMPREHENSIVE HEALTH SERVICES FOR ALL

The new “Healthy San Francisco” program for universal access to care is already being implemented and should continue. As participants in the diverse and inclusive group of representatives from healthcare, business, labor, community advocates, philanthropy, research and other disciplines who developed the plan, we feel that it represents a fair balance of responsibility. The program will provide prevention, primary care, specialty, pharmacy, laboratory, radiology, and other services, providing an affordable alternative to health insurance, with a choice of providers. It takes advantage of a locally developed, not-for-profit State-licensed health plan. As the program gains experience, it will be monitored for quality and efficiency and adjusted as needed. We are aware of concerns and even legal action to stop the program, but the only way such efforts will succeed is with the shared participation of all concerned.

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SCHOOL HEALTH SERVICES

San Francisco is not alone in experiencing a decline in school-based health services in recent decades, even though it has been demonstrated that school-based health services are among the best ways to reach children and teens.  Our School District does the best it can with the resources available.  However, more health services are needed in our public schools, and we favor a concerted effort to increase the number of school nurses, clinics, and partnerships with community health providers.  This includes the ongoing effort to improve the healthy qualities of food provided, and an ongoing need for more confidential, age- and culturally-appropriate services including those for sexuality and drug education.

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SUPPORT FOR SAN FRANCISCO GENERAL HOSPITAL/COMMUNITY CLINICS

As stated, San Francisco General Hospital is one of the most important health-related resources in our city and the surrounding region.  It provides the broadest range of quality health services, training for future and practicing health professionals, and research which benefits people everywhere.  SFGH is now embarking on an expensive but essential rebuild for the purposes of seismic safety, but this rebuild will benefit San Francisco in many other ways as well.  The rebuild needs to be supported via both, private funding and public funding such as bonds issues and other routes.

In addition, San Francisco’s network of public and private community clinics provide essential services to many of our residents.  These clinics are an important component of the healthcare safety net and require continued support.  We would like to see neighborhood groups around each clinic adopt a clinic and provide support as has occurred with some libraries and other important community resources.

For more information, try this site or this one.

ENVIRONMENTAL HEALTH AND JUSTICE

San Francisco residents are often exposed to poor air quality, pollution generated from traffic, power plants, industrial sites, and toxic chemicals in consumer products. These environmental hazards disproportionately effect communities of color and low-income neighborhoods and are increasingly being linked to a range of conditions such as asthma, cancer, and birth defects.  The aims of environmental health work in San Francisco include reducing the impact of toxins and chemicals such as lead on human health, improving the Bay Area’s air quality and addressing the effects of air pollution on human health.

See this site, or this one to learn more.

IMMIGRANTS AND HEALTH SERVICES

San Francisco has been declared a “sanctuary city” for undocumented immigrants.  The highly-charged debate over immigration reform does not change the fact that many immigrants need health services. Many illegal residents fear legal consequences for accessing health services, and delay seeking care, with resulting increases in suffering and costs.  Thus we support the provision of nondiscriminatory, confidential health services to all residents of San Francisco regardless of their immigration status; State and Federal funds should be made available for that care without restrictions due to the patient’s legal status as well.  We note that many immigrants in fact use less services for multiple reasons and thus the costs of their care is less than widely feared or alleged.

To learn more, try this site or this one.

TOBACCO-FREE SAN FRANCISCO

San Francisco has been something of a leader in the ongoing crucial effort to prevent the health impacts of tobacco, one of the most serious and lethal health hazards of modern times.  We banned smoking in restaurants ahead of the rest of the State, and have increased restrictions on smoking in other public places, marketing and sales of tobacco products to minors, and more.  The time may have come to take the penultimate logical step and declare San Francisco a “Tobacco-Free City.”  The logistical and legal obstacles to this goal would be daunting, but with the right support, a summit meeting or other venue might direct us towards what is possible.

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SUBSTANCE ABUSE

San Francisco has unfortunately long been known to have high rates of addiction and abuse of drugs such as heroin, methamphetamine, alcohol, and others.  Our city adopted a “Treatment on Demand” approach years ago; such an approach requires the availability of quality addiction treatment services.  Much progress has been made and more is needed.  We suggest that a comprehensive assessment of needs be made with a commitment to filling gaps and further reducing or even eliminating waiting times for drug and alcohol treatment.  As an adjunct to this effort, we reiterate full support for still-controversial syringe exchange programs and the approach embodied in Proposition 36, the “treatment before incarceration” approach to arrested drug users.  Finally, as a means of funding such efforts and possible other listed in this document, we favor an increase in taxes on alcohol and/or tobacco that would better reflect their true costs to our community.

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A COMMUNITY-WIDE FUNDRAISER FOR HEALTH CARE

For decades, San Francisco has presented large and very successful fundraising events for its fine opera and symphony programs, such as the renowned "Black and White Ball."  We propose that such a world-class event be presented for the purpose of providing always-needed funds for healthcare services for the most needy citizens of our city.  This "Black and Blue" (?) Ball would demonstrate our commitment to the values that make so many of us proud to be San Franciscans.

For more information, try this site.

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Sandra Hernandez is CEO of The San Francisco Foundation, the community foundation of the Bay Area, former San Francisco director of public health for the City and County of San Francisco, and a practicing clinician at San Francisco General Hospital in the AIDS clinic.